310387_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

i ype us visit; v i,ompnance inspection v vperanon review v structure c va1uauun v i ecunicaj Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: i1i ) r �{ r 1 Arrival Time: j Q Departure Time: } Q County
Farm Name: s._� QL i rl n 'Flit.", Owner Email:
Owner Name: _ { sy-r n Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
- Region: IN li
Swine
Wean to Finish
Design Current
Capacity Pop.
+1
Design Current
Wet Poultry Capacity Pop.
Layer
INon-Layer I
Design Current
D . P,oult . Ca aei P,o
ILayers
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
Dairy Calf
Feeder to Finish
f
I
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Puuets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes Q.16 ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes o ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
[] Yes NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number. 31- Date of Inspection:
. 9
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
L o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑e -11o'
❑ 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
2-Ko
❑ 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 [3.AIo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [g.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 E]4<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes q-No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes to
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EJ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes El-K-o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes UXo ❑ 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 allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 2Io ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E3 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 U N-o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [rIo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ej< ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

acili umber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[-No ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
EKo ❑ 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
QDW❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[]No �A
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[D-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
J-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
r-1 'do
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[9'1\fo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3-No
[] NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[y]Ao
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Inc
❑ NA
❑ NE
Comments (refer to':questio© #) Eapiam any'YES,;ans-wens aodlor any additional recommendat!oas or a. other"eomuten&.
Ilse drawn s:of facility to' better explain situations;(use additia al pales as necessary). :
5", r )oaL/9A '�C,0A-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Of i0 7 f -ter
Date:
21412015

Type of Visit: Q Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: C Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: �r Departure Time: z / j�� County: ✓L/ r Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ScmA C� u r w N
Certified Operator:
Title:
Owner Email:
Phone:
Phone:
Integrator: �J
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design
Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Ij
Pop.
Cattle Capacity
Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
lt a
Ca achy
P,o
Non-Dai
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ 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
❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA.
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
YNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of Ins ection: d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:�
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 WNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes LIJ 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 E21 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 Q
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[] Yes 1=J No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes YNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes d;4o
❑ NA
❑ NE
IS. Is there a lack of properly operating waste application equipment?
❑ Yes o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 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 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5/N/o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facki Number: - Date of Inspection: J13C71jtp
24, id the facility fail to calibrate waste application equipment as required by the permit?
L
❑ Yes
] ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
YNo ❑ NA ❑ NE
Other Issues
ZN
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility'fail to notify the Regional Office of emergency situations as required by the
[] Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
dN o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[%o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
YNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations oranyother comments..
Use drawings of facility to better explain situations (use additional pages,as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signa
Page 3 of 3
CC(, Phonek [ ja 16 5 b b
tore: jaivdl Date: 3 13dj I(
21412015'

caciif_Y
Number - OO -121 Division of SailWMon—ser—vation
Other Agency
Type of Visit: Co. pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Cr Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: SC-7T
Certified Operator:
Phone:
Integrator:
Certification Number: Q1911-)
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pap.
I JLayer I
Desigu
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design"Urrent
D . P,oW C•_a aci P,o
pry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Usher
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
/No
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ 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
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ZNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili ;Number: - Date of inspection:
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C311NO ❑ 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 6zo ❑ 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 [D/No 0 NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify 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 El"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application .
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes allo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2r'<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [—]Yes D No DNA ❑ 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 ['No ❑ NA ❑ NE
❑ Yes Ei/No D NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ej No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
L2rNo
❑ 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
�/Nqo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6'N-o
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: ty 1
14. 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 OVv ❑ 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? Eryes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C3<0 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [4o ❑ 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 EJ'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 ETNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
C5No ❑ 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
El -No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�eo ❑ 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 necessa
12►n^ WAC' 1ao0cV41 AUC-"_)Sr zzi`+
CA t.M6 aza--r1,0,d 0 (� E.D To 63E DOOG YJC 7'�_r 30 Dk'es , CALL.
Dw(- A<P'TC--f­ D6r3C. ,
eA>JGC. 6( O.ZC �o
Reviewer/Inspector Name: V 6
Reviewer/Inspector Signature:
Page 3 of 3
Phone(�!
Date: .5
21412015

i IMI3001
Type of Visit: Q) Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: (� Routine 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
1
Date of Visit: a9 1 Arrival Time: Q Q Departure Time: 9 5 County: -DOiPCYjJ
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: W c. - V-? C-Q A Os
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Region:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
C►attle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish 0 o
Glob
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►urrent
Dr—y P,oul Ga aci P,o ,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
113eef Feeder
Boars
Pullets
113ed Brood Cow
Other
Other
Turkeys
Turkey Pouits
er
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes [7(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 [DNA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes E30No ❑ NA ❑ NE
❑ Yes E(No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: `?j 1 Date of Inspection: 4 l
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: IAC,dot3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E No
❑ NA
❑ NE
(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
[?I/No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 1 threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ YesYNo
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[:3/No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
l0. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ef
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
dNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[%f Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
01No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�INN5
❑ 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. ErYes ❑ 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 u 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

Facie Number: - $ Date of Inspection: (4
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M/No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E2No ❑ 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 Ef No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes �(No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 Qo ❑ NA ❑ NE
❑ Yes C,3"No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
[—]Yes dNo ❑ NA ❑ NE
[:]Yes ENo
❑ Yes g'No
o
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility. to better explain situations (use additional pages as necessary).
15) aLpo TO P-EkAooE SGd . R'pR IS -=5 _DATE. COP- RE►��.�A�.
Zl,� rvus NG- WA5t(- APAI_'is_IS F4_ 2013. �"ASr­ UtCk .SAVVVCk
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
a L.
Phone:_cb 0) I R 6 -13
Date: 91,4
21412 JII

Type of Visit: d Co pliance Inspection U 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: 'T f 3 Arrival Time: ® Departure Time: County: O f b=� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: w Ct,1 O `i CU A OS Integrator:
Phone:
Certified Operator: Certification Number: 20 1 1:11U
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
VVet Poultry
La er
Design
Capacity
Current
Pop.
-
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Design
Current
Dairy Heifer
Cow
Farrow to Feeder
Farrow to Finish
Di, P,ouIt F Ca aci P,o ,
ILayers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [:]No
[:]Yes [—]No
[:]Yes W-vo
❑Yes o
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
r_ Page I of 3 21412011 Continued

