780094_INSPECTIONS_20171231

�Vn
NORTH CAROLINA .�
Department of Environmental Qua

Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Type of Visit: O Compliance Inspection Q Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: 4DIroutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: j� Departure Time: t�:3e7 County: Region:
Farm Name: ��-may ,� __D4t4tf ��Owner Email:
Owner Name:/ �1�'1�1�.�_..r Phone:
Mailing Address:
Physical Address:
Facility Contact: %�rcr •-L / j/(� �r�. Title: /) GUM Phone:
P Integrator: _�j'�riArt_ r/d/
Certification Number: _,�2yi3 ;7
Certification Number:
Longitude:
Design
Swine Capacity
.Current'
Pop.
Design Current Design Current
Wet Poultry Gapacrty Pop. Cattle Capacity Pop.
Wean to Finish
La er
Non -La er
Design Current
D Point . , ,Ca ace Po
DairyCow
IRFeeder
Wean to Feeder
DairyCalf
to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
Beef Stocker
Farrow to Finish
I-
La ers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
"
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 D;,No [DNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes [A No
[—]Yes �o
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

y 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 ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):`
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
fo
0 NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[]I�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses as immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[�:fNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
O 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
[3"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�rNlo
❑ NA
❑ NE
maintenance or improvement?
1 1. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes [1 o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):�y.nGto��Z2
13. Soil TYpe(s)=-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �No ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes rNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
-
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
0 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 [E No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [] N ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

!•. Facility Number: - Date of Inspection: (p /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes El -No DNA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [2'10 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [—]Yes O 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
C]I�o
❑ 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
L+°
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ETNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Fe--rNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Io
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
C] Yes
Q No
❑ NA
❑ NE
( q p uy YES"aoswers;a Al o 'sn -" y, addifional rero 0o so of men#s,
Use drawingsof faeiIi ' to beiter. ex 1 m
ommen er. to question Explain
(use additional pages as necessary)I cndafi s or y her co'
Reviewer/Inspector Name: _ S��y��. Phone: _22;e�3D�-Y7/,S`/
Reviewer/Inspector Signature: Date: la
Page 3 of 3 21412015

l
- Divi"sion of Water Resources
Facility Number ®- 5-71 O Division of Sail and Water Conservation
Other Agency
Type of Visit: GriCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QI routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ; 00 County: p Region:
Farm Name: ,,n Owner Email:
41
Owner Name: r Z` XX y— /'�?� ��a -- Phone:
Mailing Address:
Physical Address:
Facility Contact: ,oC- Title: Phone:
Integrator: ;w /j
Onsite Representative:
Certified Operator: j ,2 -
Back-up Operator:
Location of Farm:
Certification Number: -�` �_/Z=?_z
Certification Number:
Latitude: Longitude:
Design Current Design Current
Swine Capacity -Pop. WetPoultry:. Capacity Pap.
Wean to Finish La er
Cattle
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
Non -La cr
der Finisho
� ^` _ T Des g�
i n Current
!D 61?oult .. `- Ca aci l',o
DairyHeifer
to
Farrow Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La crs
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets Beef Brood Cow
Turkeys'
Turkey Poults
Other
-
Qther
Other T T
Discharges and Stream Impacts
1. Is any discharge observed from any pan 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? (lfyes, 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 12�,No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes allo
❑ Yes JEJ_No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - 9 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[Z No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure'3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ 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
[N 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
[C,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[D-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
[2 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [&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): JJY�`f71 l�sr� �Qv t �r ray%
13. Soil Type(s): Z—f
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?
❑ Yes
[RNo
❑ NA
❑ NE
0—Yes
20
❑ NA
❑ NE
❑ Yes
o No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [13 No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [—I 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 allo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

r
!I
Facility Number: - Date of Inspection: -- /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [S No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fallo ❑ NA 0 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 B 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 [ZNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
®No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
EgNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
®-No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better eanlain situations (rise additional vap-es as necessarv).
4
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date:Z� / 7
21412015

Type of Visit: O'Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: DrIffo—utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: - y / Arrival Time: Time: ; Departure Time: o TTUJ County: at8--, Region:
Farm Name: lToevlvelnt arm �ir� j�pt(%Z,r Owner Email:
Owner Name: /y%,z-�,� Phone:
Mailing Address:
Physical Address:
Facility Contact: jI�",.L Inr ka Title: oazoh rr Phone:
Onsite Representative: Integrator: -3rn,77Af�/Q/
Certified Operator: J,.' Certification Number: gq /3
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Swine - Capacity Pop. Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pap.
Wean to Finish
Wean to Feeder
Layer
INon-Layer
I
Dairy Cow
Dairy Calf
,3'III
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
D . P,nul Ca aei P,o
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Gilts
Boars
Layers
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
.-:.
Other -
Other
ITurkey
Turke s
Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[ ] Yes [&No ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes [:]No
[:)Yes [:)No
❑ Yes [EI No
[] Yes [allo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [DNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3.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
0 NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
C3,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Z 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 [5,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): 5�/n/44 /Ov e/�z•r�
13. Soil Type(s):-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3-No DNA ❑ 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 (y No ❑ NA ❑ NE
24
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA [] NE
❑ Yes [0 No ❑ NA ❑ NE
Required Records & Documents
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 }0 No ❑ NA El 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 q 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 J. No
❑NA ❑NE
❑ Weather Code
Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

1
Facility Number: - Date of Ins ection: — /
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes [Z No 0 NA E3NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check Yes [K No ❑ NA NE
the appropriate box(es) below.
Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? Yes 8 No 0 NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes 2 No ❑ NA 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
n No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
Yes
Co No
❑ NA
NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
[RNo
❑ NA
NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[RNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
[allo
] NA
NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
[R No
NA
NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
MNo
❑ NA
NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�1 ` "%-
Mwa '
Phone:
Date:
21412014

ivis"ion of Water Resources
Facility Number ®- Division of Soil and Water Conservation
� Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Wroutine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ! 0-0 Departure Time: D .' County: Region: f7-K 0
Farm Name: Owneai,�
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:ge d-- Title: �U�7�ir Phone:
Y -
Onsite Representative: S'�, Integrator:
Certified Operator: s Certification Number: Z9.1w i3z
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design
Swine Capacity Pop. Wet Poultry Capacity Pap.
Wean to Finish La er
Cattle
0119ign Current
Capacity Pop.
DairyCow
DairyCalf
DairyHeifer
Cow
Wean to Feeder
,f�
Non -La er
Feeder to Finish
Farrow to Wean
_
Design Current
D , PLaul Ca aci P•_o
Layers
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Pouits
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [&No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
;allo
❑ NA
❑ NE
❑ Yes
®. No
❑ NA
❑ NE
Page I of 3 21412014 Continued

Facility Number: - `r Date of Inspection: rH--
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):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
&-No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[&No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of 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
Eg No
❑ NA
❑ NE
[:]Yes
0 No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes g�.No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 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 C&No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Cig-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Ins ection:
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 [a 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes R No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes � No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 5_4 No ❑ NA ❑ NE
❑ Yes [2�No [DNA ❑ NE
❑ Yes' gNo ❑ NA ❑ NE
❑ Yes
S No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes
D�]No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional napes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: gyfYr��a
Date:
21412011

