770019_INSPECTIONS_20171231

Divisiae of Water Resources
Facility Netxnlber - O Division of Soil and Water Conservation
Q Oth.er Agency
Type of Visit: a Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: ( Routine Q Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: rj Departure Time: Q► County: 1,9a,*,.WRegion:
Farm Name: Q h a C_ R-✓' Owner Email:
Owner Name: 404, f���>e Phone:
Mailing Address:
Physical Address:
Facility Contact: ,1- 6yl`(Jt Title: Phone:
Onsite Representative: y Integrator: Cctc4 P-Vu;-
Certified Operator: u Certification Number: M) b
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Reoultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
]Non -Layer
Dairy Calf
Dairy Heifer
Feeder to Finish
2 2
D , Po H
Design
Ga ati
Current
P,o
" Farrow to Wean
Farrow to Feeder
D Cow
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other TurkeyPoults
Other Other
Dischar gs and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 1�hNo ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No NA ❑ NE
[:]Yes
[:]No
❑ Yes
®No
❑ Yes
10 No
NA ❑ NE
DNA []NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

acili 'Number: rn - 6y Date of Inspection: !
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes � No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2—qw
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 �3 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 5No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes tn No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ft?No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ lom those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�]O 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 V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �D 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 21417015 Continued

Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes ErNo
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes �a 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 provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [1� No ❑ NA ❑ NE
❑ Yes JpNo ❑ NA ❑ NE
❑ Yes � No 0 NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes `P No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 53ce
Date:
14/2 15

_ R-+^-
Wn
�vision of Water RManre"
Rai"
umber I /.-1 - Division of Soil and Water Conservation
® Other Age, ncy
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � �-i-i Arrival Time: ; Departure Time:County: 14r►.cj Region: �D
Farm Name: Ivvx C.
Owner Name: h,2 - PI l
Mailing Address:
Physical Address:
Facility Contact: — Avid Title:
t}
Onsite Representative:
Certified Operator:
Back-up Operator:
tl
Owner Email:
Phone:
Phone:
5 `r
Integrator: / rr77 r
Certification Number: IO�77J
Certification Number:
1 .nratinn of Farm- i.atitndP- I.nnoitude-
Discharges and Stream Impacts
1. Is any discharge observed from any part ofthe operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes �4 No ❑ NA ❑ NE
❑ Yes ❑ No C� NA ❑ NE
❑ Yes ❑ No [P NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No V-j NA ❑ NE
2. Is there evidence ol'a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili umber: - Date of Inspection:
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
q51 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑Yes
❑ No
NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Designed Freeboard (in):
Observed Freeboard (in): Z Ov
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
tp 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 Lp No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [�j No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [�? No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1�1 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cyop Window ❑ Evidence of Wind Drift, ❑ Application Outside of Approved Area
12. Crop Type(s): !I
13. Soil Type(s):
14. Do the receiving crops er from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
P No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
1� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q�)No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? if yes, check
[] Yes
[ No
❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[b No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EpNo
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

acili "Number: rT 7 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
IF
❑ 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
E@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
W 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
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
r_-_�L No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
T No
❑ NA ❑ NE
34_ Does the facility require a follow-up visit by the same agency?
❑ Yes
EP No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better emlain situations (use additional Daees as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: g �D
21412015

u
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
[season for Visit: 40 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:tdl�
Farm Name: Owner Email:
Owner Name: } n ,,,,Y ' bZ InY7-L Phone:
Mailing Address:
Physical Address:
Facility Contact: ,L/ Title:
Onsite Representative: 14
Certified Operator.
Back-up Operator:
Location of Farm:
U
Latitude:
Region: /`T_ '
Phone: ..'--'
Integrator:
Certification Number: -1 S1P 7,�j
Certification Number:
Longitude:
Design Current . _3 Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop.
Wean to Finish La er
Design C'nrrent
Cattle C■apacity Pop -
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
au4 (,.
rr_ Design Current
D , P,oul Ca a_ci P.o
DairyHeifer
Farrow to Wean 2-B
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
l7ther
Other
Beef Brood Cow
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
RtNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
M NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[] No
1P NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
W NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes
❑ No
NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
u
Observed Freeboard (in): L.
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] 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
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [3Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
n Outside of Acceptable Crop Window n Evidence of Wind Drift n Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes E] No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P 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 [�j No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �b No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

acifi Number: 77 1 - R Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes � No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office -of emergency situations as required by the
❑ Yes No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑NA ❑NE
NA ❑ NE
❑ NA ❑ NE
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to ,question #): Explain any YES answers and/or any additions! recommendations-idnany other comm,ent Xt
Use drawings oifacElity to better explain situations;(use additional pales as necessary) ap`
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: p1� 3 3
Date: w -
214/20I4

lVA
Div`i`sion of Water Resources
Facility Number . I� - O Division of Soil and Rater Conservation
lllOot Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:Arrival Time: I //. CX7 Departure Time: County: Region: 1599
Farm Name: Gr-- fk�ws Owner Email:
Owner Name: i!�;f7e._7 ' Imp Phone:
Mailing Address:
Physical Address:
Facility Contact: Dz.' r CY Je4/+-^7 Title: Phone:
Onsite Representative: U Integrator:
Certified Operator: Certification Number: �1F_'?J
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
-- Design Current
Design
Current
Design Gnrreat
Swine C*apacity Pog.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Non -La er
Dairy Cow
Dairy Calf
Wean to Feeder
Feeder to Finish
Dairy Heifer
Farrow to Wean
P.
Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Turkeys
..: _ ..
Other_,
Turkey Points
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
WA
❑ NE
[—]Yes
❑ No
[01NA
❑ NE
❑ Yes
❑ No
[)FNA
❑ NE
❑ Yes
[ff No
❑ NA
❑ NE
[—]Yes
E�No
❑ NA
❑ NE
Page I of 3
21412014 Continued

* 1
Facility Number: - Date of Ins ection: VAL
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;6 No 0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No U NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
1P No
❑ NA
❑ NE
waste management or closure plan?
T
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
1 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
PO 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
`Y'' No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Vl] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes W 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 /j ❑ Evidence of Wind Drift ❑ Application Outside
of Approved Area
12. Crop Type(s): �jf !I'1•trCXC! (4�M SS �i J!(� • V'L.. t/-� -
13. Soil Type(s): ,Ac.,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
F No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA ❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
D Yes
[P No
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
® o
❑ NA I I
20. Does the facility fail to have all components of the CAWMP readily available? If yes, chec
❑ Y
❑ NA '}ENE
the appropriate box.
)�`'
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Othe :
i
21. Does record keeping need improvement? If yes, check the appropriate box below.
" ❑ es
No
❑ NA P NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Wa to Tr
s
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall In pect ons
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ es
® o
T'
❑ NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ es
No
❑ NA NE
Page 2 of 3
2/4/2014 Continued

}
Facility Number: 71 -19 jDate of Inspection: z3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA NNE
❑ NA F NE
❑ Yes
❑ No
❑ NA
[ NE
❑ Yes
❑ No
❑ NA
NE
❑ Yes
❑ No
❑ NA
NE
❑ Yes ❑ No ❑ NA ® NE
❑ Yes [:]No ❑ NA 0 NE
❑ Yes ❑ No ❑ NA ,Ft NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 0 No
❑ NA
� NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ No
❑ NA
NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes ❑ No
❑ NA
NE
Comments {refer to gneshon #): Explain any YES answers and/or -any additional recommendations or.any otlier,comments�'
[Use drawinEs of facility,to_better._explain situations {use_additional!pages as>necessarv)..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
)� Phone:
�t Date:
21412014

Type of Visit: • Compliance Inspection U Operation Review (J Structure Evaluation Q Technical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other r 0 Denied Access
Date of Visit: $ Arrival Time: 0�', �OG�• Departure Time:[ County: , Gtu o+ Region: ; Z
Farm Name: 0W14C'h5 Owner Email:
�_! !
Owner Name: 146-t-Ae` L ht Phone:
Mailing Address:
Physical Address:
Facility Contact: "94 y &MV" Title: Phone:
Onsite Representative: Integra#or:
S
� qp
Certified Operator: Certification Number: I b d 75-3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Cnrrent
Design Current
Swine
Capacity P.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder
I INon-Layer
I
a' Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
o Z D
Dr Ron!
Layers
Non -Lavers
Ca aci
P.o
Non-Da'Iry
Beef Stocker
Beef Feeder
Farrow to Finish
Gilts
Boars
Pullets
Turkeys
Beef Brood Cow
Othc
1 1 Turkey Poults
Other
10ther
Discharges and Stream Imaacts
1. Is any discharge observed from any part of the operation? ❑ Yes N] No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes ❑ No io] NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ® NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No [ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [W No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 CondAmed

r'
Facility Number: 11 2 Date of Ins ection;
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ZZ''
❑ Yes
Structure 5
[5j No ❑ NA ❑ NE
❑ No �g NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
5p 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
E4 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
g] No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [P• 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 I ❑ Evidence ofj Wind Drift ❑ Application Outside of Approved Area
12.Crop Type(s):l�^^�ia
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Rectuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes [P No DNA ❑ NE
[:]Yes [�D No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes E] 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 21412014 Continued