Facili Number: - Date of Ins ection: a 13
VGaste 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
Identifier:
Spillway?:
Designed Freeboard (in):
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
,A&CotJ
Observed Freeboard (in): Zl�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes fNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes NA ❑ NE
waste management or closure plan?
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_J No [] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 6/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 0 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance a]tematives that need ❑ Yes No [DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [—]Yes �/No
No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ 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?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[:]Yes iN ❑ NA ❑ NE
❑ Yes L,4 No ❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
[:]Yes EJINo ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ 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 EKo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes 6/No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 1 -3 Date of Inspection: Z
214. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes el o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes WNo
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?
❑NA ❑NE
❑ NA ❑ NE
❑ Yes L.d ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
[-]Yes 4o ❑ NA ❑ NE
❑ Yes 12/No ❑ NA ❑ NE
[:]Yes [�No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes En'
❑ Yes
❑ Yes Noo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments:
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C 7 — -
Date: d-7 A3
21412011

I ype of V isit: U/ CO ptiance Inspection V Operation Review U Ntructure Evaluation V I echnlcal Assistance
Reason for Visit: routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: �(, Z Arrival Time: ® Departure Time: County: P Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: - Integrator:
Certified Operator: Certification Number: IL D 1010
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Design Current
@attle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
7(
Feeder to Finish
Design Current
D , P,uult . C►_a aci_ P,o P.
Layers
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Cow
Non -Dairy
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? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes g�No❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Nnmber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t. A&a-Gh
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 environments hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ 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 WNo ❑ 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 EX/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
o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Zlo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
To ❑ 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?
❑ Yes
VNo ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesZVI
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑'Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ei/No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZYNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes IZ610 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 6E(No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
hIo
❑ 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
ZNo
❑ 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
dNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
hlo
[DNA
❑ 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 ONo ❑ NA ❑ NE
Comments:(refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
0 C(rl j: J APit-IL. a;,T WA& 7_EG?,dQ0 , NCfD ANQr«Ert_ eUTZI,v61 j3E,r,2E
SHADE wr UrL.MUDA
A 30 PAL6 Ta 00 5L017&W<_ SU�i�E i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
rifuucJ,— [,Igo Ji'U
Date: L
2141201I

4
Factltty Number
3 � � 3$
k Division 4Water,Quahty
OsDlv�ision of Soil and Water Conservation' > �
a,
�RwOther�Agency,'
Type of Visit GrCo fiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 11 Arrival Time: t O 1 Departure Time: County: L- J./ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 1i-� EN O'� �A 1J.� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o = 1 Longitude: = o
Desagn CurrentDestgnDestgn-"Curre�f
` SHme _ ;Capacity Population
Wet Poultryy ;Capacity Population Cat#le Capa ty Popuiat�on°
❑ Wean to Finish
a ❑
, �..
❑ Dairy Cow
❑ Wean to Feeder
—Layer
❑ Non -Layer
❑ DairyCalf
Feeder to Finish 9400
.,
`` ' .4
n ❑Dai Heifer
x.
El Farrow to Wean:e
DryPoultrJ<"
r'`« ❑ D Cow
❑ Farrow to Feeder
"`- "� '`"'
'° ❑Non-Dai
❑ Farrow to Finish
° El Layers
❑Beef Stocker
El Gilts
❑Non -Layers
❑ Beef Feeder '
❑ Boars
❑Pullets
El Beef Brood Co
❑ Turke s
Other _ ❑,
Turkey Poults
r R
❑ Other
❑ Other
Number of 5tructures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 6 No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N
❑NA
El NE
❑ Yes
L�'N0
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: I A C7vpr�!!?
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes VJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaltheat, 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 ' F�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ((No ❑ NA ❑ NE
maintenance or improvement?
Waste ADplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes V(No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ 'Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
WN
o ElNA ElNE
❑ NA ❑ NE
X0b
o ElNA ❑ NE
W❑NA ❑NE
N,o ❑ NA ❑ NE
E e
Comments (refer to question #) Explain any YES "answers and/or any fecommenrlafions or a'ny other comments -
Use drawin s of f tcili to better explain situations use. a g ty p ( additional pages as,nece' ry) x
SSa
7
Reviewer/Inspector Name / (_ Phone: Qld 4l �-73,7
o AKA
Reviewer/Inspector Signature: Date: (.
Page 2 of 3 1 12128104 Continued

Facility Number: -3g'j Date of Inspection 1 �6
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design • ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[/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 Inspection ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�/No
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
74o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[>lo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ld 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
2 No
El NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P(No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[I NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
VN
❑ NA
❑ NE
Additional Comments and/or Drawings: .., ,.,..
Page 3 of 3 12128104

k,
Division of Water Quahty
Facility„Number 3 3 Q:Dtvisioo of Sbil anti Water C©nservat
Type of Visit pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 7Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: ZKRQ21)_, Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: W C- +j1k__Lk_ tV POS
Integrator:
Phone No:
Certified Operator: Operator Certification Number: _
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =o Longitude: 00 = 6 =
Design Current. „ Desrgn Current
Swine ' Capacity Population "Wet Poultry Capacity"PopulattOn;
❑ Wean to Finish La er
710 Wean to Feeder Vill
❑ Non -La er
ILJ Farrow to Wean I I I
AU Farrow to Finish I I I
J Boars J I�
] Other
x
Dry Poultry, � � � ;g
❑
La ers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turke Pouets
❑
Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Discharges & Stream Impacts
I - Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes iNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes El No ❑ NA ❑ NE
❑ Yes D4 El NA El NE
El Yes [No ❑ NA ❑ NE
12128104 Continued

Facility Number: 31 Date of Inspection
rWaste 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?
Structur 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �7
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ NE
❑ Yes
E� o
❑ NA
❑ 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 L 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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes L" No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
ZNo ❑ NA ❑ NE
o ❑NA ❑NE
i�j
❑ NA ❑ NE
C o El NA El NE
L No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any` recommendations or any other"c6mments
Use drawings of facility to better explain situations. {use additional pages as necessary)--.
tb>P IAL/
.. y
lq, OEE p A ✓ c o C q- � n-/+�*T tr �fi P,
c-j 0-5
Reviewer/Inspector Name d 4tJ_aPho
; � � , 16 - 3Pj (�
+:�
ReviewerlInspector Signature: Date: 3
he
_l
Page
2
of 3
1L/GV/VY {..VILLLII"L .

