310773_INSPECTIONS_20171231

2 Vn
NORTH CAROLINA
P
Department of Environmental Quai

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergencv 0 Other 0 Denied Access
Date of Visit: Arrival Time: LJ�lslJ Departure Time: L_ 1tJr.LJ County: Region:
Farm Name: jP 1, Owner Email:
Owner Name: t I Q Phone:
Mailing Address:
Physical Address:
Facility Contact: ++ W j t Title: / Phone:
Onsite Representative: ]JG�1� i e_l GIt S i i���� bb r% Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Cattle
DairyCow
Design C►urrent
Capacity Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish z4r6p
=0
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Farrow to Finish
Dr.. P.oult , Ca a c 1 t $o ,
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
U.ther
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
.of the State other than from a discharge?
❑ Yes T)o No ❑ NA ❑ NE
❑ Yes ❑ No Cr NA ❑ NE
❑ Yes ❑ No T NA ❑ NE
❑ Yes [] No NA ❑ NE
❑ Yes 71 No NA ❑ NE
❑ Yes [�6No [] NA ❑ NE
Page 1 of 3 2/4/20I S Continued

liacili 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 P NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [� No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 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 [S@ No ❑ NA ❑ NE
maintenance or improvement?
Waste AnDIICation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [7 @ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [N No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable 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
[KNo
❑NA
❑NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
�] No
❑ NA
❑ NE
❑ Yes Q No ❑ NA ® NE
❑ Yes [] No [] NA 5 NE
❑ Yes �] No ❑ NA ❑ NE
❑ Yes [ t4 o ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall o Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
Page 2 of 3
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
[DNA NE
21412015 Continued j

Facilitv Number: 1 IDate of Inspection:
24. Did the facility fail to ca brate waste application equipment as required by the permit? ' ❑ Yes
[WNo
❑ NA
❑NE
�liance
25. Is thefacility out of corn with permit conditions related to sludge? If yes, check ❑ Yes
[ tNo
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survpy ❑ 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? EAYes
Q No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? n Yes
❑ No
Q 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
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
1q] No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist -at the facility? If yes, c+ck the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
4 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E+ No
❑ NA
❑ NE
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Q-:7, Qra�� S'S -�� 04--
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Reviewer/ln\pector Name: _
Reviewer/Inspector Signature:
Page 3 of 3
- -eveVQ
Phone: C\ Vlll �
Date: QL
2/ 015 1�

Type of Visit: (ff Comp - e Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: l Title: Phone:
Onsite Representative: �� n-`� t 1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 7 7 34 S.)
Certification Number:
Longitude:
Design Current
ne C►►opacity Pop.
M�W::to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
DairyCow
ean o Feeder
on -Layer
Design Current
Dr, P,oultr Ga aeit P,o
DairyCalf
eeder to Finish
Farrow to Wean
`Z�
"2�
DairyHeifer
D Cow
Farrow to Feeder
Non -Doi
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Caw
Qther
Other
Turkeys
Turkey Poults
Other
I
I =E
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated ac ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters ofthe 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 No,. ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued
►� 1,

Facili 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 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z'�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q-Ne-
❑ 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
l_ I '''5
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes No NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes DNo DNA DNE
(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 ❑moo ❑ 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 2rNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C2 'Yo_ ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
t No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rNo ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;J-N-6- ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Oo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EX - ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 773 113ate of Inspection; Z 1
b
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
o ❑ NA ❑ NE
the appropriate box(es).below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
. No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E3No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
E] Yes
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
EKo ❑ NA ❑ NE
novicwairuisNouwJ i11ai11o: y I riumc: . • . I -
Reviewer/Inspector Signature: ]� �-�.� ��/`�` Date: G
Page 3 of 3 21412615

lype VI V IJI[: %V %-UlllPHIMUC 111NPel"[IVII V Vllera[I[I11 MCVleW LJ aLUUCLUrC GValua[IU[1 t„J I CURUICHI MSIS[anee
Reason for Visit: O/Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access,
ot
Date of Visit: Arrival Time: Departure Time:I� County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: j _ Title:
Onsite Representative: ( Cam`^ _ ( 1, i r C L
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Region:
Certification Number: ,S 3
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current-
Cattle Capacity Pop.
Dairy Cow
can to Feeder
Non -La er
Dairy Calf
Feeder to Finish
LffIrO
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr, ;,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 E��o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[DNA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
Page I of 3 21412015 Continuer