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below. T
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Otber Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
❑ Yes ® No ❑ NA ❑ NE
[:]Yes [$a No ❑ NA ❑ NE
❑ Yes P§ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ® No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [P No ❑ NA ❑ NE
Commet>ts (refer to questionY#ExplaEnany YES answers and/or:anywa honalecomimientlations ar: anykottier comments.
iJse draw�ugs�ofafac�lrtyfltaabetter�explaiu,s�teiattons,(use gdditional.pagesasrnecessaryj,_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ?Ile 3:? ��
Date: r
21412014

ti •
Type of Visit: 40 Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: • Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: y t Arrival Time: a pa, Departure Time: i r'fl County: uj7 Region:
T Farm Name: q"�pzT�i•'i—s Owner Email:
Owner Name: �Ke�7i1 Phone:
Mailing Address:
Physical Address:
Facility Contact: 7QtfI19t 4+ ir— Title: Phone:
Onsite Representative: integrator: 6u-0, goG$�,
Certified Operator: Certification Number:
9 56�53
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Curr,enty
Design Current
Swine
Capacity`o
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
C•urrent�
D Cow
Xi Farrow to Feeder
Z$ ;2
D , P�oult ,
Ca aci
" J
. Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
'Turkeys
_
r=rth
Turke Poultsr
LjOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
[:]No
[�3 NA
❑ NE
❑ Yes
❑ No
[B NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No %� NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 1P No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes tL'MV No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

IFaciUty Number: P'( 2.. jDate of Inspection: 3 I /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure i Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
" No ❑ NA ❑ NE
❑ No NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ?it
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?
T
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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 Ao lication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes (4 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 1bs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidencell
Jlof Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C0g �5Y �a 57` ) , _;1 /�: � r La��
13. Soil Type(s):1
14. Do the receiving crops
from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
IS. is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
❑ Yes EP No
❑ Yes No
❑ Yes LP No
❑ NA ❑ NE
❑NA ❑NE
❑NA []NE
[]Yes
q No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[$a 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.
T
❑ 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
[P No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ep No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: / /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below. T
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ YesLpi
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes [�j No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes EB No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [�j No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [)9 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes EP No ❑ NA ❑ NE
Comments (refer to question #): Explain anyYES answers and/or any additional recommendations or any other comments ��
Use drawings of facility to better explain situations _(use additional pages as necessary), '
Reviewer/Inspector Name:
Reviewer/Inspector Signature:'
Page 3 of 3
Phone:
Date:
21412011

type of visit: p Uompliance Inspection U operation Review U Ntructure Evaluation U I ecnmcal Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
A A
Date of Visit: 1 Arrival Time: 0 ' Departure Time: !D Q County: k4wwo
Farm Name L44C Owner Email:
Owner Name: pk'"WUO Phone:
Mailing Address:
Region:
Physical Address: J
Facility Contact: Pa%11-01 It! • lµ," Title: Phone:
Onsite Reoresentadve: Integrator: 0M." �d-(
Certified Operator: r
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
.04 Design Current
Swine Capacity Pop.
Wet Poultry
Design
Capacity
-urrentz
Pop.
urrent
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
I INon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
&9Z 210
Dr. 1'oult ,
I I Layers
Non -Layers
Pullets
Turke Poults
10ther
Design
Ca aci
Current
P,o P.
Daia Heifer
Cow
Non -Dairy
113eef Stocker
Beef Feeder
Beef Brood Cow
Farrow to Finish
Gilts
Boars
Other
Other JEJ
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
[0 NA
❑ NE
❑ Yes [:]No
❑ Yes No
❑ Yes No
® NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

lFacility Number: ! r-1 - I I I jDate of Inspection: ?1S/k3
j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[] Yes
❑ No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Iq
Spillway?:
Designed Freeboard (in):
�t—
Observed Freeboard (in): �3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
IT
❑ 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?
❑ 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)
t
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acc table Crop Window ❑ Evidenc f WlindDrift ❑ Applicationn Outside of Approved Area
12. Crop Type(s):Q� G-1�iS QS�'�-Q� . �M ' � h4enel_
13. Soil Type(s):
14. Do the receiving crops diffe from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[7pNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design []Maps ❑ Lease Agreements ❑Other:
21 . Does record keeping need improvement? If yes, check the appropriate box below. []Yes [P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 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

f
Facility Number: jol - Iq jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EP No ❑ NA ❑ NE
the appropriate box(es) below. T
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26_ Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �q No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes r No ❑ NA ❑ NE
❑ Yes 171 No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes T No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes E;�No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes FjNo ❑ NA ❑ NE
Comments .(refer to question;: Explain any YES answers and/or any additional recommendations or any other cothments. ;
Use drawings of facility to better explain situations (Use additional: pipes as necessary). _
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Jn/V31231_33ev
Date:
21412011

i ype ui v isit. w i.ompuance inspecuon v vperauon xeview l.J structure r,vaivanon V i ecnmcai Fkssisiance
Reason for Visit: 40 Routine O Complaint Q Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: a y- Arrival Time: ! / Departure Time: / %OQ/:� County: A2UlLt4J&egion�''�
Farm Name: F "`` MS Owner Email:
��
Owner Name: W t` t4L �, R Gi", Phone:
Mailing Address:
Physical Address:
Facility Contact: �►%L t r �`'^r`T _Title:
Onsite Representative: I
U
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: p n G
tl
Certification Number: �D ` �`3
Certification Number:
Longitude:
Design Current
Design
Current
_ Design Current
R
Swine -
Capacity Pop.
Wet,Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish`
DairyHeifer
Farrow to Wean
T, -
Design
_
Current
Cow
Farrow to Feeder
D `�
V
D �Poul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
-
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes T No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes [—]No
NA ❑ NE
�p NA ❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No M 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 kM No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

F,acili Number: - Date of Ins ection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: i
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
90 No ❑ NA ❑ NE
❑ No W NA ❑ NE
Structure 6
❑ Yes K No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CM No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q§ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes N 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 Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �5t &_' (Pq j , S�" • cv- v
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation desilm or wettable
acres determination?
IT Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
[n No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
E�o1Vo
TR
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes i® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility number: -47 Date of Inspection: Z 27
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 15RNo
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes M No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ® No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [ZNo ❑ NA ❑ NE
Comments (refer to question f : Explain any YES answers and/or any additional recommendations. or any other'coznment's. i
UseArawings of facility to better explain situations (use: additional pages as necessary).
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes fg No ❑ NA ❑ NE
❑ Yes C�j No ❑ NA ❑ NE
❑ Yes [5§ No ❑ NA ❑ NE
❑ Yes fR No ❑ NA ❑ NE
Phone:
Date:
21412011

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I 1 Z I r j Arrival Time: Departure Time: Q 11 County: i-/fMeWD Region:
Farm Name: C i' Owner Email:
Owner Name:_J�4" t" +� Phone:
Mailing Address:
Physical Address: j ,'
Facility Contact: f by d rLty_ Title:
It
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No: ��f
Integrator: Q !-h
Operator Certification Number: 7 r ..!�3
Back-up Certification Number:
Location of Farm: Latitude: a e [= f = Longitude: E] o = ' = "
Swine
Design Current
Capacity Population
Wet Poultry
Design Curredt
Capacity Population
. C►attli
Design Cnrrent
Capacity Population
❑ Wean to Finish
❑Layer
❑Dai Cow
❑ Wean to Feeder
I I
I ❑ Non -Layer
r
"
tx���, K
"` "
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai ry
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
❑ Feeder to Finish
❑Farrow to Wean
Dry PouEtry
tA Farrow to Feeder
flZ 3
❑ La ers
❑ Farrow to Finish
❑ Gilts
❑Non -La ers
❑ Pullets
❑ Boars
El Turkeys
Other _ ❑ Turkey Pouets
❑ Other 10 Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
q9No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
1�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
'P No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: �—
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (%No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 51NA ❑ NE
Stru tore 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes "P 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 1PNo ❑ 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 El NA [I NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below_ ❑ Yes JR 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 El Evidence of Wind Drift ❑ Application OutsideofArea
l.
12. Crop type(s) 00-':f &Y-Mu do cea��2). �'` . "� OIIQ'V%_ Ot
13. Soil type(s) A`
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
F]No El NA [3 NE
P No ❑ NA ❑ NE
11
Qj No ❑ NA ❑ NE
[PNo El NA El NE
0 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 a' ges.as necessary):
Reviewer/Inspector Name - -�� Phone: 1 p. 3 ' 3500
Reviewer/Inspector Signature: Date: Z7
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection I
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 10No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes M3 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J9 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
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
§DNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
f59 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
W No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P 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
[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
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
El No
❑ NA
❑ NE
Addrhonal :Comments andlor Dra.`
_..
t
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ®Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: G] D Arrival Time: Departure Time: County: Region: _►,rt4V
Farm Name: _ 'FIT o sS _^ Owner Email:
Owner Name: ,_4y1jd[-7�t�te _ Phone:
Mailing Address:
Physical Address:
Facility Contact: V(d AU►-n +"t Title: Phone No:
Onsite Representative: Integrator:
It
Certified Operator: Operator Certification Number: Zo 4 ?S3
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: 0 0 = A Longitude: = ° =
Design Current
Design Current
Design Current
Swine Capacity PopulationfPoUItYM@9Dac!Wet
ty Population
Cattle Capacity Population
❑ Wean to Finish
❑ Dai Caw
❑ Wean to Feeder
&Laer
er
❑Dai Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
ultry❑
D Cow
Farrow to Feeder �[U❑
7ae
Non-DairyEl-Farrow
to Finish
ers
❑ Beef Stocker
Gilts
❑ Beef Feeder
P101 Boars
❑ Beef Brood Cowl I
❑ Turke s
Other
❑ Other I
❑ Turkey Poults
JE1 Other
Number of Structures:
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 *o ❑ NA ❑ NE
❑ Yes
❑ No
YNA
❑ NE
❑ Yes
❑ No
[!R NA
❑ NE
[�NA
❑ NE
❑ Yes
❑ No
❑ Yes
EpNo
❑ NA
❑ NE
❑ Yes [PNo
❑ NA ❑ NE
Page 1 of 3 12128104 Continued