t ype of Visit: 1!�Mompliance Inspection V Operation Review O Structure Evaluation U Technical Assistance I
Reason for Visit: 42r outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: CountyRegio
Farm Name: (6�A-c ���i-t �p /G Owner Email:
Owner Name: t $ foPhone:
Mailing Address:
Physical Address:
Facility Contact: flc��✓A_ C Lt Title:
Onsite Representative: t
Certified Operator: t `
Back-up Operator:
Location of Farm:
Latitude:
TO- sC(-aZ,Y
Phone:
Integrator:
Certification Number: Z L 137
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Design Current .
Capacity Pop-WetPoult
- Fry-
La er
Non -Layer
Design Current
Ca aci
p _ ty .1'opRrttle:
Design Current
Ca Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
Non-Doiry
Feeder to Finish
Farrow to Wean
Farrow to Feeder
sD ,lPoult :
Desi c n Current
Farrow to Finish
Gilts
Layers
Beef Stocker
Beef Feeder
Non -Layers
Boars
Pullets
Beef Brood Cow
Qther
Other
Turkeys
Turke Poults
Other
_
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑"go— ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No Q A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No [5 A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [T NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Q No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [� N ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: 'r4 y-A
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes l =] <o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No tQ•PdA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E],Pbo
❑ 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
�o
❑ 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
[J No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[D-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
�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3'gfo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3'<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
,� 12. Crop Type(s): _,•c/ { _ &' , Z -G '�-& Q)
13. Soil Type(s):
14. Do the receiving crops differirom 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?
Reauired Records & Documents
❑ Yes
❑.mb
❑ NA
❑ NE
❑ Yes
[�ia
❑ NA
❑ NE
❑ Yes
CDO�o
❑ NA
❑ NE
❑ Yes ❑4o ❑ NA ❑ NE
❑ Yes V? N ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
©moo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[:J o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[] Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(]3"No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: -_j Date oflas action: (ja[L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®.too ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [:].W ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
❑ Nan -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
C3'<o
[] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[!] o
❑ 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
9<0
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
X 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
❑ Yes [�No
❑ NA ❑ NE
❑NA ❑NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes KNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [?f No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ErNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
t
4-
t�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
P32 O — 133—J 3 1
-- tqDate: ALW_
2/4/2QIl

i
zw>
be 7 'zt� t3 a t�
i ype of visit: t-vi-ompuance inspection V uperanon Keview V mrucrure r vaivanon V i ecnmcai Assistance
Reason for Visit: QKoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 9� Departure Time: County:
Farm Name: Ur —
Owner Owner Email:
Name: _ 5,,�� er/ Phone:
Mailing Address:
Physical Address:
0 ttrt Region��
Facility Contact: !�� Qcc.cl(,( `�j�.wi Title: Phone: /�
Onsite Representative: < < Integrator: .ILL x]
Certified Operator: Certification Number: /
Back-up Operator:
Location of Farm:
Latitude:
Certification Number-
Longitude:
Design Currentllll
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
S
C*
Non -La er
I
Dairy Calf
DairyFeeder
to Finish
Fa ow to Wean
Design
C urge_ nt
DrHeifer
Cow
Farrow to Feeder
D , P,ouIt .
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Beef Feeder
Beef Brood Cow
Non -Layers
Boars
Pullets
Turkeys
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 D WQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[ —]Yes [�J o ❑ NA ❑ NE
❑ Yes [-]No EINA ❑ NE
[—]Yes [:]No CUXA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes [-]No 021�A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes [D>o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes tj;Xo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 Q _ V ' 21412011 Continued

k
Facili Number: � - Date of Inspection:
Waste Collection & Treatment ,�,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [R<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [B'Ro ❑ NA ❑ NE
Structure 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 Cp4o ❑ 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 [�Go ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0No ❑ 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 [✓]'lVo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [j? o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ o ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window /❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): a'r^&ujL l f)Gt c-4., ) Y6 -
13. Soil Type(s):
14. Do the receiving crops differ Arn those designated i the CAWMP? 01
❑ Yes
5:1,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[5 No
❑ NA
0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E:�,iCto
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Eql�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2-lgfo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[—]Yes
03'Ro
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
E91 o
❑ 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
l_J <o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
0 NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
I:"e
NA
❑ NE
Page 2 of 3 21412011 Continued

41 V _( -- I I —
Facility Number: -7 1 Date of Ins ection:
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 [3.-Ko- ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ee<o
❑ NA
❑ NE
[—]Yes
E&,ldo
[] NA
❑ NE
❑ Yes
E -l-o
❑ NA
❑ NE
❑ Yes Q<o ❑ NA ❑ NE
❑ Yes [B'No ❑ NA ❑ NE
❑ Yes [33<o ❑ NA ❑ NE
❑ Yes El o
❑ Yes ®ITO
❑ Yes ErKo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations fuse additional Dazes as necessarvl.
Scc"-i<
Reviewer/inspector Name:
Reviewer/Inspector Signature: t
Page 3 of 3
Phorte'!ti'
Date:q�lT ".( 7
21412011

71�b1 Y.)-
of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
in for Visit: d Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1� t �1 Arrival Time: L}q'_ 3t! A Departure Time: j� County: Rob*--souy Region: r46
Farm Name: QQti,�j j� k 1 Owner Email:
Owner Name: �� P�1 �� mC A 1-3 Phone:
Mailing Address:
Physical Address:
Facility Contact: Q,n} MC kE-N e) Title: Phone:
Onsite Representative: OvkCN mo- t') Integrator: u1
Certified Operator: p A N (Y1 C j it q to Certification Number: 341137
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design C►urrent
Swine
Capacity}e P p :Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Cj U Non La er
DairyCalf
Feeder to Finish
h
Dai Heifer
Farrow to Wean
.'
Design
Current
Dry Cow
Farrow to Feeder
DrlyfPouutt , ;
Ca achy
PEo
Non -Da'
Farrow to Finish
Layers
113eef Stocker
Gilts
Boars
_
"'£ Non -Layers
Pullets
I
113eef Feeder
Beef Brood Cow
f Turkeys
1 e:-
`m�
-
,11 Other
TurkeyPoults
Other
Other
Discharees and Stream Impacts
Is
&No
I. any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
E]rNA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
[�NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[:]No
[31NA
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes
E�' o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

IFacWty 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
2NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[]?(No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E�(No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ffNo
❑ 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 a]ternatives 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 > ] 0% 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): W R O ;
X J
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes []No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [!3/No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes ['�4o ❑ NA ❑ NE
❑ Yes [t' No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ER No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[EfNo
❑ 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
[3�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ ] 20 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑-No
E�'NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: -9t4 I Date of Inspection: f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [y"No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [t rNo
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 [EyNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ►D No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[No
[ ] NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[TNo
❑ 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
EEfNo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 t, Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[TNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ErNo
❑ NA ❑ NE
33_ Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[RrNo
❑ NA ❑ NE .
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E�No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use. drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
1 Phone: �r _
Date: 1-')
21412011

11 _. 1,r i
n_._.I
Type of Visit: (DoCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint Q Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: S Departure Time: � County: Region: T,CJ
Farm Name: �el.�.,p_ 1'"'c—LE'tet,] 1(iu�_ Ri_ D� Owner Email:
Owner Name: , L4PL. &J Phone:
Mailing Address:
Physical Address:
Facility Contact: � jj r1 CJ&. qif Title: (fXt_v_W — Phone:
Onsite Representative: 6mr.cl Integrator: M_
Certified Operator: _beG." KAc_Le6_o Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Destgn - Current
Design Current=Powaylill".1
Design Current
Capacity Pop. Capacity 1'op.
Cattle
Capacity P.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
�]
Non -Layer
Dai Calf
Feeder to Finish
' " '"' -
DairyHeifer
Farrow to Wean
0 s.I Current
D Cow
Farrow to Feeder
D , Poult Ca act Pop.
Non-Dan
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
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 UKO ❑ NA ❑ NE
❑ Yes
❑ No
ETNA
❑ NE
❑ Yes
❑ No
L`_T A_
[] 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 6-<_
[] NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:)Yes Io ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

}
Facili , Number: jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2111o' ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ � Yes ❑ No ►faAB ❑ NE
StructurelI Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ujlq-o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0-<o ❑ 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 EjXo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E�,Ko ❑ 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 r.ldo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes K3-1Qo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [&M ❑ 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 Wind Drift ❑ Application Outside of Approved Area
12_ Crop Type(s): tDe�
13. Soil Type(s): L..o
14. Do the receiving crops iffer from those designated in the CAWMP? ❑ Yes eNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes g3'�o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E3 o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes 2'LVo ❑ NA 0 NE
18. Is there a lack of properly operating waste application equipment? 0 Yes [R l�o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [RNo ❑ 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 VNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [a Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes M/No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA [] NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection: 07
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [v]No ❑ NA ❑ NE
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [grNo ❑ 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 dNo ❑ 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 gNo ❑ 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 4No ❑ 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 d 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
gNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW1vIP?
❑ Yes
❑v "No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[2 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[KNo
❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: '!D —, 3S -
Date: % %
21412011

