260023_INSPECTIONS_20171231

NORTH CAHOLINA
Department of Environmental Qua

10 �a k 11.
0 Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 260023
Facility Status: Active
permit: AW1260023
Denied Access
Inppection Type: Compliance Inspection
Inactive Or Closed Date:
Reason for visit: Routine
County:
Cumberland Region:
Fayetteville
Date of visit. 01/08/2018 Entry Time: 10:00 am Exit Time: 11:00 am Incident 0
Farm Name: K&M Farms
Owner Email:
Owner: Strauce Smith
Phone:
910-531-3470
Malling Address: 12910 NC Hwy 210 S
Roseboro NC 283828824
Physical Address: 26910 Hwy 210 S
Roseboro NC 283826824
Facility Status: Compliant ❑
Not Compliant Integrator:
Murphy -Brown LLC
Location of Farm:
Latitude:
34" 52' 22" Longitude:
78' 33' 58"
1.8 miles NW of 242 on Hwy, 210 or 1.1 miles SE of Beaver Dam Church Rd. Farm entrance rd west of 210, black mailbox,
address # 12910, road next to small creek.
Question Areas:
Dischrge & Stream Impacts
Waste Cal, Star, & Treat
Waste Application
Records and Documents
Other issues
Certified Operator: Operator Certification Number:
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Strauce Smith Phone
On -site representative Strauce Smith Phone
Primary Inspector: Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspector(a):
Inspection Summary:
No hogs since about 2007. Owner has repeatedly applied for assistance through closing the lagoon with NRCS and Cumberland
Soil and Water Conservation. Recent retirement of tech may change the personality landscape and provide a new opportunity for
closure.
page: 1

Permit: AW1260023 Owner - Facility : Strauce Smith Facility Number. 260023
Inspection Date: 01/08/18 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations
Design Capacity Current promotions
Swine
Swine - Farrow to Feeder 0 0
Total Design Capacity: 0
Total SSI_w: 0
Waste Structures
Dlslgnated Observed
Type Identifier Closed Date Start Date Freeboard freeboard
Lagoon 1 48.00
page: 2

'A
Permit: AWI260023 Owner - Facility: Strauce Smith Facility Number: 260023
Inspection Date: 01/08/18 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No Na No
1. Is any discharge observed from any part of the operation?
❑
M ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
0 ❑
❑
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)
❑
M ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑0
❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
Yes
No Na No
4. Is storage capacity less than adequate?
❑
E ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)? .
B. Are there structures on -site that are not properly addressed and/or managed through a
❑
❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
M ❑
❑
8, Do any of the structures lack adequate markers as required by the permit? (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
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
[]
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

♦-
Permit: AW1260023 Owner - Facility : Strauce Smith Facility Number: 260023
Inspection Date: 01/08/18 Inppection Type: Compliance Inspection ' Reason far Visit: Routine
Waste Application Yes No Na No
Crop Type 1 Coastal Bermuda Grass
(Hay)
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
Management Pian(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre
determination?
17, Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Records and Documents
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available?
If yes, check the appropriate box below.
WUP?
Checklists?
Design?
Maps?
Lease Agreements?
Other?
If Other, please specify
21. Does record keeping need improvement?
If yes, check the appropriate box below.
Waste Application?
Weekly freeboard?
Waste Analysis?
Soil analysis?
Waste Transfers?
Weather code?
Rainfall?
Stocking?
Goldsboro
i■■■1 no
Yea No Na Ne
❑ M ❑ ❑
❑ M ❑ ❑
❑ N ❑ ❑
page: 4

:y
l341
Permit: AWI260023 Owner - Facility : Strauce Smith Facility Number: 260023
Inspection Date: 01/08/18 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Rjemorft and DocumentsYee
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
❑ ❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑ ❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 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 phosphorous loss assessment (PLAT) certification?
❑
N ❑ ❑
Other Issues
Yes
No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
❑
❑
and report mortality rates that exceed normal rates?
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 regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility?
❑
E ❑
❑
If yes, check the appropriate box below.
Applicatiori Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
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 on -site representative?
❑
❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

Facility Number: 260023
Inpsoctlon Type: Compliance Inspection
Reason for Visit:
Routine
Date of Visit:
01/13/2017 Entry T
Farm Name:
K&M Farms
Owner:
Strauce Smith
Mailing Address:
12910 NC Hwy 210 S
Physical Address:
26910 Hwy 210 S
Facility Status:
M ,,,,,,,,,H-1 r
0 Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
'acility Status: H40yL. Permit: AW1260023 ❑ Denied Access
Inactive Or Closed Date:
County: Cumberland Region: Fayetteville
,: 01:00 pm Exit Time: 1:30 pm Incident 0
Owner Email:
Phone: [phone]
Roseboro NC 283828824
Roseboro NC 283828824
UM Murphy -Brown LLC
Location of Farm: Latitude: 34' 52' 22" Longitude: 78' 33' 58"
1.8 miles NW of 242 on Hwy. 210 or 1.1 miles SE of Beaver Dam Church Rd. Farm entrance rd west of 210, black mailbox,
address # 12910, road next to small creek.
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Operator Certification Number:
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Strauce Smith Phone
On -site representative Strauce Smith Phone:
Primary Inspector: Bill Dunlap - Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
Working with Cumberland County Soil & Water Conservation District to clean out lagoon and close the farm,
page: 1

f x
permit: AW1260023 Owner - Facility : Strauce Smith Facility Number: 260023
Inspection Date: 01/13/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Farrow to Feeder 0 0
Total Design Capacity: 0
Total SSLW: 0
Waste Structures
Dislgnated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 1 50.00
page: 2

Permit: AM260023 Owner - Facility : Strauce Smith Facility Number: 260023
Inspection Date: 01/13/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & SIrearn Impac
Yes
No-Na-Me
1. Is any discharge observed From any part of the operation?
❑
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
0 ❑
❑
b. Did 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?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
M ❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
Yes No Na No
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (te.1 large
❑
01111
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑M
❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
1101111
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%110 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

4
w
Permit: AWI260023 Owner - Facility: Strauce Smith Facility Number:
260023
Inspection Date: 01/13/17 Inppection Type: Compliance Inspection Reason for Visit:
Routine
Waste Application
Yes
No Na Na
Crop Type 1
Coastal Bermuda Grass
(Hay)
Crop Type 2 '
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Wagram
Soil Type 2
Norfolk
Soil Type 3 '
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
M ❑
❑
Management Plan(CAWMP)?
15, Does the receiving crop and/or land application site need improvement?
❑
❑
❑
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑M
❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
M ❑
❑
Records and DocumQnto
Yes No Na Na
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
❑ ❑ ■
20. Does the facility fail to have all components of the CAWMP readily available?
❑
❑ ❑
If yes, check the appropriate box below.
WU P?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

i
Permit: AWI260023 Owner - Facility: Strauce Smith Facility Number: 260023
Inspection Date: 01/13/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
ords and Docume
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
❑ ❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑ ❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 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?
❑
❑ ❑
0
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑ ❑
Other Issues
Yes
No No No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
❑ ❑
and report mortality rates that exceed normal rates?
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 regional DWQ of emergency situations as required by 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
❑
If Other, please specify
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 on -site representative?
❑
❑ ❑
34, Does the facility require a follow-up visit by same agency?
013130
page: 6