J�
Facility Number: r]`Z — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EP+No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ 6NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30"
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? []Yes P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ElNE
(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 ED No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes q9 No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ip 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 / ❑rfd
idence of Wind Dri ❑ Application Outside of Are
12. Crop type(s) l yt4t tp( W 1,4r 7� t,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
&o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[PNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ep No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�No
❑ NA
❑ NE
""
Comments {refer to question'#) ,Explain any YES answers andJor any recamntendahans or any other comments.
Use drawings of facility to better ex lain situations. use additional a es as necessa : ,
Reviewer/Inspector Name -
W. Phone: 43 10—3-33CO
Reviewer/Inspector Signature:
Date: 0
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection r Required Records & Documents 7
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fait to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ wup ❑ Checklists ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ pNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
F'No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
['No
/P
[I NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[�No
El NA
El NE
Other Issues
rr
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
['No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
PNo
❑ 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
10 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Additional `Commen#s audlor Drawings is
Page 3 of 3 12128104

J
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: +a Arrival Time: ah- Departure Time: Io ' �a� County: P=_ q OtO Region:
Farm Name: !�f ��,: (� _ Owner Email:
tie Owner Name: , ,yj rlt�-�V--l- Pr eE4-4- _ Phone:
Mailing Address:
Physical Address:
Facility contact: t/ I M M Title: Phone No:
Onsite Representative: Integrator: �
Certified Operator: Operator Certification Number: f �b73
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E__1 o = ' = u Longitude: = ° 0 1 = W
MR -
Design. Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Wet Poultry
La er
E Non -Layer
- .
Design Current
apacity Population
C1
Design Current
Cattle Capacity Population
❑Dai Cow
❑ Dai Calf
❑ Feeder to Finish
-.., ...,
❑ Dai Heifer
Farrow to Wean A
Dry Poultry
'�
❑ D Cow
❑ Farrow to Feeder
''` '`
Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
on -La ers
❑ Beef Feeder
PEJ Boars
❑ Pullets
❑ Beef Brood Co
..
❑ Turkeys
her
Other I==
❑ Turkey Poults.
❑ Other
I
umber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2?No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
P NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
V1 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
PNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
E�No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

1
f Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes F No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [p NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: !
Spillway?:
Designed Freeboard (in):
f
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
PNo
ElNA ElNE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
�4 No
❑ NA [:1 NE
S. Do any of the stuctures lack adequate markers as required by the permit? [] Yes
'6(] No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
!I
9. Does any part of the waste management system other than the waste structures require ❑ Yes
S ,No
❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes
nNo
❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
N No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
j
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JR No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�LNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
S No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
5bNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
US No
❑ NA
❑ NE
Reviewer/Inspector Name c I Phone: TON33113m
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
- 4C
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 19 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 0 Checklists ❑ Design ❑ Maps ❑ Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes N No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ep No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
59 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
tNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[�INo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
;4No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
WNo
❑ 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
[4 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
E,:gNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�§No
❑ NA
❑ NE
. ,.
Additional Comments andlor Drawtn s =:y�'"
,- ni+a .. � T-_F�. r... �,�� :. .-.� F�fL.3/ �fl
Page 3 of 3 12128104
Page 3 of 3 12128104

Facility Number
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up Q Referral ()Emergency 0 Other ❑ Denied Access
0 -
Date of Visit: Q Arrival Time: 01, 0Q,h, Departure Time: 0 gfi, County: W44 A"Ad Region:
Farm Name: n Owner Email:
Owner Name: KeA1'1R. 926he Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: V Vf1''1
t�
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:
Phone No:
Integrator: L
Operator Certification Number:
Back-up Certification Number:
Latitude: [—] n F—] ' E:] u Longitude: [_—] ° [—] ' ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
[f �. ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Nan -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Curren#
Cattle Capacity Population'=
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: �4
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 ERNo ❑ NA ❑ NE
❑ Yes
❑ No
[0 NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
L?NA
❑ NE
❑ Yes
❑ No
❑ Yes
MNo
❑ NA
ElNE
❑ Yes
MNo
El NA
❑ NE
12128104 Continued

1 L
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
PNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes
❑ No
A NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
It
Observed Freeboard (in): 10
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? Yes
❑ No
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
(p 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
P No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
EP No
❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[)] No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or l O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drifl ❑ Application Outside of A rea
/
G✓,
` G2; (_ je
12. Crop type(s) rt
13. Soil type(s) A
r
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
qa No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
09 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
1�3 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
iV No
❑ NA
❑ NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes
N No
❑ NA
❑ NE
IComments (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 { Phone:L°%id_�4fll��f Q
Reviewer/Inspector Signature. Date: QL30
1L/LO/VY l.V!/it/.WG�[

Facility Number: r — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J�] No ❑ NA ❑ NE
the appropirate box. ❑ W UP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (p No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
DjNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
05 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
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Q§ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
MNo
❑ NA
❑ NE
Other )issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[R No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
91 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
E] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E.No
❑ NA
❑ NE
nal Comments and/or Drawings:
12128104

� Divisioa of Water Quality
:Fa Division of Soii and Water Conservation
Other Agency
Type of Visit 41 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other [I Denied Access
Date of Visit: Arrival Time: �QQ Departure Time: 1 County: ��+�''r�n� Region: ICiqo
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
w n I,
1 a.( Sca"* Lh ., n'l t..�_L dL,),K
Phone:
Facility Contact: b l iy %L[ lYl f'rl __ Title: Phone No:
It �
Onsite Representative: Integrator: ..&15 ~ e'r-4 -1 ` rR
1I �1
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = 4 = 6f Longitude: = o = 1 = u
111
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry . Cpaeity Population
Cattle Capacity Populafion
❑ Wean to Finish
❑ La er
❑ Da' Cow
❑ Wean to Feeder
❑Non -La er
❑ Dai Calf
❑ Feeder to Finish
❑Dai Heifer
Dry Poultry ---
El Dr Cow
Farrow to Feeder
❑ La ers
ElNon-Dairy
❑ Non -La ers
ElBeef Stocker
El
El Feeder
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ TurkeyPoults
❑ Other
Str
Number of uctures:
Farrow to Wean
a
El Farrow to Finish
❑ Gilts
❑ Boars
Discharees &Stream Impacts
1.
Is any discharge observed from any part of the operation?
El Yes
Q9 No
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field ❑Other
a. Was the conveyance man-made'?
El Yes
❑ No
ERNA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
El Yes
❑ No
E9 NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑Yes
❑ No
$ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
Wo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
Wo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
11/28/04
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment ,
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V1 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 1P
NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): o2
IZAM
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No qMA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
CP No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes
q9 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
[T 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?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:1 Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
"AL lWW:.r'� fm
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
14 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
EP No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(p No
❑ NA
❑ NE
:Comments (refer to question #): Explatq=any YES answers and/or any recommendatiohs otany other comments",
;.Use:drawings`flf facility to better explam�situations"(use additional pages as necessary
IV
I ed' RP-Ci s
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Pa-ee 2 of 3 12 8/04 Continued

f
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes_)9No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n [3 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
;& No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
U,No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1PNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�5 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,Q No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
09 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
[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
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
YM No
ElNA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
4No
❑ NA
❑ NE
Additional€ Coinments',and/or Drawings:' -
Page 3 of 3 11/28/04