► —M—s ,5'—O5e — z DI o
ff4l 00Lr__'7Iz
Type of Visit glance 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 El Denied Access
Date of Visit: f 2 ' / Arrival Time: Departure Time: 2; 3Q ,,, County: lRoSOA/ Region: /47-4
Farm Name: ��-�"� t'�'' NrW N6�'>t.ts<� Owner Email:
Owner Name: GWns., 44C1c&,✓ Phone:
Mailing Address:
Physical Address:
Facility Contact: A, Al /#C/C Al Title: fiiNALn104AJ� Phone No:
Onsite Representative: DEN 4/G�e,4.1 Integrator: �T - RP&Z.-Al
Certified Operator: AV1401V14 LCAAI hf�/ .A✓ Operator Certification Number: ZJ41.3
Sack -up Operator:
Sack -up Certification Number:
Location of Farm: Latitude: 0 0 ❑ L = « Longitude: ❑ ° = t ❑ u
Design Current
Swine Capacity Population
❑ Wean to Finish
21 Wean to Feeder OL7
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Qther
❑ Other
�Gapjc�it
%Current
JWet Poultry u�latt�o�ww
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Cap�ty PopulatH
❑ Dairy Cow
❑ Dairy Calf i
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
O No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
lJ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
L+7 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)
El Yes
❑ No
,/
2 NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
��NXo
❑ 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'?
12128104
Continued
sa■

Facility Number: 79-09'1
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2
Identifier: ?l /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes L No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes [R o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre t, 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 El 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 El Yes B No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L9< ❑ NA ❑ NE
maintenance/improvement? ,_�
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 3 o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) 13z✓',c�.c! C-
13. Soil type(s) L Vin
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[BNo ❑ NA ❑ NE
LR'No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Reviewer/Inspector Name I`�i•f5' Phone: 2/0• Sf3a , 3300
Reviewer/[nspector Signature: Date:
Page 2 of 1212VU4 Continued

! Facility Number: 7 —09 Date of Inspection - ' 9'/O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ' No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ 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 1"Rain
Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
UINo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
13<o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,L��o
[�R o
ElNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
LD'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
3<o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
00f4o ❑ 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
❑ 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
[3 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
ONo ❑ NA
❑ NE
Page 3 of 3 12128104

g614S ,n,,.�e✓ed S---/4_-Z4e q ,AIL
Facility Number
division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,C�ommppliance
C rIoutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date ofVisit:J ��or09 Arrival Time: �];V�flw. Departure Time: �O:LYIJ/*� County:o� Region: �ie0
Farm Name: GCCVt;C � � init�u�lYor teQS� (DV 4-)Owner Email:
Owner Name: 6'40� Phone:
Mailing Address:
Physical Address:
Facility Contact: bct­N IUGI e-GLIV Title: 49WWW M0'J'L W Phone No:
Onsite Representative:Cu/`!C.l 4-�`f Integrator: �� Reow�
Certified Operator: N91QA 11w'j A4CA�:.nl Operator Certification Number: 24137
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = ' = " Longitude: = ° = ' ❑ u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Wean to Feeder 3552
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er I I i
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L9 No ❑ NA ❑ NE
❑ Yes
❑ No<A
❑ NE
❑ Yes
❑ No
L NA
❑ NE
DNA
❑ NE
❑ Yes
❑ No
❑ Yes
[TNo❑..,,
NAElNE
El Yes
El No
E3 A
❑ NE
12128104 Continued

Facilih Number: 7g — Q y Date of Inspection 5-O -"-
Waste Collection & Treatment _. /
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,B No�o El NA ❑ NE
a. I f yes, is waste level into the structural freeboard? El Yes L-'_I'No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway'?:
Designed Freeboard (in):
Observed Freeboard (in): 3 .f
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
Eklgo ❑ 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
El�
NNo El NA NA NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes
EKo ❑ 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
^�
9< ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
E o ❑ NA ❑ NE
maintenance/improvement?
I. Is there evidence of incorrect application? If yes, check the appropriate box below. [I Yes
,—, ,�
t-ivo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindowEl Evidence of Wind Drift ElApplicationOutside ofArea
12. Crop type(s) 2.e 1+.d - Cv r,, L � L� �.•ri L O:JuiS•'C J
13. Soil type(s) L�6 LJwg
-.0 e
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NNo
❑ 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
,L�
I _'i No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
DIN o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EjrNo
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name' i _ K., j S Phone: 210, 233. 3335`
Reviewer/Inspector Signature:Date: 46 " Wo/
12128104 Continued

Facility Number: - — qLL Date of Inspection
_Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El,
Yes !J lvo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IJ No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists
❑ Design El maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[IYes
3 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONc
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;<"
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E NNoo
❑ NA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
ElD Yes
o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[R
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes To ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LI NNo
❑ 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
C 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
El,��,
Yes
f� 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
El NE
33. Does facility require a follow-up visit by same agency?
[I2 Yes
—-
o
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

i
W, &Ews 9 -eel 0 8 2Ap_
Type of Visit O C.�ommp�pliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit (31 outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 7~2 QB Arrival �/S Departure Time: IZ .` 32PAJ County: ��� Region:
Farm Name: (9e0r�_ 1;1C,1 z'AJ �NtcJf �O:F�.a JS>L Owner Email:
Owner Name•. e0ezz _ /YfC�/�w n/ Phone:
dv
Mailing Address:
Physical Address: /
Facility Contact: ?)AJ G C.u/V Title:
Onsite Representative: �)w ^J Imcle'` ^I
Certified Operator:
Back-up Operator:
Phone No: �f
Integrator: ! -5A
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 6 = I = k Longitude: = ° = A 0
46
Swine
Design Current
Capacity Population
WetPoultTD:,jsign Current
acity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
® Wean to Feeder
3552-
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
D , Poul
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
JE1 Other
❑ DairyHeifer
❑ D Cow
El Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
--
Other
❑ Other j
Discharges & Stream Facts
1. Is any discharge observed from any part of the operation?
❑ Yes
IT No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
El No
,�
ErNNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
ONA
❑ 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
/
ON A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
ElL7 Yes
No
❑ NA
[I NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Yes
ElL_f
,
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: -- g
Date of inspection 7`2%,0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes �io
❑ Yes �o
Structure 5
❑ NA ❑ NE
El NA [I NE
Structure 6
Spillway?:
Designed Freeboard (in). -
Observed Freeboard (in): 3 f
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ETNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [ Jo ❑ 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[:j
NA [INE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑yes No El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ETNo ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
E j o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence Wind Drift El Outside of Area
12.
lof Application
ptl
Crop type(s) O eoy4i4eg , (f"6,yz.Z Gl
13.
Soil type(s) LtJ
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
2<o
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[3 oo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? (3Yes
0 o
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
E T�No
❑ NA ❑ NE
Name- / sAmick-
Reviewer/inspector
Na_
�. i.. Phone: 3334
Reviewerlinspector Signature: Ge.�.�� Date: 7—
Page 2 of 3 12128104 7 , z Continued
Zeo O

Facility Number: — 91 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
❑ Yes B<o ❑ NA ❑ NE
❑ Yes BNo ❑ NA ❑ NE
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
B o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
21 or
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
ElNA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,E31
ElNA
[INE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
,Elivo
LTNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E2-116
❑ 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
LTNo
❑ 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?
El Yes
�,/
E7 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
,�,�
E 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
ETNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
tjvo
❑ NA
❑ NE
Page 3 of 3 12128104