,-- /fir _ /_ ,r
.a
--ok-'D ;O-Division of Water Resources
Facility Number 0 Division of Soil and Water Conservation
Other Agency
(Type of Visit: O'Co7Hance Inspection Q Operation Review p Structure Evaluation Q Technical Assistance I
Reason for Visit; Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access II
Date of Visit: 1- Arrival Time: Departure Time: 0y jr County:
Farm Name: Cr t `l ��evK Owner Email:
Owner Name: 'C (,�Lir I �VI Phone:
Mailing Address: I Z L1d '/VC 9111y 1 sd•*'F^�, l�7SY �nyo IVC
Physical Address:
Facility Contact: K( r4 S I 1 Title:
Onsite Representative:
Certified Operator:
Integrator:
z0 3 0 Z—
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish ik
Farrow to Wean
Farrow to Feeder \
Farrow to Finish 0
Gilts
Boars
Other
Other
"Layer
Non -La er
ury rouitry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Region:
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dal
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Q'No ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[5 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
�A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[� No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[jNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: jDate of Inspection: cT
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes QE] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No []� ❑ 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 2 f� ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6-were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ZNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 "o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [E N ❑ NA ❑ NE
maintenance or improvement? /
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2'NO ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): d-' l I `t°.
13. Soil Type(s): i ,e✓
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑-Go ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2`Rlo ❑ 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?
Reauired Records & Documents
❑ Yes to ❑ NA ❑ NE
❑ Yes �Io ❑ NA ❑ NE
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
[31'Go
❑ 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
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
&No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: `
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Imo" ' ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes To ❑ 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 Pof�o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes To ❑ NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
❑ Yes
��
L7116
❑ 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
[2054o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
l No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
gNo
NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or anyother comments.
Use drawings of facility to better explain situations (use additional pages as necessary),
u� his 6L�e.7,
CL5 Revi �b
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:��J
Dater i to••t 1 A
21412014

Type of Visit: &Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: ®'iFoutine O Complaint O Follow-up Q Referral O Emergency O Other0 Denied Access
Date of Visit: y rrArrival Time: Departure Time: 1 U 1 J County: C�f.0 it.Farm Name: �' �*- rpJ�' Owner Email:
Owner Name: 1 YC,It j�C C C i (W�jPhone:
Mailing Address: p�'� w 4j kN Z 0 "�`� 12-o S t 60 f.- 14) r Z t3l
Physical Address:
Facility Contact: � S {^-j Title:
Onsite Representative: v( f —11
Certified Operator: ( l
Phone:
Integrator:
Certification Number:
Back-up Operator: r( Certification Number:
Location of Farm:
Latitude:
Longitude:
Region: Fez,
Deslgn Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
cmapacit-Pop.
M
Wean to Finish
La er
Dai Cow
Wean to Feeder
-Layer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P.oultr
Ca aci
P.o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
OtherIBM
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [S]b ❑ NA ❑ NE
❑ Yes ❑ No Q NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
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
A ❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0'KQ
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E f No
❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility !Number: Xlb - (%D d-S Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Io ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Ea<A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[f'Ro
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
fNo
❑ 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
[!rNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ff No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. []Yes B/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 (C]rop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 1]. J' W 44
13. Soil Type(s): V 0 G p -a
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ZL>�T ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [].M ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Eg-?fo ❑ 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 [],N—o [DNA ❑ NE
[:]Yes ❑.?da ❑ 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❑
VN
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 ZNo
❑ 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
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes VNo
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: 3"--LA
JI
.71
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes &Ko ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certificd operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead -animals with 24 hours and/or document ❑ Yes [a W ❑ 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 ET -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
[2'go
❑ 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
ONo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Call�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E5"No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[B'f-4o
❑ NA
D NE
Comments (refer to question #): Explain any YES answers and/or any:additional recommendations or -any other camments.
Use drawings of facility to better explain situations (use additional pages as necessary).
C� 0 r� vf C ,�l1
C
�D6�
c
Reviewer/Inspector Name: ki
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3 ��
Date: I s zs Eyy lJ
21412014

UE
O'Division of Water Quality
Facility Number - ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of visit: QL.EortTpiiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ' tV_ County• of Region:
Farm Name: M fWm S Owner Email:
Owner Name: !r� j / r"Q.w_e_ -- c�/i2 � Phone:
9
Mailing Address:
Physical Address:
Facility Contact: 157 %/--,�z.0 C e ;w;
Onsite Representative: Slw&�'
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Title: 04,e/v7ew,' Phone:
Integrator:
Certification Number:
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Nan -La er
rou
Other
Poults
Design Current
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?
Longitude:
Design Current
Cattle Capacity Pop.
DaiEy Cow
Dairy Calf
Da4y Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Q No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21417011 Continued

Facili Number: jDate of Inspection:
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ 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?
C] Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
2 Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
10 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
0] No
❑ NA
❑ NE
maintenance or improvement?
Waste ADplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
g No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ED No ❑ NA ❑ NE
❑ Excessive Pending ❑ 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):/`hL
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes n No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �S 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 yam. No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑WUP []Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑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 EkNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®,No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ -Yes F1 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [B No ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
[:]Yes B No ❑ NA ❑ NE
❑ Yes [5 No ❑ NA ❑ NE
❑ Yes JM No
❑ Yes [Z No
❑ Yes [Z No
❑ 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:
i
Reviewerllnspector Signature:
Page 3 of 3
Phone:
Date:
21412011

I
Type of Visit: GKompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 9_11`outine O Complaint () Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 3 ! D0 1 Departure Time: t 3 t7 County: e" Region:
Farm Name: k' �' f'!��/'inf Owner Email:
Owner Name: � j--(,� tit e t� Phone:
Mailing Address: Q j�CAeC_'y 42L0 S eS� d aiv t?. 2AL211L
Physical Address:
Facility Contact: 5 T7-Q ' G ?- Title: LVII'>N Sao/
Onsite Representative: _ & O sy,c_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet PoultryCC.apacity
La er
Design
Current Design
Pop. Cattle Capacity
DairyCow
Current
Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
!)r� I;oultrF
Design
- acit
Current D Cow
I;o , Non -Dairy
Farrow to Finish -� ©— .-�
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharees 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 No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

[Facility Number: jDate of Inspection: D—
Waste Collection & Treatment
4. Is storage capacity (structural plus stony storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
s
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): �� y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
�C Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[] No
❑ NA
CE NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Ycs ❑ No DNA ONE
❑ 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): e�
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 ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ONE
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
[] Yes ❑ No ❑ NA ® NE
❑Yes ❑No ❑NA ®NE
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA ® NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
❑ Yes
❑ No
❑ NA ® NE
the appropriate box.
❑ WUP [--]Checklists [:]Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA S NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA [aNE
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