1
,Facility Number: — Date of Inspection 3
rRe uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ Wes, ❑ Checklists
❑ Design ❑Maps ❑Other
011y/es ❑ No ❑ NA ❑ NE
❑ Yes E4 ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
IQ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
� o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El�o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
NoElNA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Yes
El2
,.
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
L`J No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 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
U No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E34o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
� No
❑ NA
❑ NE
Additional Comrnents and/or Drawings:
Page 3 of 3 12128104

Type of Visit 6 Co Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑Denied Access
Date of 'Visit: 7 Arrival Time: f% Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Faeility Contact:
Onsite Representative.
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Title: Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 = I = u Longitude: = ° = 6 0
Design
Current
Design
illill
Current Design C►urrent
Swine
Capacity
Population
Wet Poultry
Capacity
Population Cattle Capacity Population
❑Dai Cow
❑ We to Finish
❑ Layer
❑ We to Feeder
❑Dai Calf
❑ Non -Layer
® Feeder to Finish
❑ DairyHeifer
G
d
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Farrow to Finish
Layers
❑L
❑ Non -Dairy
❑ Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
Number of Structures:
❑
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
No
❑ NA
❑ NE
Discharge originated at: ❑Structure El Application Field ❑Other
a. Was the conveyance man-made?
El Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[I Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑Yes
o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
Zo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
WINo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/18/04
Continued

Facility Number: 3
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: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): aE
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes &o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ZNo ❑ 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 ! 'reat, notify DWQ
7. Do any of the structures need maintenance or improvement? El 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 dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
s
No
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
VYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Uf o
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
Zo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
7No
❑ NA
❑ NE
1Cognments (refer to q teshott #)` Explatnrany YES @ s�wWers ancUor�any recommendations or any other comments.
�LJse drawings�'of facility o+better-expla�sttuahons �{useaadditionalspageS asnecessary}:
J
Reviewer/Inspector Name o Phone: .. 3
Reviewer/Inspector Signature: Date: d Q
Page 2 of 3 12128104 tonfinued

Facility Number: —_ Date of Inspection
Required Records &Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes —I�i '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 appropiate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design
g p [I Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
[7"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?
ElU/N Yes
f
o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[2(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LdNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ 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
ENo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2� o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32,
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
ElNA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O/No
❑ NA
❑ NE
Addiho'nal_Comments and/or.:Drawt©�s: "�...�� , ,� .. _ ..^. � r�_� .-��.�
Page 3 of 3 12128104

0 Division of Water Quality
Facility Number 3 f 3$1 0 Division of Soil and Water Conservation
0 Other Agency -
Type of Visit (Zj �(Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q Routine ()Complaint () Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ! 1 3 D Departure Time: County: D1 00-S0 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone No:
Onsite Representative: EN)DY (%)1A)13S Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
a; ❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 0 « Longitude: = o [= , =
'Design Current Design Current
Capacity Population Wet Poultry Capacity Population
��� ❑ La yer
❑ Non -La et
1 I`
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 Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
l
❑ Beef Feeder
❑ Beef Brood Co
i
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
❑ o
El Yes
4o
❑ NA
El NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: — 3 $ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElYes dNo El NA El NE
:r
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0'1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
0 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
�No
❑ NA ❑ NE
through a waste management or closure plan?
eat, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaZo
7. Do any of the structures need maintenance or improvement? El Yes
❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes
L'J No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
_,(
u No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
d o
ElNA ElNE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
7No ❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
V o [I NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes7No
o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�.) 3a 10N45 Tu S(wo 3,N T4 Sr Frx, 10bl Oo wNoTt4F ti. AT CN k) 4 YtAg_ i
20 3V 0AqS .'r0 0e S�'j0Q+ su"c_%f am r'g- 7.001 .00 AbiaTp6n- r,.+Q 0� *AR.
Reviewer/Inspector Name Phone: (VO) -7YL - 7 3$- 7 3S�
Reviewer/Inspector Signature: I Date: 3 td o
I.21251W [.onanuea

Facility Number: 31 — 3 g I I Date of Inspection
Renuired Uecords & Documents
11
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropiate box.
❑ WUP El Checklists El Design El Maps ❑Other
❑ Yes UNo ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
,(
El Waste Application El Weekly Freeboard El Waste Analysis VJ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
C� o
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VN o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[
El NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E�No
dNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E21'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
6No
❑ 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
0 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
EJ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
I�X
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Division of Water Quality
[Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
pliance inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
7FRoutine0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 'g6E Arrival Time: Q : Departure Time: County: 21,13« Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: -W EIJI)CLL t AA NS _, _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 = i = Longitude: 0 o = ' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
R] feeder to Finish I(.0 el.l fao
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke 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 I
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ 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 r/lNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
O No
ElNA
ElNE
ElZ Yes
No
❑ NA
❑ NE
12128104 Continued

Fackity Number: — ] Date of Inspection v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 2No
❑ 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: t..&Iyj l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �s
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes dNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
�f
ElI� Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 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
C(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 Drif! ❑ 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
LJ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? f Yes
El No
❑ NA ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
O No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
t-9 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
2�No
❑ NA ❑ NE
f 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):
LS� SGC7 Rk1'✓1vu�L �r✓���h pN� Cot�1'ZNUE Wo'ft--tC vN NC-.WiJ 5����
COAStAL— .
,tj.) Uj,7pArC ' T6C.!LZrsG: R� wrU2S..
Reviewer/Inspector Name Ll A RD ij_ Phone: l� 6
Reviewer/Inspector Signature: Date:

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EI/No, ❑ NA ❑ NE
the appropirate box. ❑ W­Up ❑ Checklists ❑ Design El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
ErYes
❑ No
❑ NA
❑ NE
❑ Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis [I Waste Transfers
El Annual Certification
❑ Rainfall LJ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E3 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ENo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�dfNo
LEI No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ENo
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[r NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElE Yes
rNo
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
[�io
❑ 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
BNo
❑ 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
,�,�
Cf No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�Wo
❑ NA
❑ NE
Additional Comments andlor Drawings:
12128104

Z ' Division of Water Quality
Facility Number ,3 3 7 O Division of Soil and Water Conservation
O
Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 04outine O Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 4 2:,�ka Arrival Time: Departure Time: County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: VANs
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Region:
Back-up Certification Number:
Latitude: ❑ o ❑ d ❑ Longitude: ❑ ° ❑ ❑
`" ro Design Curren E - ' :Desigq Current Design x Current
w Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish: ❑ Layer I I ti
❑ Wean to Feeder I 1 1110 Non -Layer
Feeder to Finish Zl
❑ Farrow to Wean Dry Poultry
❑Farrow to Feeder i
❑ Farrow to Finish
❑ Gilts
❑ Boars
i
Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Aumbenof 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 D o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
[I Yes
,❑
El NA
[I NE
El Yes
VN
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — 3 g] Date of Inspection
rWaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Strruccttu're} l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: %A &ZIN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes WXO ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) MI
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes l d No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes
R 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
LR 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
PNo
❑ 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�l2vn �n A� SG�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
E3 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 2/yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F,e(No ❑ NA ❑ NE
2'*No ❑ NA ❑ NE
[I/No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments..:
Use drawings of facitity to better explain situations. (use additional pages as necessary):...
1 S �� GlZO ��lt. w�u L.aO�C. SN'►t7 I �Gt & Em�S 4 du2.tAJG 5�2,� .
Ca C oQ77�I�% 5roue w&- MA1E) 6ROP Y-MP DONE 49 of LAST ,T�PtrG"�-oN
Reviewer/Inspector Name I / I Phone: / T
Reviewer/Inspector Signature: Q� Date: 23 AQ ii
I "5V � VJ J