Type of Visit SGo�outaine
a Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time. � County: (� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 1 J kLA^ YTS Title:
Onsite Representative: rJOV, Cj e lm
Certified Operator: V tU �V\ vy\
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator: T _A -
Operator Certification Number: v
Back-up Certification Number:
Location of Farm: Latitude: [—] o ❑ ' ❑ Longitude: = o ❑ ' [—] W
Swine
Design Current Design Current
Capacity Population.. , Vet Poultry Capacity Population
Design Current
C•aitle Capacity Population
❑ Wean to Finish 1
10 Layer
❑ Dairy Cow
❑ Wean to Feeder I
I JEJ Non -Layer
I
❑ Dairy Calf
❑ Feeder to Finish
"
` `
DryP,oultry
- ""' "'
❑4Layers
ElNon-Layers
El El
❑ Turkeys
❑ Turkey Poults
other
- - -.,ID
❑ Dairy Heifer
❑ D Cow
ElNon-Dairy
❑ Beef Stocker
El Beef Feeder
El Beef Brood Co
Number of Structures:
arrow to Wean
Qua
El Farrow to Feeder
El Farrow to Finish
Gilts
PBoarsa;
r
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
kNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
KNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
J�INA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
XNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
XNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility �Number-.72— a Date of Inspection
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
❑ Yes '5(No ❑ NA ❑ NE
❑ Yes ❑ No [KNA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): CJ
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No
El NA
El 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
5,No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yes
RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes AINo ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) 14'
(--t f
14. Do the receiving crops deer from those designated in the CAWMP?
❑ Yes
�<No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
WNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
'0No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes '%(No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comm ents.�9
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
Reviewer/Inspector Name 4 J /U _---� i phone:
Reviewer/Inspector Signature: Date: A::4.�2&QL
Page 2 of 3 W8/(�_) Continued

Facility Number: —Q 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 2( No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑ Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
[]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
[INE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
TNO
�TA
��??A
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El
El NoTNA
[INE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
❑ No
❑ NE
26_ Did the facility fail to have an actively certified operator in charge?
❑ Yes
'ro❑,DNA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
❑ No ji�NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
°No
(EMo
[I NA
❑ N E
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
❑ 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
)�PNo
❑ NA
[INE
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
PNo
❑ NA
[INE
General Permit? (ie/ discharge, freeboard problems, over application)
/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
)_4
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
fi
No
❑ NA
❑ NE
Y�# ..•�.v..a.�4s. 1�^iKT�4s :'.•�srf��:�:� i Y. .. •. .: v...,:0+,¢�.aF!F�3!�1k,�1=+C �.ildd�i'35_: •��`i .Y".S
_.�:� SL?'.. �'$'�`L
Df5c_wsscl 5 a' c SLwl,, a� cd rne4 f C32J�c
9X3 o7o 6.
Als �� can d v`e-+' ►-nl�r �i -�ar r,
:f
4hz /9% fq awlachal1�?-
EX ce- lluz� vrc a -Ws cam✓ hlla�erw�f
12128104

• � r
Facility Number `� _ Date Time iNiAl
Out
Owner
- _
Farm Name .
O.I.0 Dau', No.
C.O.C. V eneral NP
Des Current Design Current
Wean to Finish Wean to Feeder
Feeder to Finish F w to e . a30Z
Farrow to Feeder F mish
Gilts Boars
Oth
Soil types
Crop Types Pan r Window
Soil Test Plat (V r
Designed Freeboard
Observed Freeboard
Rain gauge "in breaker Daily Rainfall Waste Transfers
Calibration of spray equipment G.P.M.
Sludge Survey tii Crop Yield 120 Minute inspections
1 in. Rain inspections '---Weather code Weekly Freeboard
Pumping time J b Y J
Waste Analysis % & Month
Comments

Type of Visit ® Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit *Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facilih. Number Date (ifViMt: Time:
- , , ..-,.-.. � Not O erational Belr►tis• Threshold
® Permitted 13 Certified © Conditionally Certified ©Registered Date Last Operated or Above Threshold:
+
Farm Name: —_ vtii c c r,N. County: i2 i e,i-..r. c.� 'rL,a.,.,_
Owner Name: — _fie v` n e.4 t Phone No:
Mailing Address: __.M N + G y '14 Sa'L3
Facility Contact-. __JrA a r_ le� V n-r. C e. +%v`,Q k_ Title:
Phone No:
Onsite Representative: M e r 1 e. U a v% Cz4 , , v. s Integrator: C a E (
Certified Operator: ^ C a l n o ,n. __ Operator Certification Number: e+
Location of Farm:
Iff Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 4 0 G Longitude 0' �+ 0
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca acitr Population
❑ Wean to Feeder JEJ Laver I I ❑ Dairy
❑ Feeder to Finish 10 Non -Laver I 1 10 Non-Dairn
® Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons © ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray field Area
Holding Ponds / Solid Traps r.� ❑ No Liquid Waste Management System
Discharges S Stream Impacts
I _ Is anv discharge observed from any part of the operation?
Discharee 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 ealimin?
d_ Does discharge bypass a lagoon system? (If ves, notify DWQ)
?. 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 t Structure 2 Strucrure 3 Structure 4 Structure
Identifier_
Freeboard (inches): '0'012)
05103101
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes @ No
❑ Yes [A No
❑ Yes ® No
Structure 6
Continued

Facility Number:
Date of Inspection--f--�-t¢-�
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 4fi 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 wo
❑ Yes EV No
❑ Yes P No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [P No
1 L is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [RNo
12. Crop type B C. r-^,% L& A f a-- S, , Grrr_i. :2' _ (fit -Sr
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 1�3 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? Cl Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes �;No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[EtNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
150.
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
EONo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Wo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
V] No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
Q No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
UkNo
24,
Does facility require a follow-up visit by same agency?
❑ Yes
Vj3No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
C9 No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): E� plain any YES answers and/or any recommendations or any other aomments.
Use drawings oetter Yplain situations. {qse additianal pages as necessary):
❑ Field Copy El Final Notes
Reviewer/Inspector Name!/
Reviewer/Inspector Signature: ' C r►&z/ Date: 3 3 b
051193101 Continued

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes M No
❑ Yes V] No
❑ Yes 0 No
❑ Yes ❑ No
05103101

C
(Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: to fl - Time:O�
Facility Number
Not O erationsl Selovc• Threshold
® Permitted ® Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: �G ,rt 4-r- -� c-r County
Owner Name: _ _�� t' n[n2• Db: n e_� Phone No: of -
Nlaili ng Address: _ P • C� . �e-r .,.-e i L C - - JCS C4,S4-&-V% lk 1 C.:l�3 l i
Facility Contact: "G � V&yl C;i. ne_m Title: W� M rd= JL&P Phone No:
Onsite Representative: McrInte-grator* G_t.C4 r 11
Certified Operator: P_ ri e _ l��n C c.� r.en Operator Certification Number:
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 09 0" Longitude 0'
Design Current
Design Current Design Current`
Swine Capacity Population
Poultry
Capacity Po ulation Cattle Ca acitV P01DUlatiOn
❑
Wean to Feeder
I
JE1 Laver
I
1
10 Dairy
❑
Feeder to Finish j
10 Non -Laver
I
I
ILI Non -Dairy
®
Farrow to Wean
❑
Farrow to Feeder
❑Other
❑
Farrow to Finish
Total Design Capacity
❑
Gilts
❑
Boars
Total SSLW
Number of Lagoons I I
Holding Ponds / Solid Traps
Subsurface Drains Present
No Lrqu
Discharges & Stream Impacts
1. Is an,., discharge observed from any part of the operation?
Discharee ori-*inaied 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 gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
Area iLJ Spray Field Area 1
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection 8• Treatment
4. Is storage capacity (freeboard plus stoma storage) less than adequate? ❑ Spillway
Structure I Structure ? Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 3?
05103101
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes I& No
❑ Yes �iNo
Structure 6
Continued

a
Facility Number: IL — I q Date of Inspection �
5. Are there any immediate threats to the integrity of any of the structures observed? Oe/ trees, severe erosion, ❑ Yes 4 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes [�No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes QR No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes (2 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes QNo
12. Crop type & -n'LXC . 4- C- .-&Z , ©. S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
KNo
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
5� No
16. Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
RNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Platt readily available?
(ie/ ", checklists, design, maps, etc.)
❑ Yes
INNo
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[ENO
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
allo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[ANo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes RNo
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes [5Z No
24. Does facility require a follow-up visit by same agency? ❑ Yes �R No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes E�No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
Comments?(refer to gtuestlon #�: Explain any YES n�swe s and/arany recommendaiions or any other comments.
Use drawurgsaaf+fac�ty to better ezglam stt iaaons, (use�addrhonal pages as necessary) ❑ Field Copy ❑ Final Notes
F-'G ,,, ) e-p_ Co
Reviewertinspector Name
Reviewer/Inspector Signature:
& 16-5.a-�
Date:
05103101 Continued