Faciiit Number: 42t, - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes ❑ No ❑ NA �NE
r 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA [Z. NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA IS 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 Rev i ewer/] ns pector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA 0 NE
❑ Yes ❑ No ❑ NA ® NE
❑ Yes ❑ No ❑ NA ® NE
❑ Yes [] No ❑ NA ® NE
❑ Yes
❑ No
❑ NA
0 NE
® Yes
❑ No
❑ NA
M NE
[-Yes
❑ No
❑ NA
❑ NE
Comments (refer to'qucstion #) Exp!ain anygVES'attswcrssand/orsany a�dditionul recomnlendatiiffiie�or any othy}edr comirierits. �`' ;
Use drawings of facility,to hetter:exnlain situ fitions,(use add.itionaltpA a as necessar€y} t
z_7 1s Dry
2 % � 7 K: �y A.-, r- 1JU �r, —
� !7 F�, .�7��%1�`� �'^" �iLi r �� �'i� %17a9 i/z��l � � I � •/ � � f� /?9� � d
Reviewer/Inspector Name:
Reviewer/]nspector Signature: ,✓,r��
Page 3 of 3
Phone: /li" 7
Date: /p'� 3C7 o;Zd��
21412011

9111
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: j i�l _ Arrival Time: Departure Time: County: as Region: / Z(L
Farm Name: IU fd Y"/N S Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Q r —Title: 6910yie-e-, Phone No:
Onsite Representative: Integrator: 4Q4
Certified Operator: __. 1`�j"L� Operator Certification Number: G�=
Back-up Operator:
Location of Farm:
0
Latitude:
Back-up Certification Number:
❑ Longitude: ❑0=6 =
Design Current
Swine Capacity Population Wet Poultry
Design Mient Design C*urgent
Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑Non -Layer
El Dairy Calf
❑ Feeder to Finish
El Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
"'� "�'
El Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Cow
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Soars
❑ Turkeys
❑ TurkeyPoults
10 Other
Number of Structures: O
tither
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes J&No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
;qNo
❑ NA
❑ NE
❑ Yes
59 No
❑ NA
❑ NE
12128104 Continuer!

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
19 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 12
Observed Freeboard (in): �T9- 6r�! `GV 1�✓ % `� �j��nul �2�rr�Cy'`
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
MNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
RNo
❑ 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
RNo
❑ NA
❑ NE '
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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) �lCt
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes &No ❑ NA ❑ NE
t 5. Does the receiving crop and/or land application site need improvement? ❑ Yes J�KNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes & No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes JRNo ❑ NA ❑ NE
❑ Yes CR-No ❑ NA ❑ NE
Comments (refer to question #) . Explain any YES answers�and/or any recommendations or any�other comments.
Use drawings of facility to better, explain si`fuatigns: (use additional pngesas necessary}' �[ ��},
IJ,Ot?': Fop l'I r S d6opr rd o rrsl 2�—/'b A"ni m
T*, .
Reviewer/Inspector Name v: G--"t'- phone• 9'y y„ o
Reviewer/Inspector Signature: / Date: f Qj-v�t7 f}
12128/04 Continued

Facility Number: �p — Date of Inspection
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes MNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C,No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design
g ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EE[No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
RJNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
&No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®-No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
29-No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
(3No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[2 No
❑ NA
❑ NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
fS 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
R No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,QNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
MNo
❑ NA
❑ NE
Additi'onalCnmmentsandlor Drawings:
12128104
12128104

n
Type of Visit &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 'V Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: qaDeparture Time: County: L.WhelAd Region:FM
Farm Name: Ka M Eacal Owner Email: yy
Owner Name: r4''l _ Ertl Phone: 3.3 I --� -OS ihQ_ 1
Mailing Address:
Physical Address: c+�
Facility Contact: J 1r'4T4 fmdb Title: Obmec Phone No:
Onsite Representative: .1� integrator: ! i` 8
Certified Operator: SIYI i ` h Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ 0 0 i Longitude: ❑ ° 0 ` ❑
'Ek'RI �-' ib ..• aic, +Yr'K T °i isl i A. . ,..' "k7. .' - �C�2
u , Design t Current JF ' Design Current 3 Design Current
S � �Ca acit r P ulati�on -Wet Pdullttr ' '
Y.�CaPacity Population Cattle, Capacity Population
❑ Wean to Finish ❑ Layer ❑ Dairy Cow
❑
Wean to Feeder
Non-Layet
El Dairy Calf
❑
Feeder to Finish
""x i ,y
�'
E. ,PIskFarrow
❑ Layers
❑ Non -La ers
❑ Dairy Heifer
❑
Farrow to Weanu''
❑ D Cow
Non -Dairy
El Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
to Feeder
❑
Farrow to Finish
El
Gilts
❑ Boars
El Pullets
" ❑ Turkeys
❑ Turkey Poults
❑ Other
Othr±w,.�
❑ Other
h
Number of Structures:
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?
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 RNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[I Yes [I No El NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
RrYes
❑ No
❑ NA
❑ NE
12128104 Continued

i Facliity Number: a — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CNo ❑ 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): 19
Observed Freeboard (in): 3a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CRNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
CR 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
allo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
CR 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
5�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?
1. Is there evidence of incorrect application? Ifyes, check the appropriate box below.
❑ Yes
UNo ❑ 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) C mil_ al__V�l�hYctG[
13.
Soil type(s) &B
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ERNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
CYes
❑ No
❑ NA
❑ NE
16,
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
t'No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
�iNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name ao s'C•{.} Phone: `T/ y33 —33Q
Reviewer/Inspector Signature: Date: o�
12128104 Continued

i
Facility Number: Date of Inspection
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Fg[No D. NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [R-No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CR-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Eallo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
I�,NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
RYes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
t'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ERNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
aNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ti"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
CTNo
❑ 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
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
.
32.
Did Reviewer/[nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9—No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�TNo
❑ NA
❑ NE
4dditional"Comments and/or Drawings:
3. Sma l I stream, 4 i CO w PQSivle_ iS CL fro,61eh7,
`7©rf e 'PiQ �aL n�Pd.r 1 i`�e_Q crorx� � `� �a�,vvaooq sat j u„ctl s�j w
)6eLeari aoogsatt rd1��o rod�c�r� . �4tlfi�ldr
N
a q, N1a f a w" �t 1c, c � w fro 10,� � , roe 4 r, o
-Ihr/
e.V � c1oje- -}c YZ?
Ps-. s1�d e Svn%e waS i aoo
n q bud- 5.00-1 e�0� � % wa, e,,
Fars, isi6aII de of" 1a�°ct , Cal shams harbr-�., Q lined � l9 �" el�a,a��i�
a �-V4sjgI 1 ��°
ooq,� n ©cob,, a a s,
Tn Froces-5 of c vth� Sma119,>x
Nod AD+ t54 pd ,-xt aV 1: s l 15-1 DI see_
wtrk�d si�d sty -�y��� �d�p1 a r�,+0ev � on strB�Dq�g141Ari Ala c(
s ! e = �10 ioia I tleal�,p+ vof wfin e, Perron
5, Abt-' & Cows , n `�0Axe f vS;b waire f. 7
Page 3 of 3 12128104