TO Ut (Jl lOb-)
y, ,,.
® Division of Water Quality
Fac>Elity Number 7 $ yC Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: .3-2$' 0 7 Arrival Time: 9 QO Arw. Departure Time: iz: 3D County: ,�obeSo�r Region: /C e
Dokk eDzj1
Farm Name: George. Ige-If4-1 Fo raa .) Owner Email:
Owner Name: Ge',:4 e-E, geJfaLdsl Phone:
Mailing Address:
Physical Address:
Facility Contact: Aec.nf Mc, 1eati Title:
Onsite Representative: DeA N AWC 1eq'y
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Cdl # 11/0, 73 y, 0W9'
Phone No: ^4cf 9/0, 628,11U10
Integrator* 4�4 c. $ftrz j ✓
.01
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ='
Longitude: = O = j =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ElLayer
35SZ 2- $Da ❑ Non -Layer
❑ Wean to Finish
® Wean to Feeder
❑ Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
El Pullets.
❑ Turkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation`?
Discharge originated at: ❑ Structure [-IApplicationField El Other
a_ Was the conveyance man-made`?
Design Current
Cattle Capacity Population
El Dairy Cow
❑ DairyCalf
❑ DairyHeifer
El Da Cow
El Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ®I
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 [8 No ❑ NA ❑ NE
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
(P No
❑ Yes
14 No
❑ NA
❑ NE
❑ Yes
[V No
❑ NA
❑ NE
12128104 Continued

Facility Number: "7 $ — �µ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[)fNo
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
(!g No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[A No
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
CONo
❑ 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
[0 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[%No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
W No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [--IPAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl El Application Outside of Area
12. Crop type(s) cr-ttt Ou ►- 5a.ee61 K0Ve <C_9
13. Soil type(s) L u 1ALL )
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[XNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[A No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[3?No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewerlinspector Name ]Zt L ttl R e,v <.t S Phone: 910, V33, 3330
Reviewer/inspector Signature: Date: 3-ZS-7_0J 7
I2/2S/U4 Continued

Facility Number: -7 '9 q hate of Inspection
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [51 No ❑ NA ❑ NE
the appropirate box.
❑ W[JP El Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IF 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 fait to install and maintain a rain gauge? ❑ Yes T No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P 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
[0 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
[ No
❑ 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
[A 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
[A 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
[N No
❑ NA
❑ NE
33_ Does facility require a follow-up visit by same agency?
❑ Yes
[9 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

® Division of Water Quality
Facility Number on of Soi! and Water Conservation
-- ----�� O Other Agency
Type of Visit • Compliance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit *Routine Q Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I S; OD Departure Time: : /S County: Region: Ai`_'
Farm Name: 14-'�-I fa_AJ i S V,, NCW f A sA) Owner Email:
Owner Name: &e0!25t_ Phone:
Mailing Address: 3 / Z D :Y Fa; &•Moa►+ /1/G zsr3f 0
Physical Address:
Facility Contact: _L?cjjw AA.C,1r .J Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No -
Integrator: A"/", A-k'j•I /
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = 4 = Longitude: E__1 ° = ' E__1 u
Design Current
Design @urrent
Design
Current
Swine _
Capacity Population
Wet Poultry
Capacity Eop�latian
Cattle �_
a
C1apaci#y
Population
[IWean to Finish
❑ La erI
ai Cow
Wean to Feeder
$ 2-
❑Non -La er
I
I
airy Calf
[]Feeder to Finish
�.. ,_•
❑Dairy Heifer
ElFarrow to Wean
e
ElD Cow
-
Dry Poultry"`
El Layers
Non -La ers
Pullets
' "'
ElNon-Dairy
ElBeef Stocker
❑Beef Feeder
❑Beef Brood Co
--�
Number of Structures:
• x
El Farrow to Feeder
❑ Farrow to Finish
Gilts
El Gilts
Boars
El Boars
—
Other
❑ Other
❑ Turkeys
❑ Turkey Poults
❑Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [I Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes N No ❑ NA ❑ NE
❑ Yes
[XNo
❑ NA
❑ NE
❑ Yes
[ANo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[0 No
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
[3No
❑ NA
❑ NE
I2/28/04 Continued

Facility Number: I $ — q Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes jNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
�r
Designed Freeboard (in):
Observed Freeboard (in): 3 S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
I No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed
❑ Yes
ErNo ❑ 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
ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[4 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
[I No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside ofArea
12. Crop type(s) 13 f- +. U 10L Pas& -e, Sw,4c t G►'aa,,s
13. Soil type(s) L , I J 0 F,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[;9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[x No
❑ NA
❑ NE
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
No
❑ NA
❑ NE
'Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments_
Use drawtn s;of facility to better explain situations. (use additional. pages as necessa
g ... tY _ P p g rY) ; ...
Reviewer/Inspector Name �U��S Phone (g10)�"3300
Reviewer/Inspector Signature: Date: -7
Page 2 of J 12128104 Continued

Facility Number: '7 g—Q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [P No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [M No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
151 NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El No
Me
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
QfNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VA No
❑ 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
[A 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
[gNo
❑ 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
[5kNo
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 I2128104

�visian of Water Quality
Facility Number �. / O Division of Soil and Water Conservation
y
Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: ; Departure Time: County: D Region: r9
Farm Name:
Email:
Owner Name: Phone: 1
Mailing Address: �3 1 a o T e� -ROerdl �ur✓ A1Ds+.� _ JY� 4���0
Physical Address: f
Facility Contact:_Title:
Onsite Representative: %b+z - -- _ _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
`Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [� o [� Longitude: 0 0 =' = N
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
�Sf rQ�pfl ❑Non -La et
l
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current,:...
Cattle Capacity Population:
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Fleife)
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
DNumber of Structures:�
b. Did the discharge reach waters of the State? (if yes.. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than frorn a discharge?
ar
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
[& No
❑ NA
❑ NE
❑ Yes
M[No
❑ NA
❑ NE
❑ NA
❑ NE
El Yes
f � No
❑ Yes
1No
ElNA
ElNE
❑ Yes
�No
❑ NA
❑ NE
12128104 Continued

Facility Number: -RI Date of Inspection �- 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
Na No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3g 2*L-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
9 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
57 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
$allo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
10 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J4 No
❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
;Q No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Croptype(s) �f�?ZCl 47ae Z 4- •�-
13. Soil type(s) Z `/ f U./A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
21 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CR No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes
"No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA [I NE
Reviewer/inspector Name,'F_:,TA':;
Reviewer/Inspector Signature:
Phone: D-(
Date: /
12128104 Continued

Facility Number: Date of Inspection /� S
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 14 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps ❑Other ,..��
21. Does record keeping need improvement? If yes, check the appropriate box below. J. Yes E T10 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking 0-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 CKNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Z No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
®,No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
QNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[K No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(K 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
[X[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
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
0 No
❑ NA •.
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
K No
❑ NA
❑ NE
oil
12128104

t
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
� Facility Number
Date of Visit: Time:
O Not Operational O Below Threshold
Permitted 13 Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: _ s~ !<'I' f.5 ._. �7- l� Wit' fv County. F-%e".
Owner Name:
Phone No:
Ntaihng Address:
Facility Contact:
Title:
Phone No:
f
Onsite Representative: _ [ �,,r� .��c�.. integrator. ,Mur.,..IZAIrv.r-i
Certified Operator:. _ t Q,, !!� `� �� , _ Operator Certification Number.
Location of Farm:
�J Swine ❑ Poultry ❑ cattle ❑ Horse Latitude �' �� �'� Longitude �• �� Uu
Design Current =Da: Curcnmt ; Desaga Cit
Swine
.Capadty.P tioa M;.PoQiir9.. Po 'on. , °Cattle'` - tion
1Wean to Feeder - ❑ Layer Dairy
Feeder to Finish Non -Layer Non -Dairy
Farrow to Wean
17arrow Other to Feeder -- -
Farrow to Finish Ta��Des�
Gilts
Boars To#ai `SSLW
. NdmLer d I.agaoas
Discharges & Stream Imparts
1. Is any discharge observed from any part of the operation? ❑ Yes [P No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ 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? IV 1.4
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 QLNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): s
12/12/03 Continued