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

1 46
Type of Visit ® Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Hate of visit: [
Facility Number
S Permitted ® Certified Q Conditionally Certified O Registered
Farm Name: o 1
Owner Name:
Time Z . G
Date Last Operated or Above Threshold:
County
Phone No: _rigly) -'-<oz
Facility Contact: AI&d Bge-& Iefd•vPhone No:
Onsite Representative: t / .,trlJ N .✓O� Integrator: i
Certified Operator: �iD .i. �.� / ^ L/0�"��o'`� Operator Certification Number:
Location of Farm:
[:]Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �" Longitude L�0
--Des_ ign
Swtne.w - Ca ticit
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean !
Farrow to Feeder
❑ Farrow to Finish
- j ❑Boars
Neimbtr of tagoons
Holding Pogds7 Solid Traps:'
Current --: Design, Current -Destgrt _Cal
D _ :.. :..
uhttwn Poulin_ -- Ca achy.°Po elation Cattle Ca scity' 'Po u
N' ❑ er ❑ Da La
❑ Other
otall es
igt Capacity
- _' Tota1:SSLW =
nt Loon Area Spray Field Area eSubsurface Drains rese __ _ _
W=
❑ No Liquid Waste Management Svstem
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 ves. notify DWQ)
c. if discharge is observed. what is the estimated flow in galimin?
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 R Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
:3P,
05103101
❑ Yes )VNo
❑ Yes XNo
❑ Yes JD'No
❑ Yes RNo
❑ Yes 9No
El�`_ Yes (( No
❑ Yes'J0
Structure 6
Continued

f
Facility Number: 77 —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered ves, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ Wj�p che�qists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis sot/ ample reports
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design.
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified ANVMP?
❑ Yes VNo
❑ Yes P[No
r
es ❑ No
❑ Yes R No
❑ Yes 19 No
❑ Yes XNo
❑ Yes Nio
❑ Yes ANo
❑ Yes f g] No
El Yes / No
El Yes o
❑ Yes SCNo
❑ Yes �kNo
❑ Yes *No
❑ Yes KNo
XYes ❑ No
❑ Yes 10 No
❑ Yes XfNo
❑ Yes%9No
ElYes KNo
❑ Yes _
❑ Yes 5a No
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Commeats (refer toguesaon #) _l >iers'and/or.-any recouttnmdattous;or anv,other commenis.
Use drawzags of facity to better:txpiaut sitnattoas: (ase addtttonal:pages as necessary) Y, ❑Field Cotes ElFinal Notes t
CY
Reviewer/Inspector Name = _
Reviewer/Inspector Signature: Date:
05103101 Continued
'00/

Facility Number: 77 — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below Yes ElNo
liquid level of lagoon or storage pond with no agitation? ea
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 F No
roads. building structure.. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 1�gNo
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 FNo
L
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes W,No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
05103101

s
State of North Carolina
Department of Environment
and Natural Resources
Fayetteville Regional Office
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Division of Soil & Water Conservation
August 30, 2001
Mr. Kenneth R. Robinette
PO Drawer 160
Marston, North Carolina 28363
SUBJECT: Notice for Corrective Action
Cognac Farms, facility number 77-19
Richmond County
Dear Mr. Robinette,
1 • •
_��
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
On August 29, 2001, an operation review was conducted of Cognac Farm, facility number 77-
19, in Richmond County. This review, undertaken in accordance with G.S. 143-215.10D, was
one of two routine site visits scheduled for all subject animal operations in 2001. Staff from the
Division of Water Quality will conduct a separate compliance inspection.
During the operation review, the following items were noted for corrective action:
• Fields #4,5,7, and 9 according to the IRR-2 forms exceeded the 1 inch maximum
hydraulic loading rate as listed in the waste plan. Field #4 had as much as 1.26 inches
per acre. Field #5 had as much as 1.30 inches per acre. Field #7 had as much as 1.59
inches per acre. Field #8 had as much as 2.75 inches per acre. Field #9 had as much as
1.85 inches per acre. Make sure not to exceed 1 inch per acre at a maximum.
• Make sure to reduce the nitrogen rate for fields #7 and #8 to 187 lbs. per acre from 250
lbs. per acre. Field #2 should use 6.32 acres on the Irr-2 forms and not 7.02 acres.
A copy of the operation review report is enclosed for your information. Site findings and
recommended corrective actions as discussed are noted in the comment sections.
Please remember that in order for your facility to remain in compliance with environmental
regulations, animal waste cannot be discharged into the waters of the State, and the animal
waste collection, treatment, storage and disposal systems must be properly maintained and
operated under the responsible charge of a certified operator.
225 Green Street, Fayetteville, North Carolina 28301-5043 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer

Mr. Kenneth Robinette
August 30, 2001
Page 2
On behalf of the Division of Soil and Water Conservation, I appreciate your cooperation with
these operation reviews. Please do not hesitate to contact me at 910-486-1541 if you have any
questions, concerns or need additional information.
Sincerely,
Trent Allen
Environmental Engineer
cc: Paul Rawls, Division of Water Quality
Sonya Avant, Division of Water Quality
Vilma Colombani, Richmond Soil & Water Conservation District
Billy Johnson, Cargill Inc.
Carroll Pierce, Division of Soil & Water Conservation
225 Green Street, Fayetteville, North Carolina 28301-5043 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer

Dtvtsiion of Water iealit �
Division of Soil and Water Conservation. .
Q Other Agency
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 77 19 Date of Visit: 8-Z9-2001 'Firne: 11:00 Printed on: 8/30/2001
O Not Operational Q Below Threshold
® Permitted ® Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold:. ....................
Farm Name: Gegnac.l?armts............................................................. County: Ridmond ........................................ FRO ............
Owner _lame: Kejmeth.R ............................ Robi l.tic................................................... Phone No: 91Q-S.SZ-6611Z.........................
Nlailing Address:(?.L?x01Y!~x..16R.......................... . Mar5xQtl..1Y ........_......_...__....... 20.3.0.3 ..............
. .......................
Facility Contact: KetAA.nth.Robinetic...................................... Title: ................ ................................................ Phone No: ...................................................
Onsite Representative: � u�l)..Y..Qt1��tttttum.-.9�l1-9 S-�� 9................................. Integrator: Cargill ..................
Certified Operator:Samuel................................... Y.ttmcOxll0.QXI..................................... Operator Certification Number: 1,9979..............
Location of Farm:
)n the west side of SR 1605 approx. 1.5 miles southwest of intersection with US HWY #1 northeast of +
tockingham, NC.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �� Longitude
Design Current
Swine Canacity Ponulation
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
2178
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 2,178
Total SSLW 943,074
Number of Lagoons ID Subsurface Drains Present I❑ Lagoon Area ❑ Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed; what is the estimated flow in gat/min?.
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
1 Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Stricture 5
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
nla
❑ Yes ® No
❑ Yes IN No
❑ Yes ® No
❑ Yes ® No
Structure 6
Identifier: ................................... .....
Freeboard (inches): 37
05103101
Continued

Facility Number: 77-19
Date of Inspection 8_-_29_-_20_0 IF Printed on: 8/30/2001
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 maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ® Hydraulic Overload
12. Crop type Coastal Bermuda (Hay) Coastal Bermuda (Graze) Small Grain Overseed
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
® Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have'Certificate of Coverage & General Permit or'other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WZ]P, 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?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
0 No violations or deficiencies were noted during this visit: You will receive no further correspondence about this visit.
Comments (refer to question ff): 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): 0 Field Copy0 Final Notes
. _ .
I I- Fields #4,5,7, and 9 had hydraulic overload. Field #4 has as much as 1.26 inches per acre in one pumping event. Field #5 had 1.30
inches per acre. Field #7 had 1.59 inches per acre. Field #8 had 2.75 inches per acre. Field #9 had 1.85 inches per acre. The traveling gun
needs to be speeded up through these pulls. Do not exceed 1 inch per acre.
The bermuda rate for fields #7 and #8 is 187 lbs. per acre of nitrogen and not 250 lbs. per acre. Change the Irr-2 forms.
Field #2 should be 6.32 acres and not 7.02 acres.
Add the lime called for in the soil sample result sheet. Fields need greater than 1 ton of lime.
ReFdewer/Inspector Name Trent Allen
Reviewer/Inspector Signature: Date:
05103101 _ Continued

racility Number: 77-19 1 Date of inspection. 5-29-Z001
Printed on: 8/30/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28_ Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
J
05103101