+ Facility No. O�-33 Farm Name Date
Permit C 0 C ✓ OIC_ NPDES (Rainbreaker PLAT Annual Cert )
Y. "+f
Design fr- - .. _ .
----
��-0�---
Observed freeboard
Sludge Survey Date
---�---
Calibration Date
1
2
3
4
5
6
7
8
Design Flow
'Actual Flow
Design Width
Actual Width
Soil Test Date
Crop Yield ✓
120 min Inspections
pH Fields (¢,�
Wettable Acres ✓
Weather Codes
Lime Needed-* a - G 4 NAj Olt
WUP ✓
Transfer Sheets
Lime Applie
Weekly Freeboard ✓
RAIN GAUGE
Cu Zn �/
Rainfall >1" ✓
Dead box or incinerator
Needs P T
1 in Inspections
IV
saw
r3,31c,�c
Verify PHONE NUMBERS and affiliations -
Date last WUP FRO Date last WUP at farm App• Hardware
FRO or Farm Records & Leff 101113 Cvfkj s Ci�m � ��� Cu,� i CRI Me_
Lagoon #
Top Dike 50, /
Stop Pump gE4D
Start Pump 4%8
4f44
ea L\b — i

i
Facility Number
Division of Water Quality nR
0 Division of Soil and Water Conservation �l
0 Other Agency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 9Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I Id-ALCMArrival Time: DD p^ Departure Time: Count;
Farm Name: S Owner Email:
Owner Name: 3�ro_ucxe- s TI I ._ L Phone: ,,,_,
Mailing Address:
Physical Address:
Facility Contact. L Title: 0 y-�Phone No:
Onsite Representative�: {, Integrator: 1 f t
Certified Operator:-T-ir0- iJL — __ � i`�c _ -_ Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Back-up Certification Number:
Latitude: 0 0 ❑ I ❑ i{ Longitude: 0 ° ❑ 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I1 10Non-La et
Discharges & Stream Impacts
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
J
Design Current
Cattle Capacity Populaflo.n �i
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry0ow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
1. Is any discharge observed from any part of the operation?
❑ Yes
4No ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
ElYes
❑ No _)�NA
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No 8tNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
,EtNo ❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
)Q No ❑ NA
❑ NE
other than from a discharge?
12128104 Continued

Facility Number; -
Date of Inspection `� o
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.
❑ Yes ,l�l No ❑ NA ❑ NE
❑Yes �5No El NA El NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes .0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo ❑ 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 [I 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 RNo ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes la 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 Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) _ _A, - CmU. --=jtMC`-'t 4S
13. Soil type(s) {f1� A lti
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 19 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 'p PNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes I No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;R No ❑ NA ❑ NE
❑ Yes ,1 No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A6
Reviewer/inspector Name '�'j Phone:
/�
Reviewer/inspector Signature: Date: �lPj?-Lt- }
12128104 Continued \,3

Facility Number: — Date of Inspection D
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes %No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes AM, No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
C*No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
MNA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
39 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
K&No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JRNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�CNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
), No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�g 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
NkNo
❑ NA
El 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
�10
El 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
%Pg�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
`gNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Allis! 4a &bP r'•G r I wm jo-, 4b •eZe v .e
A
rice ,
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1�Y C_4 L �''rvon
to .e�� 3
12/28/04

Facility No.
Farm N�
Owner
Operatc
Time In C� W Time Out Date �V
Integrator
Site Rep �n
No, ( 1
Back-up No.
COC _�� Circle: CGenerI or NPDES
Design
Current
Desi n
Current
Wean - Feed
Farrow -Fee
Wean - Finish
- finish
Feed - Finish
Gilts 1 Boars
Farrow - Wean
Others
FREEBOARD: Design
Observed
Crop Yield
S"1d s'a
ey
Calibration/GPM 1
Rain Gau a �O1i�( Rain Breaker
'�-
�IT/ Wettable Acres PLAT '---------1.
WeeklyFreeboard Dail Rainfall 1-in Inspections
d.
Y —� p
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Wast nalysis•
a Nitrogen (N)
l t�
o 5 - -7
r
-0-�
Date Nitrogen (N)
V 2 I.
Pull/Field Soil Crop Pan Window
`1✓� x
AA

0 Division of Water Quality I&,
Facility Number Q o1,'3 0 Division of Soil and Water Conservation
0 Other Agency.:
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit t9 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: O�{ 'Arrival Time: ® Departure Time: County: Region:
Farm Name Owner Email:
i
Owner Name: „ `„ ,,,,, ,,,,,Lt,ru c2e e
qq� hone:
Mailing Address: I'ZA ),� kj ^� � n S,_,__
Physical Address:
Facility Contact: kkU_ wX _ , _ Phone No:,
Onsite Representative: -C itle: Integrator: �`
Certified Operator: Operator Certification Number: d
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [=] 0 0' =" Longitude: ❑ o =' =
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
f ❑ La er
4
❑Non -La er
Dry Poultry
Non-L;
Pullets
Poults
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: M
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 �ONo ❑ NA ❑ NE
❑ Yes
❑ No
rtn NA
❑ NE
❑ Yes
❑ No NA
❑ NE
❑ Yes
❑ No
N] NA
❑ NE
❑ Yes
NNo
❑ NA
❑ NE
❑ Yes
�INo
❑ NA
❑ NE
12128104
Continued

,Facilit,�Number: —Q�
Date of Inspection S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NBZVA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
o
❑ 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
Po
❑ 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
ElNE
maintenance or improvement?
Waste -Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes [ No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PKNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 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)
u-YVAVti
0
w
14. Do the receiving crops differ from those designated in he CAWMP?
❑Yes P.MNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes DiNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes OZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes -�rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes MNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name /Q� Phone: D ��
Reviewer/Inspector Signature: Date:
1212 04 LJ Continued

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

a6 � v/-
�oh4f 3�
S�

Third day
The Summit at Haw River —field tests done at one mountain and
one Triassic site
8:30 am
Leave for field (with bag lunches)
11:00 am
Arrive Hanging Rock State Park and eat lunch
11:30 am
Field visits to mountain sites (as separate teams)
2:00 pm
Leave Hanging Rock State Park for Triassic field sites
3:00 pm
Evaluate Triassic field sites (as separate teams)
4:00 pm
Complete class and class evaluations — Leave for home
Kinston Forestry Center --field tests done at one Croatan sites
and one urban site
8:00 am
Leave for field (with bag lunches)
9:30 am
Arrive at Croatan National Forest (Brices Creek area)
10:00 am
Field visits to sites
Noon
Lunch at boat landing
1:00 pm
Travel to Craven County Community College
1:30 pm
Begin urban field sites near Craven County Community
College
4:00 pm
Complete class and class evaluations — Leave for home
2

Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: — 917d Arrival Time: ,i Departure Time. //,'H � County: ' Region:
Farm Name: 41 ! K re-W Owner Email:
Owner Name: i 2 �x 1{ C r r Phone:
r �7
Mailing Address: W A IOJ!�.h 10_,5 =IV r o 4L
Physical Address: S�•a-�-�-�.L_
Facility Contact: S TY QU CC, ,srn.` Title:
Onsite Representative: '
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator: er' 14
If r
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ ' 0" Longitude: 0 ° = ` = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
I ❑ Layer
.36-0 � j, "� ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
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)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stockez
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ID
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 wzr MNo ElNA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes [31No ❑ NA ❑ NE
❑ Yes [ANo ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): p'�'D
❑ Yes EN No ❑ NA ❑ NE
❑ Yes [jNo ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CK No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes U�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? [9Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �KNo ❑ 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 P(Yes RI.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. C&Yes ❑ No ❑ NA ❑ NE
Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ISr r•m a ,L ''H" r�-Grn� , /.," i //
13.
r -
Soil type(s) r�Z- -
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L5No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
9&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
CKNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
X No
❑ NA
❑ NE
�� �y,� r•- ;�r�a./'Z� B•sh..1..Gt �'l...l7zzs...7�
z-aks 01v.
-fit- a. �cdo+tr. �,c ;T �jr, i n. Lotu ulr<c } ��
o of
Reviewer/Inspector Name.-�t�5`; ?�`ati4't Phone:. -4/ %
Reviewer/inspector Signature: Date:
IZAM/U4 uonrrnuea

;J
r Y�
Facility Number: — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [Z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 19No ❑ 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. EX Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ZCropYield ❑ 120 Minute Inspections ❑ Monthly and I" 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
❑ No
;F�NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9 No
❑ 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
5?No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
21NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J&No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
93 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
TKNo
❑ 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
54 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
X No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J] No
❑ NA
❑ NE
Additional Comments and/or Drawings:
-F , L3 {o Fb r �5 D M
f d La
12128104

i - ,
Facility Number Date of'Visit: t� ! O Time: O : Ob
Not O erational 0 Below Threshold
® Permitted ® Certified 0 Conditionalh• Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: _ 14 4- M FCxr,x S County. Ctaw+fnc?r dr h.! oP-6
Owner Name: S+I—Cites cr rn Phone No: '71,0�633 i - 34G�D
]flailing Address: lagi o d 141,.1u __ _.2t 2 _-_ ,A"k 2 Q3cP�
Facility Contact: fw,L,c-z Title: Phone No:
Onsite Representative: . S},r-c�[Q �yo�,�, - Integrator:._ NC­'l2
Certified Operator: ��,i�y� � _--_ %on dia Operator Certification Number: .� rz _-
Location of Farm:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude �• �• ��
Design Current Design Current Design Current
Swine Capacity Population Poultry Ce acity Po ulation Cattle . Ca acity PoiDulation
❑ Wean to Feeder I JEJ Laver I 1❑ Da'
❑ Feeder to Finish 1 10 Non -Layer I I JE:1 Non -Dairy
❑ Farrow to Wean
® Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons l 1LJ Subsurface Drains Present JILI Lagoon Area ILJ Sprav Field'Area t
Holding Ponds / Solid Traps ❑
No Liquid Waste Manes ement'Svstem
DischargesS Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes P No
Discharge originared at: ❑ La¢oon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes P No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 5 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes C] No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: a`- a 3�
Date of Inspection
-+-
1
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?
Wastq Avolication
10. Are there any buffers that need maintenance/improvement?
❑ Yes X No
❑ Yes ;& No
❑ Yes 12 No
❑ Yes fia No
❑ Yes R No
❑ Yes M No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes (,'Z'No
12. Crop type Re.j"rV L,, Ca , Gy-C. i n . d . s ,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes P 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 M No
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Q No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
[M No
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
El No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
2�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?
❑ Yes
Wo
(ie/ discharge, freeboard problems, over application)
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
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer tn'ques#tan # Ei( lain an Yl?3 answers and/or an rec6 f s or ati
p y y :mmendatio"n ' y other commentsq
_
Use drawia s of facility tb tietter ei 0Nlh situ&i6nd;, use additional pages as necessary) a ❑Field Ganv ❑ Fina1 Notes
—UI'r'1 J f'e Ga lctD 4 rvv-,, Ls DL-a
Reviewer/Inspector Name „� �' ,E� „; E„ i .
Reviewer/Inspector Signature: Date:
05103101 o Continued

Facility Number: — 3 pate of Inspection
n or 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?
22. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? Re. 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. NVere 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 till pipe or a permanent/temporary cover?
Additional
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes �O No
❑ Yes No
❑ Yes No
❑ Yes ❑ No
05103101

Date of Visit: D3 Time: O Ca �
FaciGh• dumber
Not O erational 0 Below Threshold
® Permitted ® Certified ©Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Dame: 4- . M County CU no L s G
Owner ?dame: rc. u. e,, Phone No: __2 10� .'i � 1
Mailing Address: 1Ag10_ 14-0. E�t'e!-,�ir_� . 21USo�.�t-, 2�.4e 130t o _„-r_G A$3g-2
Facility Contact: U Title:.._ 0 L'LlNe? e— Phone No:
Onsite Representative: ti Integrator: Al fZ4,�iL,
Certified Operator: �rn �'�-1-; Operator Certification Number: 1 �-
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 9 K Longitude • �
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder 10 Laver I 1 ❑ Dairy
❑ Feeder to Finish ❑ Non -La er ❑ Non -Dairy
❑ Farrow to can
Farrow to Feeder ,6a ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 0 ; ', �] Subsurface Drains Present ❑ La oon Area 10 Spray Field Area
"Holding Ponds / Solld Traps . ❑ No Liquid Waste Mana erneni System
Discharges S Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a• If discharge is observed, was the conveyance man -mane?
b. if discharge is observed, did it reach Water of the State? (If yes, notify D WQ)
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 l Structure 2 . Structure 3 Structure 4 Structure 5
Identifier.
Freeboard (inches): 3 0
05103101
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
(,�� No
❑ Yes
No
❑ Yes
No
Structure 6
Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? (if any of questions 4-6 was answered yes, and the situation poses an ❑ Yes (] No
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuetures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes V No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes P No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [�a No
12. Crop type (� ern.. u �� S v,,._LC Csi~���n d ,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
P No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
P 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
R] No
16. Is there a lack of adequate waste application equipment?
❑ Yes
ERNo
Required
Records Rc_Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readiiy 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? (icl 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?
❑ Yes
[] No
(ic/ discharge, freeboard problems, over application)
23,
Did Reviewer/Jnspector 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
EP No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments refer to question #!): Explain.any YES answers and/or any recommendations or>any other comments: 4' w
Useri)rawing�saof facility to better explain situations:§(use+Additional pages:as necessary}❑Field Copy ❑ Final Notes
3�
co
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101
Continued

Facility Number: A (, -- Date of Inspection ! •
Odar issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
05103101
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No

Type of Visit IPCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 7§ Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
Permitted I$ Certified 0 Conditionally Certified D Registered
Farm Name: 1� i R S
Owner Name: '-Ar&'.kCe
Jt �i Time: 1 16,03
10 Not 013crational Q Figlow Threshold
Date Last Operated or Above Threshold:
County: KbrA.., F�
Phone No: _ =3i.4 76
Mailing Address:
Facility Contact: Title: 0wn4/ Phone No:
Onsite Representative: 0U_V14_-r"
Certified Operator: �Zit�St� S. �Sr►„�-�,
Location of Farm:
Integrator:
Operator Certification Number: Can qqz
Swine []Poultry []Cattle ❑ Horse Latitude 0 �' �" Longitude ' u
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): (]i
05103101
❑ Yes % No
❑ Yes Cl No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes ( No
❑ Yes (P No
Structure 6
Continued