Facility Number. iT— 1'V Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc-)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes U No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 1P 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 ❑ Yes No
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenancer=paovement? ❑ Yes ® No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes [:R No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12- Crop type 46��_ m C4 _e Q r _' r 1142 2 / r / / C:-tom : r. O S
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 m No
b) Does the facility need a wettable acre determination? ❑ Yes [ No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes] No
16. Is there a lack of adequate waste application equipment? ❑ Yes �3 No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below ❑ Yes [ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes M No
Air Quality representative immediately.
Coomxs{�er�t5agaes�a�k�$>r�agy�YE'�'��vasandlar��aty' _ �:amy�othrraoa�ar�.--�'`��s�:
...�,.,
Use dtaw�`n�•faa'St9 Id C '
�9 Fie ❑ Final Notes _
Y
Inspedo ? Name
F
wer r ver/iuspector Signature; CCc Date:
I2/I2A73 ' Cen�inued

Facility Number: — Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ® No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ® No
23. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes IN No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ soil sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [Ig No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes IN No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ® No
27. Did Reviewerfinspector fail to discuss reviewfinspeccdon with on -site representative? ❑ Yes m No
28. Does facility require a follow-up visit by same agency? ❑ Yes No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, slap questions 31-35) ❑ Yes IgNo
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I - Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

:i9A.-f'.. � _ _ •_ -, N.._.-+-i.-i�v �x .�.. 1.:4'9�'`' ice— �r�_si•+�K"r_�w-_e,.��.t .. .'�...e _. r � .. .. ... _.. �. _ .,. _ -
Type of Visit ® Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Faeilin Batc of Visit: 2 0]. A3 Time: �0� a
Number
Not O erationaC 0 Below Threshold
Permitted ® Certified 0 Conditionaliv ( Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: to 1`r i'VMe r-, L"hou_(nio D tf/ e; N County: 6_
0-
Owner Name: Ge-or
1U,C'Le"f, __ Phone No: 0 (• — �.Oj
Mailing Address: 31D.0 .� _l i�oG� _ _ c; ,,,..mac r .%f C
Facility Contact: (Sr C4 14 P MC Lehr` _ Title: t-1 , ^i.0 r— _ _ Phone No:
Onsite Representative: C~ e n'4'. V%A C_ Lp Gr, _._ Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
I@Swine ❑ Poultry ❑ Cattle ❑Horse Latitude • �� �" Longitude ' • �•'
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
® Wean to Feeder ❑ Laver I JE1 Da
❑ Feeder to Finish ❑ Non -Laver ❑ Non -Dairy
❑ Farrow to V.7ean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ BoarsTotal SSLW
Number of Lagoons I I I
Holding Ponds / Solid Traps
Discharges S Stream Impacts
1. Is anv discharge observed from any part of the operation?
Discharge oria-mated 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 gal/min?
d. Does discharge bypass a lagoon system? (If ves. notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
Area JLJ Spray Field Area
❑ Yes NO
❑ Yes ❑ No
3. Were there anv 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 storm storage) less than adequate? ❑ Spillway
Structure 1 Structure ? Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 3 S
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes 1pNo
❑ Yes 53 No
❑Yes JQNo
Structure 6
Continued

FacilityNumber: — Date of Inspection J.;Q o 0
.31
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes QNo
seepage, etc.)
6. Arc there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes [P 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 PNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes F41No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes PNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 91 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ER No
12. Crop type R erm v rL .1- CI . Ch
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [P No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
[�JNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
Q/No
Reouired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
"No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
�&No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[RNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
PNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[P No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
0 No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[ANo
24_
Does facility require a follow-up visit by same agency?
❑ Yes
rM No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
IP No
0
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Co nts (refer tb gieestiiin: Explain any YES answers and/or and: recommendations or any other ctmme_ats.
Use drams tngs of faciht` to:better explain situations (use addrhonal pages as necessary); ❑Field Copy ❑Final Notes
. _.. _.. -
7elj_e�'
J
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
05103101
Continued

Facility Number: r8 — Date of lnspvxtion O d
Odor- Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor 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 durin- 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 of
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 ISI No
❑ Yes k) No
El Yes WU
❑ Yes No
❑ Yes ® No
❑ Yes ❑ No
Additional Comments.and/or.'.Drawin;s: _
05103101

Type of Visit ® Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit ID Routine O Complaint Q Follow up O Emergency Notification Q Other ❑ Denied Access
Date of Visit: a f d Time:
10 Facility Number 9
Not Operational 0 Below Threshold
® Permitted IN Certified [3Conditionally Certified ❑/ Registered Date Last Operated or Above Threshold:
Farm Name: f'f . _/%T ��/Jd �ns�b/JF � county: A
Owner Name: �� . _ %f�c�,t,�y/ Phone No:
Mailing Address: �3/2 O ell o,
Facility Contact: _����� Title: Phone No:
Onsite Representative: ���c F /%.�..� Integrator:
Certified Operator: ��d %��%��f% Operator Certification Number:
Locatian of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0 0 Longitude ' 0
swine
E
;Design Current W Design ::Current Design Current
Cariacity Ponulattori Pot,ttry Canattity Population Cattle '.CaQaciri--Pouittatwn
eanto Feeder
eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
❑ Boars
Non
<ILJ -Laver
7.
`ry + ❑ Other
zz
aA.°:.
TotalDesign-Capacit�j'�'''`"' x--
Total'SSLW ,
Number:of Lagooas; .�/ ' ❑ Subsurface Drains Present ❑ Laooa Area ❑ Spray Field Area
Holdtg Ponds 1 Solid:?raps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon [ISprav Field ElOther
a. If discharge is observed. was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste CaUgction S Treatment
4, is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillw•av
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
❑ Yes A No
❑ Yes ® No
❑ Yes 9No
❑ Yes 01 No
❑ Yes No
❑ Yes No
❑ Yes ® No
Structure 6
05103101 Continued

Facility lumber: — Date of Inspection 0
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, notifv DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there anv buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oc/ WUP---,,becklists, design, maps, etc.) _ f
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?
Oc/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection 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 allo
❑ Yes [RNo
❑ Yes EgNo
❑ Yes [JNo
❑ Yes Wo
❑ Yes �kNo
❑ Yes 9 No
❑ Yes 52 No
❑ Yes N No
❑ Yes [RNo
❑ Yes �RNo
❑ Yes PLNo
❑ Yes XNo
❑ Yes X No
❑Yes,,MNo
❑ Yes !E No
❑ Yes I] No
❑ Yes FX3 No
❑ Yes ;S�No
❑ Yes ® No
❑ Yes ® No
❑ Yes CO'No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments,(rrfer.to gerestiinn #) =Explain any:YES answers'snd/ar.any recamrnendatioirs or any oilier comments
llse drawings aity of_facto lietii" i o—" sibutionsJow additional pages:as ts esessary): — _ { pRv ❑ Final Noted
. ❑Field -- ..
7 `rii'v,✓� sF�
!�
7 cGia /� o'/ f��i.✓.a�J �.✓7o
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: 78 — 9f/ Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes �No
liquid level of lagoon or storage pond with no agitation?
27. Are there anv dead animals not disposed of properly within 24 hours? ❑ Yes 4--1 No
28. Is there anv evidence of wind drift during land application? (i.e. residue on neighboring vegetation. asphalt. ❑ Yes �R 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 �RNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.c. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes *1 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 9 No
32. Do the flush tanks lack a submerged fill pipe or a permanentltemporary cover? ❑ Yes �No
O5103101