IFacility Number D_EZ5= I Date of. Visit:
XPermitted 0 Certified 0 Conditionally Certified [3 Registered
Farm Name: .... ...............................
Owner Name: ....... Jew4e�i ....... ............. L-Lav-'7,� �,e ..................
FacilityContact: ............... I .............. ......... I ...................................... Title: ........................
4 bn-'� ..,/
Mailing Address: A ......... ......................... ...... .........................................
Onsite Representative:
5;� .......... 1'. ...................
Certified Operator:.... . ....... ..........
Location' of Farm:
Time: LJ
rO Not Operational 0 Below ThresholdI
Date Last Operated Above Thresh Idld: .........................
County: ....... . .....
Z.. .. ................ .......................
Phone No: ........
......................... Phone No:...........-
rQ
A/
... ...........C............ . ...... ...... . ............. . . .
Integrator: ...............
Operator CertificationZber: ....... * .....................................
[I Swine El Poultry [] Cattle [] Horse Latitude 0 4 64 Longitude 0 4 64
-Design Cuirifit Design , Curi*nt
'��ttle
on Cajj�clty;l
Swine Capacity Population Poultry Capacity.. on;,.-,
❑ 0ry Wean to Feeder 0 Layer ❑Dai
❑ Feeder to Finish E] Non -Layer ❑ Non -Dairy
Warrow to Wean 2171'
0 —
Farrow to Feeder [0 Other
❑Farrow to Finish TotalDesign.C6jwity'
❑ Gilts
D Boars
Number of Lagoons-oons. - Subsurface Drains Present 10 Lagoon Area I0 Spray Field Area
Holding Ponds Solid Traps [[—]No Liquid Waste Management System Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? 0 Ye
�j S�ro
Discharge originated at: [I Lagoon [I Spray Field [] Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Z
b.o
If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes
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? El Spillway
Structure I Structure 2 Structure 3 Structure 4
Structure 5
0 Yes No
[] Yes No
0 Yes 0
C] Yes 0
Structure
Identifier:
Freeboard (.inches)-
5100
............
5
Continued an hank

f
Facility Number:77 - Date of Inspection - -O/ Printed on.• 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
& 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 maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
. elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type eQr
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?
lb. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
L7; � •yiQlatiQn�s ;off def c�epcies were �Qt;e�• dig #his;vis�t; • Y;o>j� wiii-
corresDoride"' abaniti this :visit: ::...::. . . . . . . . . . . . . . . . . • . • . • ..... • . • .. - : - ::..:... .
iestion Ii)
Lswers
❑ Yes PNo
❑ Yes PNo
❑ Yes �No
❑ Yes No
❑ Yes 1
❑ Yes o
❑ Yes to
❑ Yes o
❑ Yes 90
❑ Yes No
❑ Yes &NO
❑ Yes o
❑ Yes o
❑ Yes KNO
❑ Yes P(No
❑ Yes A No
❑ Yes JB Vo
❑ Yes M-No
[]Yes r- No
❑ Yes igNo
❑ Yes f ZNo
❑ Yes ANNO ,
Reviewer/inspector Name 114 M& ` 7'
Reviewer/Inspector Signature: ,
Date: 5-4--0/ - 5100

Facility Number: `] — Date of Inspection Z—d Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes )kNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes] No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or ' \
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes WO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes )'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Addillonal:Conments an or Drimings- W,TY_
5100

r} 4
�. Division of Soil and=Water
[3Coaservahoni :Operation Review — ;
—L = —.
�� 13 Division of Sort aad.:Water Coaservation :Compliance inspection
®:Divrsjop of Water QualatyComplyan�c�e Inspection � � .� �� y� � =
:Other Agency Operation Review
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 77 J Date of Inspection JZ
I'irne of Inspection , a 124 hr. (hh:mm)
® Permitted © Certified [3 Conditionally Certified 13 Registered 113 Not O erational Date Last Operated:
Farm Name �.4.'`',b �- .. 11 �'^ County: Xi .� ............................
................ -.-. -.....................,................. .......- .... .- .-.. ,P..N-
Owncr Name:-..-..�C.. !'k' ..R �1✓Ff1.......................I..........--.....--... Phone No: .... G..I./ � .e ...............
' l
Facility Contact: ........ 0-10. Pie r��--..-( C�J f '�%Title:................................................................ Phone No:.......--------....................................
Mailing Address: ......-/...5.-..Qr.......��'',G//.//oi�!.. f-.fa''....1I�...G......s........................:..................:....... ..........................
Onsste Representative: '`°!� f .....-... t�0..!'i.. ,✓sv.•/...... Integrator:..... r¢ �4..............................................
........... ..... ..................... 1.
Certified Operator:••--•••,•, r u;. -- .. ......••••• Operator Certification Number
Location of Farm:
..................................................................................................................._..........................................................---------........................--......................-:................................. w
Latitude �� �` ��� Longitude �• �� ��`
Design
Current:' .-. Design Current Design Current
Swine _ = Capacity
:-- _
Population Poultry ... Ca' "actin Po ulatiost -„ Cattle ._ -capacity Population
❑ Wean to Feeder
.r..
❑ Layer ❑Dairy
El Feeder to Finish
❑ Non -Layer ❑Non -Dairy =-
Farrow to Wean /7
%7 _ -
❑ Farrow to Feeder
❑ Other
:-
;; ❑ Farrow to Finish
= Ttita Design Ca acit Y Y.
P
❑ Gilts,
.W - - -.__:
❑ Boars
:. Total-SSLW
=Number of Lagoonsm, :
❑ Subsurface Drains Present ID Lagoon Area ❑Spray Field Area
-
Holding;Pouds / Solid Traps
--
❑ No Liquid Waste Management System
Discharges & Stream Impacts
L 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 XNo
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 `�N0
2. Is there evidence of past discharge from any part of the operation? ❑ Yes '`No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Flo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway []Yes RNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure a Structure 6
Identifier:
. d /r
Freeboard(inches):......................................................................................................................................
5- Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes (PNO
seepage, etc.)
3123/99 Continued on back

A
(Facility Number: 77 —/, Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes Wf No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? *es ❑ No
8. Does any part of the waste management system other than waste structures require maintenatce/improvement?es zb\-No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes JqNo
Waste APPlication
10. Are there any buffers that need maintenance/improvement? ❑ Ye No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes W5 No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes A No
c) This facility is pended for a wettable acre determination? ❑ Yes 'UNo
15. Does the receiving crop need improvement? ❑ Yes VNo
16. Is there a lack of adequate waste application equipment? ❑ Yes Eg.No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes XNo
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 gNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis soil sample reports jqYes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ANo
21 _ Did the facility fail to have a actively certified operator in charge? ❑ Yes 1XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) fi `i*Yes XNo
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative? Y ❑ Yes P No
24. Does facility require a follow-up visit by same agency? ❑ Yes I"No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes )0 No
�. �. . viol..i os:ot-deficiencies N,- noted• during fhis:visit. • Yoir will -receive �i6 fut-th¢r
' rorres�&ideiice about. th" visit:.. .
Reviewer/Inspector Name
Reviewer/Inspector Signature: ������ Date:
3/23/99

Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
[3 Permitted © Certified Q Conditional] Certified © Registered 113 Not Operational Date Last Operated:
Q / �!..Y� ...... Farm Name: .C!i9...1. G a f'!Y�- County:.........../[..e.G...? ........................
Owner Name:_.......eYl.l1.l...i�..........!/L.!9L'........ ....... Phone No :.............. .....O,Z..D Z
FacilityContact: C� �r .............................. Title :........ ................... ..._..._........... Phone No: .................. .................................
]]ailing :address:
Onsite Representative: �Gi irQ J f............
Integrator:.............. JJ
........ .......... .
Certified Operator: ................................................... . Operator Certification Number:
Location of Farm:
.y
Latitude �� �` �" Longitude
Design Corrent 'Design Current Design E 'Current
.Swine.
=
,_Ca �aclty_.Po ulatio' :-Pdultry. Capacity: Pa ulation Cattle Ca aci ?;"Po ulation
❑ Wean to Feeder ❑Layer ❑Dairy
❑ Feeder to Finish ❑ Non -Layer JEI Non -Dairy
Farrow to Wean Z J y. ' . r 5 , <
❑ Farrow to Feeder ❑ Other _ r ,:..
❑ Farrow to Finish acrE n Total Deli Ca t ❑ Gilts = g. P . .YY._µ
❑ Boars - ~Total SSLW =
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made" ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the Stale'! (II'yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Doss discharge bypass a lagoon system? If yes, notify DW ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [:]Yes [-)No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �No
Structure I Structure ? Structure 3 Structure; 4 Structure; 5 Strue;turc b
Icicntii ie:r: 1l
Freeboard (inches): .........
....... L.................
5. Are there any imm i to threa to t e irate .ity of any of the structures observed? Oe/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on buck