Facility Number: 5 1 7-7 3 Date of Inspection: 41
Waste Collection & Treatment
���
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E] �o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in): ► `j �
Observed Freeboard (in): L
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
;7r 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
[]-N-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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EfNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes El -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3 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
E2-N`o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ 1�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
['' No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E]�No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [a"No ❑ NA ❑ NE
Page 2 of 3 21412015 Conlinued `,. '4

Facifi Number: '3 f - Date of Inspection: J / r'
24. /Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes L No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check QYes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 1A ❑ 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?
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes Z No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Flo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
Na ❑ NA ❑ NE
f' ❑NA ❑NE
[No ❑ NA ❑ NE
Date: 1 I / l�
21412015

Type of Visit: Q Co
Hance Inspection U Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other Q Denied Access
Date of Visit: Arrival Time: � Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Qhka.0 V I DEL L-5 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: — 9S 6 S-3
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish I JLayer
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
I
INon-Layer
I
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr. P,oultr, Ca aci P,o
JLayers I
D Cow
Non-Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [:]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 ❑ ❑ NA ❑ NE
❑ Yes [aNN ❑ NA ❑ NE
❑ Yes YNv ❑ NA ❑ NE
Page 1 of 3
21412014 Continue

Facilily Number: - Ds ection: it
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 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: XZj
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 environmenta hreat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ YesVNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
ZNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
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.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes VNo�
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes EKo ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes �eo❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes or ❑ 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 Inspection[] Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3
21412014 Continued

Facilit,% Number: - Date of Inspection:
24. Did.the facility fail to calibrate waste application equipment as required by the permit? Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F3/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 ❑ NA ❑ NE
rNo27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ 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 ❑ LagoonlStorage Pond ❑ Other:
❑ Yes L30<o ❑ NA ❑ NE
❑ Yes Rio ❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
❑ Yes EYNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�
❑ NA
❑ NE
No
❑ NA
❑ NE
❑✓ /No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or'any:additional reeomrnendations or any'other comments.
Use drawines of facility to better explain situations (use additional: Pages as:necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�J U I-6A) "I .1 Phon� ��(� — --off
D
Date: ( r
21412014

Type of Visit: ATompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: W-' J Arrival Time: I q,, 00 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: Integrator:
Certified Operator: D OW1 � � W I\\kWe4 " :a— Certification Number: q� 366-�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
FI
Layer
DairyCow
Wean to Feeder
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr, P,oultr,
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
NJ Other
I
10ther
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 ONo ❑ NA ❑ NE
[:]Yes ❑ No
[:]Yes [:]No
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) []Yes []No
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes J3 No
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 6 No
of the State other than from a discharge?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21412011 ContinuedQ
Page 1 of 3

FacilityNumber: Date of Inspection: -L4- I
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 J�j 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 �Z 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 2TNo ❑ 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? 91
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes �TNo ❑ 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
E] Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JZ] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
QfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
gNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes rZ 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 10 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

li acili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZNo ❑ 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 ZNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes PTNo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes )6 No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes WT 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)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
KNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
—No
1/ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
TO 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).
C4 hi 6MAZ_z'_O� a013
564t Ste,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:5a��6!-d
Date:
21412011

(Type of Visit: (�pliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative:�\Ppj I GL. Integrator:
'tACertified O erator: (.i_ Certification Number:
Back. -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
DesignWte,ujEgntM
Swine Capacity Pop.
Wean to Finish
esign Current Design Current
Wet Poultry Capacity Pap. Cattle C*apacity Pop.
La er Dai Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Design Current D Cow
DrDr, P,oult�, Ca acit P,oCa acit P,o , Non -Dairy
La ers Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes I XI No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
[] NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ YeskNo
No
❑ NA
❑ NE
of the State other than from a discharge?
2/4/2011 Continued
Page 1 of 3