Divrsron of Water. Quality
D>evisibn of Soil and Water Conservation
:. =Other_Agency
of Visit ;(Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit btRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit. Time: L== Printed on: 10/26/2000
Q Not Operational Q Below Threshold
Permitted Certified 0 Conditionally Certified 13Registe d ate Las pera d qyr r#bove Threshold: ......•••.........
Farm Name: 1..,? WCZea,,.- 4rI'n �Co ...../..�....CJ....L/v..�_ .....................
.�".....r................ ,r..................
Owner Name: qtw.r��,,,,• N e- Phone No: Zo /AQ/
..........................................................................................................................................................
Facility Contact: . ..... Title: .............. .. .................. Phone No:...................................................
Mailing Address: ........3.1..Z.. .b.....,.1I..�......4Jit............ ...1rr.�..li—, .. �?l�a. ....Vc............... ........................
J.................................... ....
Onsite Representative: ,-,-„-„Q �...� -el.� .. Integrator: CT.—O. Ax.
Certified Operator:,,.&&/.7. I°. f l....... �.
+8 � ......._... Operator Certification Number:
...............
Location of Farm:
A6
_ I
❑ Swine ❑ Poultry ❑ cattle ❑ Horse Latitude �' �� �•� Longitude �' �� �«
Design Current
OWNuC
•Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current
Poultry Capacity Population
❑ Layer I I �]
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy I I :d
❑ Non -Dairy
Total Design Capacity 1 355-2 -
Total SSL W
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area 10 Spray Fietd Area
Holding Ponds / Solid Traps ID 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. II'discharge is observed, was the conveyance man -nude?
h, Ii'discharge is observed. did it reach Water of the State'! (If yes, notify DWQ)
c. Ifdischarge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (Ifyes, nold-v 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 (frechoard plus storm storage) less than adequate? ❑ Spillway
Structure I Stllcturc 2 Structure ; Structure 4
❑ Yes A110
❑ Yes No
❑ Yes o
❑ Yes ONO
❑ Yes o
❑ Yes o
❑ Yes r
Structmr 5 Structure 6
Identifier:
Freeboard (inches):
5100
........................ ...................
Continued on back

Facility Number: — Date of Inspection 11- Printed on: 1 0/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or 1
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?
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 oUver application? Excessive Pondingf ❑ PAN ❑ Hydraulic Overload
12. Crop type ,P[ 1 ply %�4►-15 k0t r e_ ,
13. Do the receiving crops differ with those designated in the/rti
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?
Animal Waste Management Plan (CAWMP)?
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?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
yiolaiioris:oi deficiencies mere nQtec7 dirririg �his:visit; Yoir will r'eceivti? Rio fuither
cor'respondence agouti this visit: :::::::::.:::::
❑ Yes No
❑ Yes No
❑ Yes ENo
❑ Yes o
❑ Yes No
❑ Yes
ElYesINO
No
❑ Yes No
❑ Yes No
❑ Yes kNo
❑ Yes j(No
❑ Yes kfNo
❑ Yes $(No
❑ Yes No
❑ Yes No
❑ Yes U(No
❑ Yes 4 No
❑ Yes 1No
❑ Yes KNo
❑ Yes W�No
Comments (refer #o."quesaon #) Ex lain an YES answers.and/or an recammendaiions or any other comments
y y
Use drawings of facility to better explain situations- (use additional pages -as necessary) - W
FrU4' 1•0,is
,-e4--a.c;pr, .
Reviewer/Inspector Name
Reviewer/Inspector Signature:
1=
Date: 5/00

Facility Number. Date of Iuspection I-7W Z:d7 Printed on: 1/4/2001
30_ Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
32_ Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
33. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes o
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. v
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
01/01/01

Routine O Com laint Q Follow-uE of DWQ inspection Q Follow-uE of DSWC review Q Other
Facility Number `% Date of Inspection
Time of Inspection E� 24 hr. (hh:mm)
Certified [3 Conditionally Certified 3 Registere�.13 Not rational Date Last Operated:
a -Farm Name: ..-(.2. 1?.._Y CL.4`au� irin-- .lC ?'! c°�ES. County:........ f�rSG?` ................... .......... �..
Owner Name:.._...��.t° lgl!`G.l�............ A G1�- Phone Na..................................
Facility Contact: ........W�................................ Title: ....................... .......................
................. Phone No:...................................................
NC— 24-309
Mailing Address:
Onsite Representative:..........421A ll't- � ... Integrator: ............ .�A ! r0 �1 �S
Certified Operator:..., Operator Certification Number.
C
............ a ............................... p •--................. ....................
Location of Farm:
Latitude • ��
Des Curren
gn
.Swine i`sanarity - Pnniilatinn
dWean to Feeder
�5
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
Longitude
Design Current
Poultry Capacity Po 'ulation Cattle
❑ Layer I ' ❑ Dairy`
❑ Non -Layer JE1 Non-Dain
❑ Other'
Total Desigq Capaci�tyx
_ TOW SSE
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ANo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? [I Yes A'No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes PZNo
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 ANo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 4No
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:
Freeboard (inches): ....... .....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Z-Afo
seepage, etc.)
3/23/99 Continued on buck

Facility Number: '7S — 9, Date of Inspection Zl-dZ7
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
ONO
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
0 No
8. Does any part of the waste management system other than waste structures require maintenancetimprovement?
❑ Yes
PTNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
ONO
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
klNo
11. Is there evidence of ver application? ❑ Exz1ve Ponding ❑ PAN
❑ Yes
\RIo
12. Crop type a, �'� jryi : i-
13. Do the receiving crops differ with those desigr4ted in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ONO
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
15. Does the receiving crop need improvement?
❑ Yes
gNo
16. Is there -a lack of adequate waste application equipment?
❑ Yes
XNo
Required Records & Documents
17.• Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
gNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
j�No
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
qNo
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
gNo
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
FeNo
23- Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
RNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
MWo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
CE(No
�'Vo jr., dtticiehcies &Je ' puled jJ(WingOjs:vlslt, Y:oex Wiil•ree�iye do futjtitgr
''roriesporidence: about this 'visit. ......:::: :::...:::::::::...:.......
Reviewer/Inspector Name � �X, __ h
Reviewer/Inspector Signature: Date: —2L -�jj

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
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
.--,No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
MNo
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
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
60
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush Links lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
w& i
N.

t
r _ rs0 Drvision.o£Soil:and Water Conservation = Operatioi Review r
." Division of_Soil and"Water Conservation - Compliance, Inspection
`Division of FYaterQuality- 'Compliance Inspection w n
OtherAgency.-°Operation-Review.
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of inspection 12- ` 9
Time of inspection 24 hr. (hh:mm)
❑ Permitted Certified [3 Conditionally Certified © Re istered Not O erational Date Last Operated:
.�J ( / ..........................
Farm Name: "l7Lt�%t�. CL ...f...`�r.m.(l .t.!L !*?6�.....��.ai.. Cunnty:........ 14�5�.. Q 4-- �............."......
Owner Numc:.L L� T ".................. /....`...... ................... I.......... Phone Na:.........C�?.. .rl..'.. l�ct/ ........................................
Facility' Contact: "... .w ,c Title: Phone No: .................. .................
MailingAddress: .. ..1...L�.Ox..i.L.I............................................ ........"................... ....L..'=� i C11�fYki.�....... 'INC... ............................. ........ 37` ....
Onsite Representative :...... LJ k1.P.["..... .. ..... .. .. Integrator: t 1'.c.C.Y`Q.. ......................................
.. . .... ............. ........ ..... .
Certified Operator: ....... LQ..Irk!.eY................................................ ......................... Operator Certification Number:..........................................
Location of Farm:
"............."......".......................".......................................................... _
Latitude Longitude �• �° ��°
Swine Capacity Population
Wean to Feeder
TS-2,
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer F
Dairy
❑ Non -Layer Non -Dairy
❑ Other
Total Design Capacity�'�
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area [] Spray Fietd Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discha es & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes P No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. Ii'discharge is observed, was the conveyance man-made?
h. Il' discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State
c. li' dischan-e is observed. what is the estin3ated flow in fral/min?
d. Does discharge hypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier
Freeboard (inches): ........................
Structure 3 Structure 4 Structure 5
❑ Yes No
❑ Yes fqo
❑ Yes 0No
❑ Yes No
❑ Yes No
❑ Yes Q'No
Structure G
1 /b/99 Continued on back