Facility Number: 5(7-52) Date of Inspection 15 A 9 a;;L
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?
❑ Yes 0 No
❑ Yes 0 No
❑ Yes DO No
❑ Yes L No
❑ Yes [A No
Waste Appiicati2o
10. Are there any buffers that need maintenance/improvement? ❑ Yes % No
11. Is there evidence of over application? ❑ Excessive Ponding El PAN ❑ Hydraulic Overload El Yes [AI No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? El 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
jg] No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[� No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
10 No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
R 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?
❑ Yes
IX No
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O No
24. Does facility require a follow-up visit by same agency?
❑ Yes
M-No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
10 No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments wefer toa((,uestion:# Explain an YES answers andl'araan recninmenditlons or an gther comments,;
( �jli^' ) py Y -". } y
r {p�Se'..&ytKa 1 r h
Use drawings of facility'to better explain situ ations..(useudditional pages nsjnecessary) ❑Field Copv ❑Final Notes
t..
ff
qe Mja, ►
I tr 4AA;s are- &_ o A spfa�.j e,��, SmJa c�icc;n S�r,o�cR �e c Lxs
Scan CS ¢oss'���e cL�a,A oua,-5�`,►t� a� �ae�—Mc�a, SM,
}t
� A �� I +� �� r^ r`C, i S O-ft'c, Q L%net LO � T� 4 -- +"Q l L7 14 Y L+ «se_
J `J
,
Name ��w� �,- ' ,
Reviewer/Inspector -.777771
Reviewer/Inspector Signature; Date: GQ_
05103101 Continued

61
Facility Number: cP(r —,)'3 Date of Inspection 5
04-OL ln=
26. Does the discharge pipe from the confinement building (o 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 (here any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover'?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
05103101
❑ Yes ❑ No
❑ Yes [)9 No
❑ Yes [S No
❑ Yes M No
❑ Yes No
❑ Yes No
❑ Yes ❑ No

Facility Number 23 pate of Visit: Time: 4 - -- - -
Not Operational 0 Below Threshold
QPerniitted 0 C
e
rtified 0 Conditionally Certified [3 Registered Date Last Operated or Above T1hresho�lld:
Farm Name: ....... d.......'.. ..... a� l!Yf.S................................. County: .... 4.. ! !110 f,f [ . ` `................................
OwnerName:........ �t�` s e.................... L.s...................................... Phone No: ..... j�3.4..":....31.Z2.................... I................
Facility Contact: .............................................. .. -" Phone No: "�-
�p l (�Title:...................................................,...j........, ,, r •..................................................,
Mailing Address:.....l� s .....f�..t......1..1. �.....:;3................................................ ......�i ?.� '.I? t^D I `!. C............................. i 2'
OnsiteRepresentative ..................C2..4 !`1.......................................................... Integrator: ............. AM..". `....L'..� 1�:....
Certified Operator:.... �t ,m..5.. -, .......... .... .........5.ft.r.. .......................... Operator Certification Number:..........................................
Location of Farm: J
I
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ��
Design Current Design Current, �DesiW_.111
Current
iSvvine Capacity Potiula&o Poultry Ca'Dty 00DI I8d6n Cade �.Capacity.,'Poavlatloa'r'.
❑ Other
Total'DeSlQn' Capacity,
Total SSLW
❑ Subsurface Drains Present ❑ Lagoon Area
❑ No Liquid Waste Management System
Discharges & Stream Impact's
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)
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
80n8je
iia9TraFt�'.
c. I ' discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
Spray Field !My
❑ Yes No
❑ Yes �No
❑ Yes ANo
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
❑ Yes (f'No
❑ Yes " No
❑ Yes o
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes F �Io
.Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches): Zg
5/00 Continued on hack

r
1
r "1
+Facility Number: 2-6 — 2-3 Date of Inspection - -a
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 0No
closure plan? ❑Yes
(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 qNo
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes o
12. Crop type, D-r! c4� /�(r
13. Do the receiving crops differ with those design9ted in the Certified Animal Waste Mythnagement
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?
1
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
Plan (dAWMP)? ❑ Yes
9No
❑ Yes
No
❑ Yes
:No
❑ Yes
No
❑ Yes
t 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.)
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?
•YIQ1P�K}gs'ak' ¢fc�e�� ire �i:ed �1H`� ��is'��S�t; Yoi wii� fee iyo'
coiresb6fid6ie. ab6if th1S VlSltr ' . . ' . .
❑ Yes 0 No
❑ Yes KNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes KNo
❑ Yes No
❑ YeslNo
No
❑ Yes
its.
f4 r-�41 ks 14e//X2"'t
Reviewer/Inspector Name i , _
Reviewer/Inspector Signature: Date: 11- 7 ` D 5/00

Y'
IFacility Number: — 23 I 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 kYes [:]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 XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes f� No
roads, building structure, and/or public property) , 1
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes P�o
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 PO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number LG 3 Date of Inspection L / _
Time of Inspection ; a 14 hr. (hh:mm)
,1 Permitted p Certif��ieed 0 Conditionally Certified [3 Registered Not Opera �tDate Last Operated: ................:.........
Farm Name: .................15.... ../: .....egra"5............................................................ County:.........,Gr. /t. 'C./ ...... ... I ..................
.
Owner Name: ......... .72*,jAr.rX.....!^!..r`........ Phone No:..�I��).5.�..,�.��d ............................................................... .............. ................
i
Facility Contact: .....,5-4
n 4..... 7� .............•...... Title:............................................................... Phone No: .......
MailingAddress:........ tL ,..... ,1....., `, ... Z ......1. P. o!G®yl..N.4..... fl Z....................................................... ..........................
Onsite Representative:....., ......e...... t!.......................................... Integrator: ..... A!.`.�. .. ...........................
Certified Operator:........ .'............. .S/ -e•.................................. Operator Certification Number:..........................................
Location of Farm:
Latitude • 4 66 Longitude 0 6 66
lY i e Number"of L'ag'aons t € ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
t
Holding,Ponds RESEW Traps s ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yis No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes RNo
b. If' discharge is observed, did it reach Water of the State? (Ii' yes, notify DWQ) ❑yes 9No
c. If discharge is observed, what is the estimated Flow in gal/min'?
d. Does discharge bypass a lagoon system? (II' yes, notify DWQ) ❑ Yes B No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes J0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes J@ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes jRNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ............J11..............................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes JS No
seepage, etc.)
3/23/99 Continued on back

i
d
Facility Number: 1,e — ,Z 3 Date (of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
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
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?
Reguired 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?
(iel 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?
y'o o ii�ee$iye too t�pioal idos'�d�k , .
.. ;corresnoxidei & ahi ' this :visit.. ................... .
❑ Yes to No
❑ Yes OtNo
❑ Yes Wo
❑ Yes XNo
❑ Yes No
❑ Yes No
❑ Yes gNo
❑ Yes 02 No
❑ Yes 5? No
❑ Yes CR No
�[ Yes El No
r❑ Yes J'No
❑ Yes KNo
❑ Yes ArNo
❑ Yes No
❑ Yes No
❑ Yes KNo
❑ Yes;wNo
❑ Yes (XrNo
❑ Yes R No
❑ Yes fRNo