Facility Number: 31 — Date of Inspection 7r3 'fi
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Nao
o El NA ❑ NE
M 20. Does the facility fail to have all components of the CAWP readily available? If yes, check El Yes ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other /
21. Does record keeping need improvement? If yes, check the appropriate box below. B Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ SO;ff A ysis ❑ Waste Transfers
ElElElElAnnual Certification
Rainfall Stocking Crop Yield El120 Minute Inspections Monthly and I" Rain Inspections❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes t No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
❑ No
[g'KA
❑ NE
❑ Yes
❑ No
1j.>k
❑ NE
❑ Yes
D<o
[] NA
❑ NE
❑ Yes
❑ No
D A
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
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/lnspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes B'No ❑ NA ❑ NE
❑ Yes E34 ❑ NA ❑ NE
❑ Yes 04 ❑ NA ❑ NE
❑ Yes P4D
❑ Yes 2 No
❑ Yes 6[2 No
El NA El NE
❑ NA ❑ NE
El NA ❑NE
Additional Comments and/or Drawings:
A6
T
Page 3 of 3 12128104

Type of Visit J6 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 3 Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
'"%l
Date of Visit: Q Arrival Tim. e/: 3„3 5 Departure Time: County: Region: v�eK
Farm Name: �� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
/
Onsite Representative: ! k�V[J_,/� � 414I.JS _ _ _ Integrator: J
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = I = 11 Longitude: = ° = d =
it
Design Current Design Current
Capacity Population Wet Poultry Capacity Population_
❑ Layer G
Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
t'o0
i
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
❑ Daiai Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
— I W_ -
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 WNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2fNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12128104 Continued

Date of Inspection 4
Facility Number: —
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[9No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: 1/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
,� No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
JE No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Z No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
gNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
A No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
able Crop Window ❑ Evidence off Wi d Drift ❑ Application Outside of Area
❑ Outside of AZl
=i
dvSEFd
12. Crop type(s) \ema'014414
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
[Z No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
m No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
jo No
❑ NA
❑ NE
�� �&.C©►r�t`nC�fl-�NS�{�cc..z.�� �., �f45�F� O
!R AWD Co c
�A.1� COP, - mZJ
� yDP� r,
/YI 1tkt-- ilk
Reviewer/inspector Name �.� , 4 Phone: a/4-,3f
Reviewer/inspector Signature: Date: O$"
I2128104 Continued

Facility Number: `� 3� Date of Inspection O�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 21 Yes ❑ No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Z No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Z Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall JOStocking CACrop Yield ❑ 120 Minute Inspections 71 Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z 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
Z No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
PI No
❑ NA
❑ NE
27_ Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
,ZNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 0No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes 1Z 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 )f 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 VNo
❑ 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 10 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes O No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Z 003
12128104

1
D1VISioii;OfSoi'i'and Water Conservation
E
Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation
for Visit )6 Routine ' Q Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
Q Not (Operational Q Below Threshold
Permitted %`Ceyyrti iced 13 Conditionally Certified © Registered Date Last Operated or Above Threshold: ... ._ .. .
Farm Name: ......YY EWQ�... 5...�.flevv_\ ................................................... County: ... ..... �S Q�:�.N.. .............. .. ................
OwnerName: - ------------- - --- --- -- ------ -- --------------------------------------------------------------------------------- Phone No:-------------------------------------------------------------------------------
MailingAddress: --.- .................................... ..........................................................................
Facility Contact: Title:.. . - - -- - Phone No:
Onsiie Representative: ... t Integrator: - _..---------------- ------
Certified - .
--- --_
Operator:.............................._ ....__.. __.. _........_._ ....._ ........_.. Operator Certification Number:...�_.�_...._... �....
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` " Longitude • 4 «
- s Design , Current _ Design � Current `, Desr<ga n Curr nt75
Swine Ca
T
P.o - elation Poultry "
Po ulatiori Cattle =, Pdf) Lion
- - a
_ .0
ci ; - act .-.
, ❑Layer
❑ Dairy
[I Non -Layer
:' ❑Non -Dairy _
H
Other
Y Total Desi gn Capacity
®, a ,. .
a Total SSLWr
,- Number ofI+agoons e
a
G
x
Qi.
Wean to Feeder
Feeder to Finish
r' O
l
e Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Dischar>res &Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes VNo
Discharge originated at: [I 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) El 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) [I 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 [�To
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? [I Spillway ❑Yes No
Structure 1 Structure 2 Structure Structure 4 Structure 5 Structure
Identifier:.._----........�_......_.......----------^............_­_.................­.- ..... ....._..._.........._._........

Facility Number: 3 — 3 �'] 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 ❑ Yes 2No
closure plan?
{If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes /VNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? XYes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 7 No
elevation markings?
Waste ARRUcation
10. Are there any buffers that need maintenance/improvement? ❑ Yes JdNo
11. Is there evidence of over application? If yes, check the appropriate box below. [:]Yes ONo
❑ Excessive Ponding ❑ PAN ] Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type gcamopA LµQ 9MALL GrLAr,�,S OJER$t C()
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ff No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? ❑ Yes YTNo
c) This facility is pended for a wettable acre determination? ❑ Yes j�No
15. Does the receiving crop need improvement? ❑ Yes XNo
16. Is there a lack of adequate waste application equipment? ❑ Yes XNo
Odor INsues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes )dNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ElYes XNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes XNo
Air Quality representative immediately.
Comments (refer to queshoi #} Expiarn Y YFS ansersndLar any recomrendatitus or anyatl�er coMmme ;_
Use dlrawingsf facrlety to better explaur 5ltpattpnS: (ase aclditrona! gages as necessary):Field Cop Final Notes
) t 1.1AS U. W SPaT, rJkCn SmPr4OVE nG&-r COJ GEVCLT-d&.
at.) 0(=L-1) CoC AND ?6RhAi.-r w_'M4 �AV_M I_Cc.-fins,
13" (Of 2-1 1o3 1'7" -7 /lq/03 $'' owNFz DrD uaT K� for
Reviewer/L�spector Name x92
��D1
ReviewerAnspector Signature: Date: 31114
12112103 1 Continued