Facility Number: ��— Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes 10 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes )WNo
(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 maintenancelimprovement? ❑ Yes 9 No
S. Does any pact of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNo
9. Do any Stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Pondino ❑ Nitroaen
❑Yes
No
12. Crop
type >°....f>fl........."t�........................................................................................................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. Does the facility lack wettable acreage for land application'? (footprint)
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
( No
16. Is there a lack of adequate waste application equipment?
❑ Yes
UjNo
Required Records & Documents
17 Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
11 No
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
j No
21. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ANo
(ie/ discharge, freeboard problems, over application)
23_ Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
[KNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
rdNo
No.violattons-or. deficiencies .were noted during. this: visit.. You will receive no further .: .
. ctirtresp...... about. this v. . ; ..... ; ..
; ; ; . .
Cominents'(refer to question #): Explain any YES answers and/or any recoi
Use ilawings of facility to better explain situations. (use additional pages as
Oda,ble
` 40) 16ojiti j�} , o-*,
Jj�
iL,,. 6 6teew
ns'or any.other commierits.--!-J,
- z
AL
Reviewer/Inspector Name Jo q
Reviewer/Inspector Signature:114� Date: 2
1/6/99

Division of Soil and Water Conservation 0 Other Agency
IN Division of Water Quality
is Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Date of Inspection
Facility Number ���
Time of Inspection l24 hr. (hh:mm)
Registered C/e�rtified 0 Applied for Permit [3 Permitted 0 Not Operational Date Last Operated :..........................
Farm Name. d1O.ubtc.............. L. County: ................. hvelne.:5_Qom.........• .. .......................
Owner Name: Geo :mj-v.... .A [ G L APR.+ 1....................... Phone No:
91..............6a.-
Facility Contact: ! .tirr.4 ............. Title ................................................ Phone No: ........................................ -•.........
Mailing Address: .......... t1.. i .......... 1........... .. . 4�......cr.lf..................................... ............ Qfl l Yrr.........-•-•--•-o7U..
,..n �.......
Onsite Representative:......... e. ,�'! g
..., 7e :7............................ Integrator: R..� I�Q. /. ...... t y .c....
Certified Operator:...............G eow!yt�............/14GLca,rj. ..................... Operator Certification Number ......... D1..
Location of Farm:
Latitude Longitude 0• �' �"
Z
gn Current 5ta Design zDesgn Cur�ient
Rx , ,Cnrrerit
Somme Gapactty" Population :# Paaliry Capacity"Popida' Cattle Capacity Population
Wean to Feeder
I< ❑ Layer 1Y.10Dairy"
❑ Feeder to Finish
❑ Non -Layer I I Z1❑ Non -Dairy
❑ Farrow to Wean
[] Farrow to Feeder
❑Other � it
❑Farrow to Finish
S e
:} h x:: TOtaI DeStgtl capGty3 5-
❑Gilts
r
❑ Boars
.;* gym, ;° eke
r ',Total 5SLW
r.
tar-'°�5�%st � `, , ;4w.s - aw•. „r.H k ...
Number: of Lagoons / Hplcung' Ponds .' d❑ Subsurface Drains Presen7jEl Lagoon Area IDSpray Field Area
❑ No Liquid Waste Management System
',?b'/aiF„, .,, i&<V:-•xrxy •+hz
a`"�,� L u+.i3`xeF"'^"J,t,� ,`L'�,. 3 n. ul�fX&Re;:
General
1. Are there any buffers that need maintenance/improvement?
2. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes Iff No
1
❑ Yes go No
❑ Yes 0 No
❑ Yes Ra No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes ]K No
❑ Yes 0 No
❑ Yes CK-No
Continued on back

Facility Number: ZL
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoon-Ol jldinL Ponds, Flush Pits, ete.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
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?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'!
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, ur runoff entering waters of the State, notify DQ)
15. Crop type .....i [/N'!!I ..-.......
5.. '4 +....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWVIP)?
17. Does the facility have a lack of adequate acreage for land application?
w
18. Does the receiving crop need improvement?
19. ,Is there a lack of available waste application equipment'?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative"
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste :Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'!
Q
0 No.violations or deficiencies were,
ere noted during this visit. You.will receive no further
correspondence about this,visit:-.
i (iefei to question #): Explain any -YES answers andfor any recominendations or any other�comm
ngs of facility to better explain situations. (use additional pages as necessary)
Fesn_ wo wePD nm,a,d( neQy,�k ..P4J
-rk cmwMP l)MO
76 SP10,3 fLa 4e4,�.rj ct� aj-
ff I cew_zo ,
❑ Yes KNo
❑ Yes KNo
Structure 6
❑ Yes X No
❑ Yes J4 No
❑ Yes KNo
❑ Yes
JKNo
❑ Yes
KNo
......................................
❑ Yes
No
❑ Yes
No
❑ Yes fl4 No
❑ Yes J91 No
❑ Yes Od No
0 Yes ,� No
❑ Yes No
❑ Yes XNo
❑ Yes O&No
❑ Yes ❑ No
7125/97
Reviewer/Inspector Name
x
Reviewer/Inspector Signature: _ Date: 9—��

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Steve W. Tedder, Chairman
George McLean
George McLean Farm
RR 1, Box 511
Fairmont NC 28340
Dear Mr. McLean:
I k1u."FA
T 400
OL
ED E N R
% -F LY
UP 5 1 1997
FAYETTEVILLEE
Subject: Classification of Animal Waste Management Systems
Facility: George McLean Farm (new/northeast)
Facility ID #: 78-94
County: Robeson
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study Commission on
Agricultural Waste, was enacted by the North Carolina General Assembly on June 21, 1996. This bill
requires that a certified operator be designated as the Operator in Charge (OIC) by January 1, 1997, for each
animal waste management system that serves 250 or more swine, 100 or more confined cattle, 75 or more
horses, 1,000 or more sheep, or 30,000 or more confined poultry with a liquid animal waste management
system. Our records indicate that your facility is registered with the Division of Water Quality and meets
the requirements for designating an OIC.
A training and certification program is available for animal waste management system operators. For
information on the training programs please contact your local Cooperative Extension Agent. Operator
certifications are issued by the Water Pollution Control Systems Operators Certification Conunission
(WPCSOCC). For information on the certification process, please contact the Technical Assistance and
Certification Unit at [phone]. The type of training and certification required for the operator of each
system is based on the nature of the wastes to be treated and the treatment process(es) primarily used to.treat
the animal waste. There are two types of animal waste management systems, type A and type B. Type A
animal waste management systems are generally used to treat waste generated by monogastric animals
which produce a low -fiber waste. Type B animal waste management systems are generally used to treat
waste generated by ruminants and other animals which produce a high -fiber waste. The type of training and
certification an operator receives should correspond with the type of system(s) they intend to operate. For
more information on the classification of your system please contact the Technical Assistance and
Certification Unit.
As the owner of an animal operation with an animal waste management system, you must designate an
Operator in Charge and must submit the enclosed designation form to the WPCSOCC. If you do not
intend to operate your animal waste management system yourself, you must designate an employee or
engage a contract operator to be the Operator in Charge. The person designated as the Operator in Charge,
whether yourself or another person, must possess a currently valid certificate of the appropriate type.
Sincerely,
Joseph B. McMinn, Supervisor
Technical Assistance and Certification Unit
cd/AW OIC Designation
Enclosure
cc: Fayetteville Regional Office
Water Quality Files
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

0 - ------ -- -- - - .. - - -- --- --' — - —- ___-._ .__
1 .
nra #" Date of Inspection -Za
Facility Number Time of Inspection Use U hr. time
Farm Status: - k t!,,, l3-2 r CA Total Time (in hours) Spent onReview
or Inspection ('includes travel and processing)
Farm Name.
boukk" [1 l county:... �obe�QrL!
,. , ....
Owner Name: v M �L e.. �., -- - -Phone No: l r..t a„1zQ Z fr " 9 (o O
Mailing Address: �� �T _ _r�"� O h�= --11iL _ 2 V3T0
OnsiteRepresentttive: �.� �7�rL n5.,.._......._ Integrator: mOIC S
Certifird Operator; Gte= e- Mc Lea.._- Operator Certification Number.
Location of Farm:
Latitude �•` OK Longitude
1 Not 2Eerational Date Last Operated:
Type of Operation And Design Capacity
� ] •ii33 -' 3w � 4xn 4!c :i..a�"�.,,, ,Fw��
} F p: a ^ -Fa "` "y�.,S.T
SWjnC [5 e i� w�' „"b�"Fi\nlnbei"43� `4r� poUitij� "4 zNlliiiber � �wi►tt1C r� Nltili�"� M�ffi
Wean to Feeder S S *�Dairy P
Feeder to Finish
Beef
Non- n Farrow io Wean �fg
Farrow to Feeder -
Farrow to Finish ❑ Other Type of Uvestock
�,�Ntlmblr of I$goon5 Holdrng Ponds 4 ❑ Subsurface Drains Present
�
Lagoon Area;Spray Field Area
neral
I - Are there any buffers that need maintenaaorJun rovement?
2- Is any discharge observed from any part of the operation?
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Was there any adverse impacts to the waters of the State other than from a discharge?
S. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenan erJiasprovement7
❑ Yes
K,o
❑ Yes
ONo
❑ Yes
PNo
❑ Yes
gNo
0 Yes ANO
❑ Yes )KNo
❑ Yes WNo
❑ Yes )2rNo
Co dmued as back