Facility Number: ,�[ — 2,3 Date of Inspection / Z�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes WNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ;`No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes KNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes JUNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ;ErNo
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover? X Yes ❑ No
tlana ' Comments an Or Cawin s: k e ' t' ,, t " rg
... ,:..,., �.. .. �.-.,� �,-:�- 1. _, I!.! � . '� 3
I"

�"I zl.,Djmsi n,of SoAl atldVater" Cdnse'rvatlonOperltion Revle" w
©;Divisio'n of Soil and Wtttcr'Conscrvation - Coulplianc'clnspectian =�
Divisibn,irF Water Quality'- Compliance Inspection
,`[3 Other Agency -Operation Review
® Routine Q Complaint 0 Follow-u) of [)W ins )ection Q holinw-u) c>f DSNVC review Q Other
Facility Number, 2G Date of Inspection �
Time of Inspection Z r_" 24 hr. (hh:mm)
© Permitted ® Certified 13 Conditionally Certified (3 Registered JE3 Not Open Date Last Operated:
Farm Name: .... { %1% l9�=�'t�. County:......�re. .....................
.........e....................................................... ..............................................
Owner Name:.....5 .�} .....,...� �H................................................... 1'hnne No:..�� Q. ,...` T..7Ly....................
It
Facility Contact: ..41....f+`.............`Iitle:..............................................,................. ' Phone No:...................................................
Mailing Address: ....f.�r. ��t Z'� /�Q..r�.�"Q.R.i� ........................ ..........................
Onsike Representative: ,,•, LAs4 .rs' ..... ........ lntet;ratar:....... 'Lida J�7 ..../`.¢ i!•- ....................
c
Certified Operator:...... t�r!r ....... .....,,ef+............................................. Operator Certi(icatinn Number:..... .7 Z............
Location of Farm:
'.....................
.....
.............
..................
..........
................................
.........
......................
..............
........
.....................
..............................................
................. —
...................................................................................................................................
Latitude tc cc Longitude 0 c 66
Swine
Design Current Design Current
Capacity Population Poultry Opacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
19 Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Cattle Capacity Population
FDairy
Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons L ❑ Subsurface Drains Present ❑ Lat;nnn Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps 10 No Liquid Waste Management System
Dischart!es tic Stream Impacts
1. Is any discharge observed From any part of the operation (If yes, notify DWQ)?
Discharge originated ,w ❑ Lagoon ❑ Spray Ficld []Other
a. If discharge is ohsa ved, was the conveyance rnan-rnac
h. If discharge is observed, did it reach: ❑ Surface Waters []Waters of the State
c. if discharge is observed. what is the estimated flow in gal/ruin?
d. Does discharge hypass a lagoon s}'stem?
2. Is there evidence of past discharge frorn any part of the operation`?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adcyuatc?
Structure I Structure 2
IdeIII i fier:
Freeboard (inches):
...........�...l.............................
Structure 3 . Structure 4 Structure 5
❑ Yes RNo
❑ Yes 9 No
❑ Yes tErNo
❑ Yes
PNo
❑ Yes
tallo
❑ Yes
UfNo
❑ Yes A -No
Structure h
1/6/99 Continued on back

'A
Facility Number: 2a< — _23 I Date of Inspection
5. Are there any immediate threats to the integrity of* any of the structures observed? (ic/ trees, severe erosion, ❑ Yes- i%No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ YesNo
(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 I'No
9. Do any stuctures lack adequate, gauged markers with required top of'dike, maximum and minimum
liquid level elevation markings? ❑ Yes fV-No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ex No
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen ❑ Yes XNO
12, Crop type .......ble" ,.............................................................................................................................................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes aj "No
14. Does the facility lack wettahle acreage for land application'? (footprint) X"Yes ❑ No
15. Does the receiving crop need improvement'? ❑lYes Wo
16. Is there a lack of adequate waste application equipment? ❑ Yes >K:No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes No
19. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? rr
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes )KNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes (kNo
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 certified operator in responsible charge? , ❑ Yes NNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ,A 'No
23. Did Reviewer/Inspector !'ail to discuss review/inspection with on -site representative? ❑ Yes XNo
24. Does facility require a follow-up visit by same agency? ❑ Yes KNo
No.vitilations•or.deficiencies.werenotedciurin' 'tliis•visit:.• 6u'wil1.reeeivenaftirtlier.:
enrr�spo dence.about.tht.. ... . . . . . . .... . . . . .. .. . . .
Comments (refer to duesti[6: 64):%Explain any YES answers hndlor any.recommendations or, any other comments ':'' E'.,
Use.drawings;of facility: to better explain situations. (use additional pages as necessary): E
d> /�PQ . J/�+ rJ�i � T
a�j��j" ,S�r�F �-r,.h�„�,�.?`o bx% �.�.� s�o 7�.t e-✓ /.?�ed,✓ .
IReviewer/Inspector Name
Reviewer/Inspector Signature: ^ ..,iT Date: ,�/S f z z 1 1/6/99

K
Q Division of Soil and Water Conservation ❑ Other Agency
10 Division of Water Quality
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection
a2 !a
Time of Inspection 0 24 hr. (hh:mm)
E3 Registered Certified © Applied for Permit © Permitted 0 Not Operational Date Last Operated:
Farm Name: ............... !.:Y+ T .. County:................... ����.....................
OwnerName: ............... 1..77"rAt!ifCt�... r'.1.V.1.................................................. Phone No: ........................ l..�a....... .:........ ­1 ..............
FacilityContact: ............... ... S............ Title:........................................................... .. Phone No:...................................................
MailingAddress:.....:..........'f.:.....,....`.JC1,.......Z.....,......................................... .............1C4.r7 .. ....^^............ ....
Onsite Representative: ........................................ Integrator:.............�...k4.
Certified Operator; ........................! .... / `......,.r�/t�'i( � ...................... Operator Certification Number,.........f...�o.7. ..
Location of Farm:
Latitude • ` 46 Longitude • 6 «
g VUsrgn . uurrenr r
Swine Capacity `Population Poultry
Vesign ksurre"L vesign k1urrent
Capacity Population Cattle .Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy_
❑ Feeder to Finish
❑ Non -Layer
I0 Non -Dairy
❑ Farrow to Wean
;
Farrow to Feeder❑Other
'
Farrow to Finish
Total Design"Capacity 5-5-0
❑ Gilts
❑Boars
Total SSLW
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
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
No
c. If discharge is observed, what is the estimated flow in gal/min?
N
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
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
7. Did the facility fail to have a certified operator in responsible charge?
ElYes
rNo
7/25/97