I
adlity Number: 31 -- 3t)l Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Farm ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
XYes ❑ No
❑ Yes � No
❑ Yes VNo
❑ Yes QVo
ElYes /O No
,VYes ❑ No
❑ Yes JZNo
❑ Yes )6No
❑ Yes 10 No
❑ Yes gNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Type of Visit Q'Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 10 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
EFacilih- Number ,�/ 3
Date or Visit: 14 Ox Time: %S : OS
Not O erational Q Below Threshold
❑ Permitted 0 Certified (] Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: t1"/ Q "? d \ V n s ' `' "0—) Count•: D U
Owner Name;h S Phone No:
Mailing Address:
Facility Contact: J / J Title: Phone No:
Onsite Representative: v r n� C I ry `� n f Integrator: 23y-d _-"W- 01�0
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` « Longitude 0 a 0
W`Destgn _1 _Current Design Carretit Destgn Current
t
:Svrioe; - Ca a_cih.:=Po ulariou_..' PoutfiF-- Ca ari i'o ulatian_ .cattle _ _.Ca"actty.=Pa oration
n ❑ Wean to Feeder I ❑ La er 1 40 Dairyi
❑ Feeder to Finish 10 Non -Laver I I Non -Dairy
❑ Farrow to Wean r
w ❑Farrow to Feeder w : ❑ Other
❑ Farrow to Finish
Total Destgn Capacity.
❑ Gilts
❑ Boars °SS
„ - t
___ TetslLVh
Number of Lagoo s 0� ❑Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
xold'ug Ponds= Solid�Traps
0 ❑ No Liquid Waste Mana ement System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c_ If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1
Freeboard (inches): 34
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes JZ No
[:]Yes ZNo
❑ Yes ZNo
Structure 6
05103101 Continued

Facility Number: .7 1 — 8 r] Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Z`No
seepage,- etc:) ...
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes _ZNo
(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 j2rNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 0 No
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes IffNo
11. Is there evidence of over application? ❑ Excessive�P+onding ❑ PAN El Hydraulic Overload El Yes P No
12. Crop type B e� r+ m uAe1 � � � `Sn.t 4 G Y eet ; .-1 O V.0 '-See' t
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ONO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes JNo
b) Does the facility need a wettable acre determination? ❑ Yes ';TNo
c) This facility is pended for a wettable acre determination? ❑ Yes _L No
15. Does the receiving crop need improvement? ❑ Yes ONO
16. Is there a lack of adequate waste application equipment? ❑ Yes ZE�No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes _ZNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes &No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes HNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes )Z No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes /EfNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application) ❑ Yes �E2No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes P'No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Coaiateii (refer j q
to uestion #) Ezpiaut any YES atxswess andloeany recommeaciations ar apv other caotnmetits.
Use drawmY s of facts to better:ex lam sttuattotts. (nse ad
to tty p dttion$I pages as necessary)
:., � ❑ ❑ Final Notes
6e�w,r,�t� Ge*o10 ►s ave►-q �l 960dq
Sow► e Ct r 2�S )? �6 h� /e C�,-� �cOt� ��F��f r -�� int��avQ Ae Goo
C3r-tiO� ri-.EVGt�S AIse,, 44e -PGo�GZS
t,✓ ►'� fit ; �
q re well (ce/fl� . Be use 4tic (-tle' S-}e A.-ted I 'S da 4 edrwi
C�tl�
6o d a s �' ct�f� �%tea-�,a�-, eve.�� �o t.�a-�� ��I e ,1 ��•^ao�e•-� �c���;���
Reviewer/Inspector Name S o
Reviewer/Inspector Signature: Date: OZ
05103101 Continued

is
Facility lumber: T) -3g7 Date of Inspsctiort 4 p'16
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30_ Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentltemporary cover?
❑ Yes ❑ No
❑ Yes -,E� No
❑ Yes 'PrNo
❑ Yes _,ZNo
❑Yes 1zNo
❑ Yes _ZNo
❑ Yes ❑ No
Additional;Comrncnts and/or Drawings:.-
C"'"-�'"',t-a� DPP rt�� �n ��.� Apy' �i�G4�--�it�r.-� lCGdrp��. �r- �,./c,►-. S �
lyaes 4he zikw(7s;r
/z-
,C`'r s ]d]; r e wall n�a �'n-�cc,`•�ud
G�r'to( I'I✓. C-/alfnl Cft'df'}S R� �'�lQ�er'���'�j 7`le r"``t I�
g god order- q fe e v e ote /74 q i a fpre C: �e7t 4eof
05103101

C4
�� v. � � �;'�� � � _ � Dinsion of Soil and Water Conservation k -
r r Other Agency �- _
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit � Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 2 ��' D Tirne: Printed on: 7/21/2000
Q Not Operational Q Below Threshold
© Permitted © Certified (] Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .............
Farm Name: tX ✓ 1."1 & zo .. County ..`. a'LGL/..!! ............................. ..................Y
Owner Name:
Facility Contact:
....................... Title; ..........................
Phone No:
Phone No:
Flailing Address:.................................................................. ...
Onsite Representative: ✓1 " integrator:.-•j 0
....................... `�....
Certified Operator:
Location'of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��° Longitude
Design Current Design . Current I)�sign . Cadent
Po ulation . Poultry Ca aci Po elation Cattle. Ca ci Po` ulation
Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish f (p ❑ Non -Layer ❑Non -Dairy
;_ Farrow to Wean
- Farrow to Feeder
❑ Other
Farrow to Finish Total DesignCa ci
Gilts � tY .
Boars TotSl:
Discharges & Stream Im act
1. Is any discharge observed from any part of the operation? ❑ Yes ,Z(No
Discharge originated at: [I Lagoon ElSpray 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. lf'discharge is observed, what is the estimated flow in gal/ruin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure i Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ...................................................................
Freeboard (inches): 36
5100
❑ Yes ❑ No
❑ Yes 1,10
❑ Yes No
❑ Yes o
Structure
Continued on back

i( ei
Facility Number: — S Date of Inspection /2-7 AR AO/ I Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed. {ie/ trees, severe erosion, ❑ Yes 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 Q�No
(If any of questions 4-6 was answered yes, and the situation poses an /
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes �No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? El Yes �No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �No
I l_ Is there evidence of over application? ❑ Eyess`ve Ponding PAN ❑ Hydraulic 0 rload �] Yes ❑ No
� � • � • / II •Ill.��.�iUr',��/!ii'-L`:'Il►r7l�/7L�'�'J%��L��*J��
13. Do the receiving crops differ with those designated in the C41ified Animal Waste Management Plan (CAWMP)? ❑ Yes 1E1 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
10
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?
❑ 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?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�] No
0; INO-yiolati6 is:or• &fie ndje$ were noted- ding tbis:visit; • Y:oit will •reegive fio fuj-thgr "
• ' corFes�6fideitce: about: this :visit.
1 lvr (446--r�pw�G 56%5bd), AIF-,-&
5�&Z-
RG '!5 r-5 6,, V r &O D
146
Reviewer/Inspector Name 1.
Reviewer/Inspector Signature: Oe
, q
Date;
5100