6. Is facility not in compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/l/97)?
S. Are there lagoons or storage ponds on site which need to be properly closed?
Structures {Lagoons and/or Holding Ponds)
9. Is structural freeboard less than adequate?
F=eeboard (ft): Lagoon 1 Lagoon 2 " Lagoon 3,
10. Is s ipage 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/impravement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adquate markers to identify start and stop pumping levels?
Waste ADyllcation
14. Is these physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type - 00 aSf-g I_ W
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?
i S. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Facilities Only
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Inspector fail to discuss review/mspection with owner or operator in charge?
❑ Yes No
❑ Yes No
n Yes *0
❑ Yes )(No
Lagoon 4
❑ Yes *No
❑ Yes XNo
❑ Yes �No
❑ Yes Wo
❑ Yes *No
❑ Yes )&(No
❑ Yes 0No
❑ Yes PNo
❑ Yes gNo
I'X Yes ❑ No
? ❑ Yes �No
? ❑ Yes WNo
❑ Yes allo
XYes XNo
a .. } ... x�d.
CommCnts (rCfer to tluest[OII $� �11), plam any YI:S aAswcbs ffild/Or.BnyarCCOD][rrendatlOrrS Or=BYYy O�l1Cr CollItitent5�
�f% w Fat - c. %�' - 3 i�ae Es 4 fP •.Fr.„.ArFYP 1i #.�t. _.ri�."Yf �,T is£h.
;iise drawings„of facility to bmcr explain srtuatztins fuse $dd�hanal pages as aec�ss ►j &f .. ^� .
�-- _5
° zQ. 2� . iV d One- LOOS CC�A- Ct - +ke WX . J - A e C Ot � a [alq f
Ca&d'AAed-Fl"r-O , -}4., r Sery + c e ers a F
4
C - I1 - 97 nee.; �ned west aAc .r.. -4 14 m
+fie "'`.�.. P
a
Reviewer/Inspector Name
-11
ReAwerMspector Signature:
cc: Division of Ulmer Quality, Water Quality Section, Facility Assessment Unit
Date: .V--ZI) -q
l L/14/96

w T
State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Mr. George Mclean
Rt. 1, Box 511
Fairmont, NC 28340
Dear Mr. McLean:
X"WA
AIS a
�EHNR
DIVISION OF WATER QUALITY
July 8, 1997
SUBJECT: Annual Compliance Inspection
George Mclean Farm & Double D 1-8
Registration Nos. 78-20, 78-94, 78-95
Robeson County
On May 20, 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 need any of the copies of the information which you forwarded to me please let me
know and I will return it to you.
If you have any questions concerning this matter, please call John Hasty at (910) 486-I541.
cc: Operations Branch
Central Files
Audry Oxendine - FRO DSW
Ed Holland - Robeson Co. NRCS
Sincerely,
r/John C. Hasty, Jr.
Environmental Specialist
Wachovla Building, Suite 714, Fayetteville NOF
FAX 91a486-0707
North Carolina 28301-6043CAn Equal Opportunity Affirmative Action Employer
Voice 910-486-1541 50% recycled/10% post -consumer paper

Rotitine O Complaint O Follow-up of DWQ inspection
No f"
Facility Number 78
Farm Statue: `t �I AM r!J
review O Other
Date of htgwtion 1.2201917
Time of Inspection : 5" V Use ?A hr. time
ITotal Time (in hours) Spent onReview I
or Inspection (includes travel and processing)
Farm Name:.beIL4:k1V- !� - _ County: Re 6 e 5D r, _ - ---
Owner Name• a r CC 6XI Pv Phone No:���) 4e??s -!z 6 0 r
Mailing Address:•
Lr j I
Oasite Representative: laa ,?'�D Uu STI h �..,, _ - Integrator•. �Gtt 1�d �� S --
Certified Operator-. _ ; e—= a M c Lem.` Operator Certification Number:
Location of Farm:
Latitude Longitude 6 44
❑ Not O erationaI Date Last Operated:
a ype of vperatnon ana Design uspacity
Swine Number
Wean to Feeder S
r--t -- - -- v-• . .
Number K� :k.:--1
❑ Other Type of Livestock
` Number of Laooas ! Holdeng Ponds h ❑Subsurface Drains Present x,-
x„x�u " s: ¢ - Lagoon Area Spray Field Area:
eral
I. Are thew any buffers that need maintenancerunprovemeat? ❑ Yes No
2 Is any discharge observed from any part of the operation? ❑ Yes R(No
a. If discharge is observed, was the conveyance man-made? ❑ Yes PNo
b. If discharge is observed, did it nmch Surface Water? (if yes, notify DWQ) ❑ Yes )UfNo
c. If discharge is observed, what is the estimated flow is gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ANO
I Is them evidence of past discharge from any part of the operation? ❑ Yes XNo
a. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes W"No
S. Does any part of the waste management system (other than lagoonslolding ponds) require ❑ Yes No
mainteunce/fir;m vement?

6. Is facility not in compliance with may applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection after I/l/97)?
L Are there lagoons or storage ponds on site which need to be property closed?
fractures (Lagoons and/or Holding Ponds)
9. Is sa ucaual freeboard less than adequate?
Frttboard (ft): Lagoon 1
lam/
Lagoon 2
D Yes No •
U Yes No
E3 Yes Flo
E3 Yes No
Lagoon 3 Lagoon 4 X.
10. Is seepage observed from any of the atrvctertrs? E3 Yes *No
11. Is trosion, or any other threats to the integrity of any of the structures observed? ❑ Yes )qNo
12. Do any of the structures need ent? ❑ Yes JNo
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or eavironmental threat, notify DWQ)
13. Do any of the structures lack adquate markers to identify start and stop pumping levels? ❑ Yes �(No
Waste Application
14. Is there physical evidence of over application? ❑ Yes gNo-
(If in excess of VVW, or runoff entering waters of the Start, notify DWQ)
25. Crop type
16. Do the active crops differ with those designated in the Animal Waste Management Plan? ; ❑ Yes )No
17. Does the facility have a lack of adequate acreage for land application? r ❑ Yes PNo
18. Does the cover crop need improvement? ❑ Yes PNo
19. Is there a lack of available irrigation equipment? ❑ Yes gNo
For Certified Facilities Oaly
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? Yes ❑ No
21. Does the facility fail to comply with the Animal Waste Management Plan in any way? ❑ Yes tNo
22. Does record keeping need improvement? ? ❑ Yes WNo
23. Does facility require a follow-up visit by same agency? 13 Yes allo
24. Did Reviewer/lnspector fail to discuss reviewImspection with owner or operator in charge? XYes *No
Cormneats (refer to.question #): Explain any YES answers and/or any recommendations or any other cbmmeiiw-
USe draoviags of facility t6 better explain situations:.(use eddi onal,pages as necessar,►)
ZO. 2+� . NO Due LZaS Pre-eap* a•�- `} I e �ec,-i a Al cA.)qS Q
COA-A,tAeA -Kro jk, -ke,r Sery ice persoFJ
Reviewer/Inspector Name
Reviwer/inspector Signature: Date: .S ZD —r/��