Facility Number Date of Inspection 5
Time of Inspection 24 hr. (hh:mm)
© Permitted j Certified E] Conditionally Certified Q Registered JE3 Not Operational Date Last Operated
TIn.?r..-�.Q. l f�
Farm Name: ............la 1L�....6................................................ County ........1.}.ICI!m....-.............�-�.'un ...............
pay
Owner Name:.....--. �ct7!lln..!lL........... A. .......... r It .L.ri�: 'G ....... Phone No: *- ._ .........................
Facility Contact: .... , jfA4*j4...-. ... 'eltiter Title: Phone No: .............. ..
-j j �...... ,,I
Mailing Address:.............. It....xCA.T&A..4n'�........................................... .......'.....!q�, ? 1�..1!�.. ............... 343
. ...[.. Integrator: �
....................................Onsite Representative: l
Certified Operator: ......... `s�>!'!ti%.[.....r....... ..a?r?CLQ? ..................... Operator Certification Number:..........................................
Location of Farm:
Latitude a ` i Longitude • f «
- Design
Swine Capacity
❑ Wean to Feeder
r
to Weanto Feeder
❑ Farrow to Finish
[]Gilts
❑ Boars
Number of Lagoons
Holding Ponds / solydtraps
_.. A -
Current'. = ..-_: -. Deiign,
- :Current
o ulatton Po�eltiy *_Capacity_ Po elation Cattle
::
❑ Layer
❑ Dairy
❑ Non -Layer I
I-°
❑ Non-Dair:
❑ Other
r _=
Total Design Capacity
`Y
-.... _
-Tot#1.SSLW
...-..
Design -Current
�J F
❑ Subsurface Drains Present I0Lagoon Area ID Spray Field Area
�' ❑ No Liquid Waste Management System'
C3
DischaEges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes j No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other },
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed. what is the estimated flow in gal/min'?
d- Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: gg it
Freeboard (inches) . ............ f!�.{......... ...... ........................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc-) K
3123199 Continued on back

1~'acility Number: Dale of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintcnaricelimprovement? ❑ Yes [gNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes Pq No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes IVNo
11. Is there evidence ofzu
on? ❑ Excessive Pondi g ❑ PAN El Yes IX No
12. Crop typeAe
13. Do the receiving crops differ with those designated in the Certified 7aCnimal Waste Management Plan (CAWMP)? Yes ❑ No
14. a) Does the facility lack adequate acreage for land application?- fJ �Y10 iM ❑ Yes No
b) Does the facility need a wettable acre determination? / ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? I`� Yes ❑ No
15. Does the receiving crop need improvement? s .' KYes ❑ No
16. Is there a lack of adequate waste application equipment? 04VIt
o
Required Records & Documents a `_
v
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? 104 ^ A6 J 441.n
22. Fail to notify regional DWQ of emergency situations as required by General Permi Q
(ie/ discharge, freeboard problems, over application)-
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative�6'5
24. Does facility require a follow-up visit by same agency? VM
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�: o yiolaikms or defcieucies -were h0 ed- dtWing-his:visit. Yo4 will -tee Hye oc fuirthgr
corresponde�rce abhut. this :visit. .
❑ Yes VNo
❑ Yes X No
❑ Yes 9No
((Yes ❑ No
❑ Yes No
❑ Yes { No
❑ Yes K No
❑ Yes RfNo
❑ Yes �INo
❑ Yes [�i No
'� art.. t� S� �. on � a� ��m � c� S� -•-,
A -
'�f� tell 4�ei•v. /�
13 Oro
f.A
Reviewer/Inspector Name [ n -
Reviewer/Inspector Signature: y Date:
3/23/99

Division of Soil and Water Conservation [] Other Agency
Division of Water Quality
J%Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other J
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
E3 Registered Certified [3 Applied for Permit *ermitted [3 Not O erational Date Last Operated: ..........................
Farm Name: .............. 1!11a.�......[..a.Y'l.S.---..... County: ..... L.C—I�. 4Yt.........
Owner Name:...49-kl.r'.1.. ..le......�o�lc!!l.e .9.... ......... Phone No: ................... .................. .............................................
Facility Contact: b w ►'� .. (" .. Title: ... Phone No:
1z� So
MailingAddress: ....................................---�-•-------L•---'- ••-�•�'•� ... .............. .2!�3G
jj� '.grator:......... /•�• T ..p
...................... ..............VInteOnsiteRepresentative:.. a �......
Certified Operator;..LLc6perator Certification Number:................. .....V..........
................c-'------ -....
Location of Farm:
c
.... .. ..... .. .... Mc
Latitude =* =, " Longitude =0 0' 0"
M; Current:.
Design Current `' '
Current
a , �y; ,Design, .
�.r. Capacity Populaton
ti Poultry
a ,
Capacity Population Cattle �'
„Desrgn, T;
Capacity Population
wSwme ,.
.'
W,.
>.
Wean to Feeder
❑ Layer
❑Dairy
"
eeder to Finish
F
❑Non -Layer
❑Non-Dairy
`Farrow to Weanj
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
2-1
❑ Gilts
❑ Boars
.Y .,
, Tota ssiw
x
,�741
--,
Number&of Lagogns ! Haldug Ponds ❑ Subsurface Drains Present 110 Lagoon Area IDSpray Field Area
0 No Liquid Waste Management System<
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
2.
Is any discharge observed from any part of the operation?
❑ Yes
o
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 DVVQ)
❑ Yes
❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system`? (If yes, notify DWQ)
❑ Yes
❑ No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
ANo
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
AN
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
)�,rNo
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
0
7/25/97

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeoons.Uolding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier.
...................................
Freeboard (ft): .. ...................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(jr any of questions 9-I2 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
Structure 5
❑ Yes KNo
❑ Yes to No
Structure 6
❑ Yes WlNo
❑ Yes J�No
❑ Yes gNo
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes (No
Waste Application !/
14. Is there physical evidence of over application? ❑ Yes KNo
(If in excess of WMP, or runoff en ering w ters of the Sta. , notify WQ)
15. Crop type'. ........... ............_.......................... ............................................................. ....................
16. Do the receiving crops differ with thos designated in a Animal Waste Management Plan (AWMP)? ❑ Yes ONo
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Qnly
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?
No.violations,oi deficiencies.were noted during this:visit. You'W" receive•no.ftirtlier
c4rresppndepce about this:visit:-
Need -lam ge-� eat-r�-�- t...�o�5� ar�Q�l.tfi3.
mead 4-c keep we-e.ki-iee4�o�d l e�lc[.
N ee4 4v {�T c, c-n e-� 1 c-r-le l f e f p'lt [ 4*Lr_j Cer fi i C'4C O-C ct/ercl
}ter n41_-bU J
gc,zj Iboh rw� 4 p��C �6 �1 ic`O15
❑ Yes 0,No
❑ Yes RNo
❑ Yes VNo
❑ Yes TNO
o
❑ Yes
❑ Yes 0,No
❑ Yes F No
❑ Yes ,QNo
❑ Yes KkNo
7/25/97

Farm Status:
Farm Name: C O ncgG ., .... County: ----KiC--k M o PA
:r
Owner Name: Ke„ nCtlKD p ne Phone No: LCf 4 5 S'Z - 9300
Mailing Address: 170 C o4 fiat Mar S n , NC 2-y- 3 6 3
Onsite Representative: 5.ar+.� ! �on Ca.nKox-- Integrator. i �3.-----------------
Certified Operator. Sa M &A e- M V O m C a H ,no Operator Certification Number:
Location of Farm:
V
Latitude Longitude Q• 0' 0�
❑ Not Operational Date Last Operated:
Type of Operation and Design Capacity
,$ >i.:,'.�.,,,� ;„�`� m - .h :.••�iS' �" as„� .za .�"a..trs" �:,df r A $" �^3�z" w�-x.,� rie3� .s#"� "x� #�, au
'y �'x& .`S w °'Y+Sa..,'"� *e"�s ��!` �y��.,�Raa'..,o... ,�..'�fiM a,,. - ... 4 F '4�€�-L�€�"�gr,a,; � �'... �� 'fir-�'�5_� "✓?�'
SwiIIe *m e a Number. iN
k� .�... 3 Pouitrym -.. , Numberk. Cattle .Number
` ❑ Wean to Feederr� ❑ ❑Dairy
❑ Feeder to Finish ❑ Non ❑ Beef j
<
RF
Farrow to Wean �� ss5 Ej
Farrow to Feeder. .yak
r �.. `
EM
Farrow to Finish y❑Other Type of Livestock
- VIA
i+' 'e'�"� ?
Number otL"spoons z1Halduig Ponds ,� ❑ Subsurface Drains Present
rw •'N ❑ Lagoon Area' ❑ Spray Field Area
I. Are there any buffers that need maintenance/improvement? ❑ Yes kNo
Z. Is any discharge observed from any part of the operation? ❑ Yes )�No '
a. Ifdischarge 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?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ ya ❑ No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes �No
4. Was there any adverse impacts to the waters of the State other than fmm a discharge? ❑ Yes I No
S. Does any part of the waste management system (other than lagoons/bolding ponds) require ❑ Yes IoNo
maintenancefmVmwemeW
. /rn"/iwv.A.4 nn hark