Facility Number: — Date of Inspection / O
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 0 No
liquid level of lagoon or storage pond with no agitation? �No
27. Are there any dead animals not disposed of properly within 24 hours? ❑Yes
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ydNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes VNO
5/00

1
ii,
•, k Q Division of Soil and Water: Conservation- � N - � � w � � ��
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit o Routine O Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: /0 3o pa Time: � Printed on: 7/21/2000
Q Not O erational Q Below Threshold
© Permitted 13 Certified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: W ,�f. 5.... 1 County:..... t1371iA......................................................
f.. , ! ........ ........................... j/
Owner Name:.........i�IliA.)�2. .. Phone No:...il� 2'.".....L.............................
Facility Contact: .............................................................................. Title:...................... Phone No:
Mailing Address: .... ....L........ o.�t..... .{-1- ..... GQr............ ....M...Jladha . ...... t4c . z�:C....T
............................ .........
Onsite Representative: .............. . Integrator:.... 8(Q(,c,Ja.,5......
Certified Operator: Q ](, .a,.l.............. .......... r.............. Operator Certification Number: .... zd..l. .0...
Location of Farm:
bj Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ° ;1 Longitude • r��` 44
Design Current
Swine CaDacity Population
❑ Wean to Feeder
Feeder to Finish
0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity Z Q
Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑ Lag -on Area ❑ Spray Field Area
Holding Ponds / Solid Traps I ❑ No Liquid Waste N-lanagement System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes N0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? El Yes � No
b. if discharge is observed, slid it reach Water of the State? (If yes, notify DWQ) ❑YesNo
c. li' discharge is observed. what is the estiinated flow in galhnin?
d. Dees discharge bypass a lagoon system'' (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes � No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Struct re I Structure 2 Structure ; Structure 4 Structure 5 Structure 6
Identifier: ............... ` 1........... ...... .............................. ...... .............. ...............
Freeboard (inches):
5100 Continued on back

I
Facility Number: 31 — 3g Date of Inspection P-A - 0 __0­4 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
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?
Oe/ 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 yWhti6ris'ot- deficiene�es mere noted- during ibis:visit' • Yop :will -receive ,io further • ; •
correspondence. about this .visit_
❑ Yes 4No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes IVNo
❑ Yes Vo
ElYeso
❑ Yes j No
❑ Yes] No
❑ Yes �C No
❑ Yes j No
❑ Yes] No
❑ Yes No
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):
j
Reviewer/Inspector Name
ti
Reviewer/Inspector Signature:
❑ Yes No
❑ Yes No
❑ Yes No
Cl Yes r No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes �j No
❑ Yes t 0
,-
Date: 005100

f
a
Facility Number: —3$ Date of inspection 1/0--30--Oq Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge valor below ❑ Yes KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes RNo
28. Is there any'evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes (No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [ANo
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
5100

C
Lagoon Dike Inspection Report
Name of Farm/Facility �O EAL�,A -4 � j —
Location ofFarm/Facility L \SU.
Owner's Name, Address
and Telephone Number
9t0 -- 0,6g--z(
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH: IV
Embankment Sliding?
(Check One, Describe if Yes)
t_�10
Z.� Names of Inspectors
VrvSSG—�t-L
j Freeboard, Feet
Top Width, Feet
. z
Downstream Slope, xH:IV
Yes
Seepage? Yes '--No
(Check One, Describe if Yes) -
Erosion? Yes '---No
{Check One, Describe if Yes)
ass_ wt)C)-------------------
--
I
Yes No If Yes, Depth of Overtopping, Feet
Follow -UP Inspection ection Needed? Yes L'''� No
P
Engineering Study Needed? Yes 1�-� No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes ''~-' No
Other Corm-nents L-jla t Yl1U,M. �A
. I
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?

C
Lagoon Dike Inspection Report
Name of Farm/Facility j �, j L AKA. 1(%ti
Location of Farm/Facility S2� � � � �, L3
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:IV
Embankment Sliding?
(Check One, Describe if Yes)
Z-� Names of Inspectors_
Freeboard, Feet !r
i
Top Width, Feet
c T Downstream Slope, xH: IV Z
Yes -- o
Seepage? Yes L-�No
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Yes L---_'No
6 iV s/ _- ern owl
Yes ­'"' No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes L� No
Engineering Study Needed? Yes k - l' No
Is Dam Jurisdictional to the Darn Safety Law of 1967? Yes `�No
Other Comments t_j1EL(_ KQrL f1 iGL44, � J

Facility Number
Permitted M Certified p Conditionally Certified p Registered
Farm Name: W.endy..Evans.Farm...................................... I——..........................
Owner Name: W.andy.................................... Exans ............................................
Date of Inspection
Time of Inspection 0 24 hr. (hh:mm)
p Not Operationa Date Last Operated:
County: Duplin WIRO
........ Phone No: 9.10-289:.21.7J..........................................................
FacilityContact: ...............................................................................Title:............................................................... Phone No:....................................................
Mailing Address:..702.B1iad.Bridgc.FQad..................................................................... 1.!'laguoliaAc............................................. I.......... 289453i..............
Onsite Representative: .......................................................................................................... Integrator: Browvn'.s..of.Carialina,.Inc_................................
Certified Operator: .................................................. ............................................................... Operator Certification Number .........................................
Location of Farm:
Latitude ®• ®®
S%vine Eapacity'' Popj
Wean to Feeder
® Feeder to Finish
p Farrow to Wean
Farrow to Feeder
p Farrow to Finish
p Gilts
t7 Boars
Longitude ®• ®6 ®46
_ms estgn urrent
Poultry Capacity Population C
_.
_ --::
Total Design Ca
�Total
1. Is any discharge observed from any part of the operation? p Yes []No
Discharge originated at: p Lagoon p Spray Field 0 Other
a. If discharge is observed, was the conveyance man-made? p Yes ©No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) C] Yes 0 No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) p Yes p No
2. Is there evidence of past discharge from any part of the operation? p Yes []No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [:I Yes p No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? p Spillway p Yes p No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...................................................................................:...................................................................................................................................
Freeboard(inches): ...............2.4............................................................................................................................................................ ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, []Yes []No
seepage, etc.)
3/23/99 Continued on back

Facility�Number: 31-3$7 Date of Inspection
6..Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
p Yes
[]No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
[]No
Waste Application
10. Are there any buffers that need maintenance/improvement?
[]Yes
[:]No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ 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?
❑ 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?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
p Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
.❑ No
a : No:vititations:or. deficieileYes.were.noted _dliring: this visit.: You_ Twill .receive na fui thee. :
. -. - .c6fresi*ddek6. about this:visit: .
ient freeboard available. No problems observed. Well kept embankment.
Reviewer/Inspector Name �patrick Fussell Richard=Moore (DLQ)
Reviewer/Inspector Signature. Date:

E3 Division of SoilAnd , Vate r-. Co
Division of S 6H and'Watei'Coi
of Water 4ue iik
ElMer Agency- 6tib4iske,#
-Oaithiji: - Operation Review -
J'Peei6 v6tiojd-- Compliance xis
6414eciion
JJR Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSNVC review 0 Other
Facility Number Date of Inspection
I Time of Inspection RKZ] 24 hr. (hh:mm)
R!7 rmitted [3 Certified 13 Conditionally Certified E3 Registered 1[Not Oper;tional Date Last Operated: ...........................
Farm Name: ....... Wit ................ ii��aits ............ County: yh�
..................... ................... .......
Owner Name- W,
..... .. . .. e N .......................... Phone 0 ... ..................................
....... ....... Title: .................................... Phone No:
Facility Contact: dr ......... Lilin.S. ( .....
Mailing Address: ..... ... 7 41
........... ........ ...... .......... . ..................
'rise ...... ............. ............
IV h
Onsite Representative ... we", .. Da(l .......................... ...........................
............ Cyms ............................................... Integrator: ...........
Certified Operator:......: Wee.�4 ............... .4�T .................................... Operator Certification Number:..........................................
Location of Farm:
....... I .... I ............................................................ ................................. . ........... ................. 1.­._...1­.­._1 . ... . . . ......................................................................
Latitude Longitude
Design Current DesignCtiri�efit 'J Design
Current.
wine,, Capacity Population", F!Oiiltry._,_� n Cattle
S-Capacit�r Pooulatio Capacity
Population`
❑ Wean to Feeder ❑ Layer ❑Dairy
Non -Layer -Dairy
Feeder to Finish 2,j jjp Non
❑ Farrow to Wean
V. Farrow to Feeder ❑ Other
❑ Farrow to Finish [_DegigmCapacity
Tots[
El Gilts
D Boars Total SSLW
Number-oftako'Ons
—i ld Area
Subsurface Drains Present �ago�onArea 10 Spray F7
ED No Liquid Waste Management System
7- Holdiiiip�,Voiids / Solid Traps
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes KNo
Discharge originated at: El Lagoon El Spray Field E] Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes No
K If discharge is observed, did it reach Water of the State? (If yes, notify DNVQ)
E] Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes No
2. Is there evidence of past discharge from any part of the operation?
El Yes gNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
E] Yes )0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway
El Yes Ir 0
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(incites): ......2.. ............ . ................................. ................................... .......................................................................................................
--ats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
S. Are there any immediate threats E] Yes NO
seepage, etc-) X
3/23/99 Continued on back

Facilfky Number:3 — I)ate of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require main ten arice/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 ;r/ - Y6
13. Do the receiving craps 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?
0:tec3 dix`iizig �hzs:vist: Yoir wiil ti eeeige rio further
Jeora-esponuence: about this :visit_ :
❑ Yes M\No
❑ Yes N6 No
❑ Yes N No
❑ Yes 0 No
❑ Yes JkNo
❑ Yes )j No
❑ Yes ;0 No
❑ Yes JANo
❑ Yes O'No
❑ Yes C(No
[]Yes )d No
❑ Yes �kNo
❑ Yes &No
❑ Yes CNo
❑ Yes 0 No
❑ Yes (LNo
❑ Yes 9,No
❑ Yes 0 No
❑ Yes 9—No
❑ Yesj No
❑ Yes No
oniments (refer' to question #): «Explain any, YES.answeis andlor any recotnrnendattonsgf any other comments:
Ise_;drawings of facili to better ex .iarn-srtuatiiins. use adcliiional a es a§ neressa )
t3'. p ( p g Iy
Cr e- his �eln d4f-,-,w1 ca.4 .
�l
YY���✓o2rc� ankh ,�a,�L fiu��
Reviewer/Inspector Name 1 t
T��� _�
Reviewer/Inspector Signature A4 n ti ']?�/J '1% )o r-,, Date.
3/23/99

Facibty Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ 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 4No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes j No
roads, building structure, and/or public property) J�
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? (ixbroken 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 MNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
AdditionalComments And/orawhngs:"
rI
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
1% Routine 0 Complaint 0 Follow-up of DWQ inspection O Follow-up of DSWC review 0 Other �
Facility Number
3 3 Date of Inspection
Time of Inspection � 24 hr. (hh:mm)
Registered ;I Certified E3 Applied for Permit E3 Permitted JE3 Not Operational Date Last Operated:
FarmName: .................. 0.ea4 .... E.V&w . ....... axc.................................................... County: .... D.41� h..................................................................
OwnerName: ........ _....... W.ldt.kl............ .......... L:AIAS........................................... Phone No:... .............................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: ....... A11..... Mull ......grad`6�e...... .�+Yd.................................................... ... .� a'y.'Aiar... tJ...c.............................................. ..,14.ri?�.......
Onsite Representative: .......................ks,. kA.....SY460.S......................................... Integrator: ........ 1-lYglu.vt.s.......................... .................................
Certified Operator:............................................................................................................... Operator Certification Number:.........................................
Location of Farm:
Latitude =* =, =" Longitude =• =' ="
Design Current Design Current , Design Current--
Swmye �_ Capacity Population -� Poultry CapacityPopulation, Cattle �'� a on Capacity_Populah
v ❑ Wean to Feeder I0 Dairy I I=,
Feeder to Finish JEJ Non -Layer I JLJ Non -Dairy
❑ Farrow to Feeder10 Other,'.
❑ Farrow to Finish r 4 , Total Design Capacity
❑ Gilts
❑Boars •Total SSLW
Number of Lagoons'/ Aoldutg Ponds �, ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area `
❑ No Liquid Waste Management System
`ztn 41 F...e 9^. 'e ✓"` i �yx hf' � �. e `..h'e.e.`
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
CR No
2. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
[PNo
c. If discharge is observed, what is the estimated flow in gaUmin?
"1T
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
®No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
)@ No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
id No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
Y° No
- maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
l)j No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
7/25/97