J
Facility Number: z— a3
8. Are there lagoons or storage ponds on site which need to be properly closed? Cl Yes No -
Structures fLagoons,Ifolding Ponds, F'Itt.shfits, etc./
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure l Structure 2 Structure 3 Structure 4, Structure 5 Structure 6
Identi fier:
Freeboard(ft): oZ.......................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ 1'e, 0
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes
12. Do any of the structures need mairttenance/improvement'? Yes C1 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 rnaxintum liquid level markers? ❑ Yes] No
Waste ;application
14. Is there physical evidence of over application'? ❑ Yes No
(If in excess of WMP, or r n ff entering ate of ie State, noti 'y DWQ)
15. Crop type..... .................... ......`,........•........•...............•
15. Do the receiving crops differ with those designated in the Animal Waste Management Plan AW,IMIT ❑ Yes No
17. Does the facility have a lack of adequate 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 allo
20, Does facility require a follow-up visit by same agency? ❑ Yes kNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes eNo
22. Does record keeping need improvement? ❑ Yes X No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes P(No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ❑ No
0 No.vio'la' dons or deficiencies were note'd-during thisvisit., .You. wiII receive no further
'. correspondence 0ioitt this'. visit'.-'.'
Com ttents;(r'efcr to:question #)i ' Explain any YFS'answers and/or a
Use drawings'of facility to better explain situatiiin5 (rise iidditiodal 1
.con #mendattnns or any`other cdminet
tasnecessary)
s
7/25/97
Reviewer/Inspector Name.
Reviewer/Inspector Signature:

{
04
' �'a °Y, ,w flu .t'�.%, ,` 'n:.��«.�.,a.vaw ,t ,£a u£ ....«,,..... .a,;'.�'f9r,.:., �.m..::�:{b. v'i- &.. �..,'aw.:,wdt ,.w»�4..,w�o..u,.,.�..u,G.:.: � U' k
Dif S
* ' 0 vision of Soil WaterConservation
and onservaon ❑ Okher Agency � � wal
MiN �::!N'MA
;
°`, Division of Water duality
Routine 0 Com laint 0 .FolIow-u of IDW ins cction 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number D Time of inspection %:. 24 hr. (hh:mm)
0 Registered ■ Certified 0 Applied for Permit 0 Permitted 10 Not [) erational Date Last Operated:....
Farm Name:.........., <. e^.. /Q '``5........ ......................................... County:....,. rG�cfA?v................................
Owner Name: ..... �sl.&l.efr........... ...........
.�.'....,........,,................ Phone No:(9w)..5,?/. ...3 176................
FacilityContact: ................... e'........................................ Title:...............................'.................................. Phone No:...................................................
Mailing Address: ....... /��....��,r,...�c?X.,023.1.......!\.4..�.... ...... V C.......r�c�.� 2..................................... ..........................
Onsite Representative: ............. ............... :.......... ........... Integrator:..........................
LL� r / 7,aZ
Certified O erator;.,..,.1Vr!... �Fwir. ......... O erator Certification Number;,...,..5 ...............................
Location of Farm: j ,.,,— � s i i ,2 /Q , —,,oe . 0�&'� /.5�.-•,.�.C.0 f�b�r""'
Latitude Longitude �• �� �«
Design Current
'Design"' Cnrrenty
Design Curret>It
°'Swine . Capacity I?apulatton
Poultry
Capacity Population Cattle Capacity Population
10Layer
❑ Dairy
❑Non -Layer
❑Nan -Dairy
a#
❑ Other
a'
Total Design Capacity,
4
y
Q f:
"
x
`
'Total SSLW
Number of Lagoons/ Hol¢eding€Pnnds ❑ Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area
, ❑ No Liquid Waste Management System
h J
,a ....E AAirvf,...:.8`.
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
® Farrow to Feeder
❑ Farrow to Finish
❑ tilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
. No
2. Is any discharge observed from any part of the operation?
❑ Yes
No
t
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
$LNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
Wo
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
KNo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
JKNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
PNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
KNo
maintenance/improvement?
6, is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
.�'No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
*No
7125147 Continued on back

Facility Number:,2a —,
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures„(Lagoons,flolding_ Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier:
Freeboard (ft):............ .` 3t ., ......,r,{optrs.s'-�..............
10. Is seepage observed from any of the structures?
Structure 4 Structure 5
............I...................................................
.1
❑ Yes Xj No
❑ Yes ff No
Structure 6
.................................................................................................1.
❑ Yes XNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes LN
12. Do any of the structures need maintenance/improvement? iKYes ❑ 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?
Waste Application
14. Is there physical evidence of over application?
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type s !!!-!tOi .SL!s l ". .4' 1.....................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For 'Hied or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.v161aid ons-ar deFiciehde's.werenoted-during t h i s'v i si L -Nou.wi11 recei:ve•no-ftirilier:-
:. • correspondeince ab"out th is: visit. • ; . • . � . • .. � � .: � . : � :. � . • - :: : . � .� . • . . _ �
❑ Yes ;(No
❑ Yes eN No
❑ Yes Q No
❑ Yes ® No
❑ Yes 00 No
❑ Yes I? No
❑ Yes JX No
❑ Yes WNo
A Yes ❑ No
❑ Yes KNo
❑ Yes PM No
❑ Yes CC No
12, /11.r. ,5 i✓.� yr/p ,U�it�i� G'O��•c �,�,�sr� �/ ��v� �.F.t.�s o.✓
.
7/25/97
Reviewer/Inspector Name ,r,;y' 1 "`wl
l
d'3 �'
Reviewer/Inspector Signature: ssT� Dale: /O

Site Requires Immediate Attention:. 0
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEN IENIT
AND4AL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: L5 L AL , 1995
Time: Io o o .
Farm Name./Owner. VAQAM_
Mailing Address: t _1 Bo X Z3 Ida ebD o {` J • z $ 3�1,
County: C.y� �,+�►AnT] �...� }-
integrator: \fvx, LNJ VA(LAM 5 T JOC1 Phone: , `100 =ZtC% , %t9
On Site Representative: __• Z Mc V S M t R ►A_ Phone: 10 IS31-- )41fl
Physical Addrem/Location : z ":•\;L W 046� Z'�Z 0v\. u W 1 S t.0. ON `lit
Type of Operation: SwinetK v Poultry Cattle
Design Capacity: 3 S O Number of Animals on Site: 3 5 0
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitudc:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of l Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) X� or No Actual Freeboard: 3 Ft. (o Inches
Was any seepage observed from the 1 oon(s)7 Yes o 1 o Was any erosion observed? Yes or io
Is adequate land available for spray? Y or No Is the cover crop adequate? es No
Crop(s) being utilized. „Lc'k r'L t-
Does the facility mcet SCS minimurn setback criteria? 200 Feet from Dwellings. Yes r No
100 Feet from Wells? OiEejor No
Is the animal waste stockpiled'within 100 Feet of USGS Blue Line Stream? Yes or®
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar main -made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management
spray irrigated on specific acreage with cover
Additional Comments: 7%(L- .'SV�4' ►S ow,
L:►
�iv� &,I
Inspector Name
s (volumes of manure, land applied,
or No ek
0
cc: Facility Assessment Unit Use Attachments if Needed.