6. Is facility not in compliance with any applicable setback criteria? ❑ Yes MNo
7. Did the facility fail to have a certified operator in responsible. charge (if inspection after l/l/97)? ❑ Yes Plo
& Are there Iagoons or storage ponds on site which need to be properly closed? ❑ Yes ONo
Structures (Lagoons and/or Holding Pondsl
9. Is Structural freeboard less than adequate? ❑ Yes O�No
Froeboard (ft): Lagoon 1 Lagoon 2 Lagoon 3 Lagoon 4
3`
10. Is seepage observed from any of the sbucam? ❑ Yes PfN0
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes �No
12. Do any of the structures need maintenanceri nprovement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the sb uuctures lack adquate markers to identify start and stop pumping levels? ❑ Yes X(No
ZZ`aste Application
14. Is there physical evidence of over application? ❑ Yes ONo
(If in excess of WHIP, or runoff entering waters of the State, notify DWQ)
16. Do the active crops differ with those designated in the Animal Waste Management Plan? ElYes P ,No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes IS No
I S. Does the cover crop need improvement? ❑ Yes Otiio
19. Is there a lack of available irrigation equipment? ❑ Yes JyNo
For Certified Facilities Only
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes Palo
21. Does the facility fail to comply with the Animal Waste Management Plan in any way? ❑ Yes KNo
22. Does record beeping need improvement? ❑ Yes ONo
23. Does facility require a follow-up visit by same agency? ❑ Yes KNo
24. Did Reviewerlluspector fail to discuss review/inspection with owner or operator in charge? ❑ Yes Owo
Coaunents`(r fur to question #) Faupiaiafany YEs ansysreis and/or sny r ommendattons or inv"other cone , y
;Use. drawtgs of facility to beEtcr t�plaui situations (rise addi�onalpages asecessar)-
La�ae,� bin k nce s 4-o be mewed. Mr, IloK�e�t1M►— Said he is
Prac`.eSf o! reseed;.5,
�+QrwtSQ -r y.;3 -�rm ► S in 90ac1 r��e.
i
ReviewevInspector Name
Reviwer/Inspector Signature:
Date: 5I-d— 99
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit t 1 / 1 d/4F

State of North Carolina
Department of Environment,
Health and Natural Resources 1 •
Fayetteville Regional Office
James B. Hunt, Jr., Governor A&I
Jonathan B. Howes, Secretary IDF.:HNF;Z
DIVISION OF WATER QUALITY
April 14, 1997
Mr. Kenneth Robinette
170 Cognac Rd.
Marston, NC 28363
SUBJECT: Annual Compliance Inspection
Cognac Farm
Registration No. 77-19
Richmond County
Dear Mr. Robinette:
On April 11, 1997, staff from the Fayetteville Regional Office of the Division of Water
Quality inspected the subject swine facility. Please find enclosed a copy of our Compliance
Inspection Report for your information. It is the opinion of this office based on the
information provided and observations made during the inspection that the facility was in
compliance with 15A NCAC 2H, Part.0217 at the time of the inspection. Please refer to the
comments section on the rear of the inspection form for information regarding your facility.
Please be aware that all swine facilities with a liquid waste collection system designed for
a minimum of 250 hogs must have a certified waste management plan on or before December
31, 1997. The district NRCS office, Agriculture Extension office, or the Division of Soil and
Water have specialist available to assist you with upgrading of existing facilities and
certification.
If You have any questions concerning this matter, please call John Hasty at (910) 486-
1541.
Sincerely,
/JoC. Hasty, Jr.
Environmental Specialist
cc: Operations Branch
Central Files
Audry Oxendine - FRO DSW
Wendy Rudd - Richmond Co. NRCS
Wachovia Building, Suite 714, Fayetteville Ni� FAX [phone]
North Carolina 28301-5W An Equal Opportunity Affirmative Action Employer
Voice 910-486-1541 50% recycled/10% post -consumer paper

of
F dEq Number !
Farm Statsas: L er-�• -- -
oiiow-up of DSWC review _O Other
Date of Inspiwdon
Time of Inspocdan 3 . l use u far, time
Total Mine (in boars) Spent aniteview
or Insperdon (includes travel and processing) El
Farm Name: o griRG _ -- _ Cou dr.
owner Name: Ken new f ne Phone No: Cc? /O) 5 rZ - ?30 a
MN aag Address: 17o CeepaC Rd. Mau 0,, NC 2-g 36 3
OnsiteRepr+eseafttiv _; L t T
Certtf ed operator: sa ►u K e d P4V o n �' ce n r+a �. Operator. Certiilcadm Ntmibea . 19 S 7 9
Location of Farm:
Latitude Longitude �• 0` Q�
113 Not Operation Date Last Operated:
Type of Operation and Design Capacity
jy=.1.�1yw�s� ,.+..: -,�t,.
.•��1��k"w x;� �"'m5"r.
\.iYSC w 4 axi �LYIR ✓
•Y' - -
L r4 Cr Dairy
N Be f
,a
f�
..w�iY$`LiFyT'J".'Fp�F';�i` .•..Y f'k'iME
.� �� �T':.-
13
�vv��JJf'
•
0 Other Type of I_ivettodc
_e
- ;. 'rz «:.° :AZ�Z:r . s'..5. yc !.`" s S �• d
w� to Feeder
Feeder to Finish
Farrow to wean
�
Farrow to Feeder
Farrow t Finish
Subsurface Drains Present
Number bf Lagoons f Holding Ponds s� ; n�
r
..
Ligoon Area Spra Field Area
t
1. An these any buffets that need ataintenaaorJaaprvvemeaC! Cj Yes UN6
2 1s any discharge observed 5vm any part of the operation? E3 Yes 9No
a. If discharge is observed, was the ooavryanx ataa-made? 13 Yes 0 No
b. if discharge is observed, did it Hach Surface Water? (if yea, notify DWG - [3 Yes ❑ No
C
. if dischargc is observed, what is the estnmated flaw in gallmia? "
d Does discharge bypass s Iagoon system? (If yes„ notify DWG El yes ❑ No
3. D there evidence of past discharge from any part of the oprrrtiaa7 13 Yes KN,)
4. Was there any adverse bwacts to the waters of the Stele other than ftnat a disrmnge? Q Yes i�No
S. Does nay part of the waste management system (other than lagoonslholdiag ponds) Mquire 13 Yes � No

C is ficHity not in compii=ce with any Vpiicsble WAack erimia?
7 Did the f.cility rail to have a certified operatm inuspons ble asvge (lfiaspection after Ind?
L Are there lagoons or storage ponds on site which need to be propedy dosed?
Structures (Lagoons and/or Holdinj Pondsl
9 Is structural fled less than adequate?
Fieeboard (tt): l Imeoon 2
lli. Ia seepage observed from any of the stret*aes?
13 Yes aw
n Yes U(No
1.3 Yes P(No
D Yes ];(No
Lagoa 3 • Lagoon 4
11. is erosion, or any over On- - to the integrity of any of the structures observed?
u. Do any of the ass need
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, no* DWQ)
13. Do any of the structures lack adquate markers to identify start and stop pumping kwds?
Waste Aaniication
14. Is there physical evidence of over application?
-(If in ezceas of WMP, or nmoff entering waters of the State, notify DWQ)
13_ crop type _ 0-
16. Do the active crops dffer with those designated in the Animal Waste Managemrnt Plan?
17. Does the beflity have a lack of adequate acreage for land application?
13. Does the cover crop need improvement?
19 Is them a lack of available irrigation equipment?
For Certified Faepities Only
2tk Does the fa=lity fail to have a copy of the AWnW Waste Management Plan readily available?
21. Dos the facility fad to =Va y with fire Anima] Waste Management Plan in any way?
:M Does Mcm keeping need impaavemzni?
23. Does ficility require a follow-up visit by same ap=yf!
24. Did RevjewcdInsp«xor faun to discuss review on with owner or operatm in die?
13 Yes P(No
t] Yes �NID
Kyes ©No
D Yes P(No
0 Yes JMlo-
t] Yes Po
❑ Yes Pio
E3 Yea 01�0
fl Yes $No
E3 Yes PIo
E3 Yes $,No
t) Yes ONo
D Yes J,No
n Yes Vim
Cotnmeata (referto`question #): Explain
Use drawirigs1d'iac�ity #o boner �aplain'sitelatzona::insc
my,ES answers aad/orrttiy rcca mendat:ons
addopaiagesaseoasr). y��, x* �r'�a
12_ • L0- ieeJs
4c, be gnawed. /Or. :ror►�a�f`f�Or- Said he K
proceo reSCed wj.
" C *'P'+Jj5e 145 -T rrot i S in
74d VA.YC.
Rsvkwer4nspecwr Name w ; y r : i a'
Reviwerftspector Mpatow. Dot=
cc Divisidon or Water OtrQlhtr. vier D.On v Serrian eacaky 4"MIMont Unk 1 1 /1 AI04