FacilAiF Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structures(Lag oonsZolding^Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft): ......... .1......... ... ...... .................. I ...... I ...... I... ...............................................................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes
No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
• 9No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
RNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ......................... f?�:?'.i!:WG-................ �......gJYt�ir..................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
13 No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
[2?No
18. Does the receiving crop need improvement?
'*"*a" Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
10 No
20. Does facility require a follow-up visit by same agency?
(R Yes
® No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
allo
22. Does record keeping need improvement?
®, Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily avaiIable?
❑ Yes
1� No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
RNo
0 No.violatio'ns-or deficiencies:werenoteddi ring this:visit.-:You:vvill i-eceive,no°firtli.&
correspandeke: about this:visit:• : :: :: :: : :
tions oY
l2 ' Oj 4,_ 44-.eg 4 (im` r, SAvvjd sue- MOV4 %w._ Ot/ w di'(Cc ua(l ofi fine& • d44 iw41
5 kWO toe V00e.0. 6 ttsto'. Art WS Or• t nrw- (� i lL WA l i o f ja5oer► 5 hau�d b ° IRI tj v %s s�•
g• 6, vJa
1rus be
lrn�►�vrt).
F.e(dsr�s�trsc��{� -, spri►�' fig•
2- i�aSIC
p..s,. �szs
Slnwj� �e.
v�dc U .
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: nj,-& — 111e_'. 1 ._ Date: 13

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
May 12, 1998 RECEIVED
Wendy Evans MAY 15 1"8
Wendy Evans Farm
707 Blind Bridge Road BY --
Magnolia NC 28453
SUBJECT: Designation of a Certified Operator in Charge
Wendy Evans Farm
Facility # 31-387
Duplin County
Dear Ms. Evans:
North Carolina General Statute 90 A-47.2 requires the owner of each animal waste
management system that serves 250 or more swine, 100 or more confined cattle, 75 or
more horses, 1,000 or more sheep, or 30,000 or more confined poultry with a liquid
animal waste management system, to designate a properly certified operator as the
Operator in Charge (OIC). Our records indicate that the OIC you previously
designated is no longer a certified animal waste management system operator.
As the owner of a registered animal operation with an animal waste management
system, you must designate a certified animal waste management system operator as
the Operator in Charge. Enclosed is an Operator in Charge Designation Form
specifically for your facility. Please return this completed form to this office by
June 12, 1998. Please be advised that nothing in this letter should be taken as
absolving you of the responsibility and liability for any past or future violations for
your failure to designate an appropriate Operator in Charge.
If you have any questions regarding the certification of an operator, or need assistance
in locating a certified operator in your area, please contact
Cindy Dudley with -the Technical Assistance and Certification Unit at
[phone] ext. 309.
Sincerely,
Joseph B. McMinn, Supervisor
Technical Assistance & Certification Unit
cd/Desig. of certified OIC
Enclosure
cc: Wilmington Regional Office
Water Quality Files
WATER POLLUTION CONTROL SYSTEM OPERATORS CERTIFICATION COMMISSION
P.O.HOX 29535, RALEIGH, NORTH CAROLINA 27626-0535
PHONE [phone] FAX [phone]
AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER . 50% RECYCLED/10% POST -CONSUMER PAPER

V-
Wz
❑ DSWC Animal Feedlot Operation Review
4
R9 DWQ Animal Feedlot Operation Site inspection .
O Routine 0 Complaint Q Follow-up of DNVQ ins cction Q Follow-up of DSWC review O Other
Date of Inspection II
Facility \umber
Time of Inspection S D 24 hr. (hh:mm)
13 Registered 13 Certified [3 Applied for Permit © Permitted [l Not Operational I Date Last Operated: ,.
Farm Name:......... ....County:....u....S.h...................................Y..V..t...i
OwnerName: .............. .. ............. �,. ..................I............................. Phone No: ... ....0.. ....Z $..i.. - .1.1.. ........................
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: � Q �.......fjA1.ln:�...... g.r.i..��.....�..a.�..�.................. ...M..�.`.'. �.�-0..� �..4..r....15.�.C...................... ...z..&4,S..3
Onsite Representative: V
P i k ........ t.. 5...................................... Integrator: �..........---............-.
Certified Operator:............................................................................................................... Operator Certification Number..........................................
Location of Farm:
...Q.rt.....h.a�.�-}-�..��....Ss.... ....Q...... +-:4..Y..l..t'.Y.�a,.. ©.'.. .............................. �',••�.i...!2.�......!^-:A.�ttii.ul.li:.S.�...a .... � ........ ...............
..........�.L%2 L................. .
....................................................... i
Latitude �` �� ��� Longitude•
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design -Current Design, Current
Poultry Capacity Population Cattle. Capacity, Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number. of Lagoons I Holding Ponds I0 Subsurface Drains Present ❑ Lagoon Area ToSpray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes 19 No
2. Is any discharge observed from any part of the operation? ❑ Yes LZ No
Discharge originates! at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance matt -made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (11' yes, notify DWQ) ❑ Ye\\s � No
c. If dischar�-e is observed, what is the estimated flow in gaUrnin? iN
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑Yes ®No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? - ❑ Yes ,tNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes (allo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes IN No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes KNo
7/25/97
Continued an back

r�
Facility Number: — 3
8. Are there lagoons or storage ponds on site which need to be properly closed? 0
❑ Yes
KNo
Structures 1La oons Iloldin Ponds Flush Pitsq etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
JjA No
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: 21.......
Freeboard(fty...................................................................................................................................................................................
....................................
10. Is seepage observed from any of the structures?
❑ Yes
El No
IL Is erosion, or any other threats to the integrity of any of the structures observed?
Yes
ElNo
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
gNo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
® No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .... 4 si'1,..................
..
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
gNo
17. Does the facility have a lack of adegdate acreage for land application?
❑ Yes
® No
18. Does the receiving crop need improvement? .Yes ❑ No
19. is there a lack of available waste application equipment? ❑ Yes 14No
20. Does facility require a follow-up visit by same agency? ❑ Yes 19 No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 0 No
22. Does record keeping need improvement? [-Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes No
24- Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ,� No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes &No
ff- No.violations or. deficiencies.were-noted during this'. visit. :Y. u:will receive'no further
correspondence aboitt this:visit:•
7/25/97
Reviewer/Inspector Name y6m \:j�i Q.<
Reviewer/Inspector Signature:
Date: n 17 n I e -7

•
Site Requires Immediate Artcntpon,
Facility No.
DNISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION SrJE VISITATION RECORD
DATE. , 1995
Time: _123627
Farm Na
Mailing
County:
Integrate
On Site ]
Physical
Type of Operation: S ' e Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ' S-6 ' 60 _" Longitude: " 02Z �" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have ufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) � es r No Actual Freeboard: _AL?' Ft. 6 - Inches
Was any seepage observed from the lag on(s)? Yes or No Was any erosion observed? Yes qr N
Is adequate land available for spra . Yes r No Is the cover crop adequate? Yest�09
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No'
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
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 or No If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific
Additional
r
Inspector Name
cc: Facility Assessment Unit
with cover croD)? Yes or No
Si
�C
Use Attachments if Needed.