INcility Plumber: - 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 IIStructure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LXCLW
Spillway?:
Designed Freeboard (in): 9 " 5
Observed Freeboard (in): f�
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.) �k
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �i No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes tNo
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes &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 Ponding ❑ Hydraulic Overload [3Frozen Ground ❑ Heavy Metals (Cu, Zn, etc N
❑ 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): A 64 1J
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
tN
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
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.
r❑ WUP ❑ Checklists Q Design Q Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑Yes ANO
[] Waste Application Q Weekly Freeboard E] Waste Analysis Q Soil Analysis steTers
Q Rainfall []Stocking ❑ Chp Yield Q 120 Minute Inspections Q Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3
❑NA ❑NE
0 Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued ��

FSitciii Number: jDate of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑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 V No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ 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 �kNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes *No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[3 Yes No
❑ NA
❑ NE
Comments. (refento question #): Explain any; YES;answer s and/or Any, additional recommendations or any l
`other;comments
oetter.explaispUse drawings of facility tbages as neeessary,).,I
WA.
3199
j .59
�d15i1i (3-11-y
.NuC3 C
�,v T � � �� �c.� CAN?�o�
mow P�g� TO?
U rr LAC cx�f �� F 4 . S 1 E�- j)GCGS S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 6��9 taO i )
Date: ��10aba
21412011

Type of Visit: , Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Arrival Time: Departure Time: Q® County: Region:
Farm Name: ��� _�J P i F RC C Owner Email:
Owner Name: �UNi �E�- �l �C (Z-7— Y 'Q Phone: `U� .0:4s 04a-4
Mailing Address: Q 9 9- G Eo2C L 13/4oC A?_ C8 w(}(_LACE 08(-%& O
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative:-T�
Certified Operator:
r `
! F L
LL S
Integrator:
Certificati1 , Number: 9 9 3 VS J
a n 1 e_L W H 1 i F
iW F LL.S
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
CattleE KC�@apacity Pap.
Wean to Finish
La er
Dai Cow
Wean to Feeder
on -Layer
Dai Calf
Feeder to Finish
Q
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
1)r, P,oult e
Ca aci
P,o ,
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes V `No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge.from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes tko ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

IFacility Number: - Date of —inspection:
Waste Collection & Treatment `��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes •I ti{ 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): )q/. 5
Observed Freeboard (in): 39
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
\1
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
✓✓✓
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): S(!,f ?,e �Z—(�)1
13. Soil Type(s): i ifis y79_lAl)lLLE
_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes V No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes , No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �jNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
No
❑ NA
❑ NE
the appropriate box.
Q WUP ❑Checklists Q Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No [3NA [3NE
0 Waste Application Q Weekly Freeboard E] Waste Analysis 0 Soil Analysis ❑ W/ste T 8ifers 0 Weather Code
0 Rainfall ❑ Stocking ❑ Crop Yield Q 120 Minute Inspections Q Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes] No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: /
• 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 9No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �&No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No JNA ❑ 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 No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes '[] No
❑ Yes TTii No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any<additional recommendations :.or any other comments ,
Use drawings of facility to better explain situations (use additional pages. as necessary). � _• ,Mi a"a
bo'v f (_-O" er r r ) j
s61�. s�mP�s
lip L0 3(60'n C-W b�A C-_ Cr_% -A I
104-P 0A wEEb5
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �11 f�- NWT
Date:
21412011 �I

Type of Visit BCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Cl/Y Region:
Farm Name: —N I p�CZ VL1 CMG C iA2f� Owner Email:
T i419,0- 85- 3v
Owner Name: ��y� iE��C �7 "� Phone: I`w) �%6-D'4l
Mailing Address: o`-7a C fC� 6 Sf1�� V� W AL-LJqCE , -� ��Z'j�.O(0
Physical Address:
Facility Contact: 1 Title:
Onsite Representative: 1 L W6_LL-S
Certified Operator: )L4N1 t~ L- WI4,11r WELL-S
Back-up Operator:
Phone No:
Integrator:
OperatorjCCeertif cation Number: n53
Back-up Certification Number:
Location of Farm: Latitude: 0 0 ='
= Longitude: = e =
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish $$fl
❑ Dairy Heifer
❑ Farrow to Wean
pry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑OtherI
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
No
✓✓✓✓✓✓ ��,��,
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
D�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
)allo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — -3
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:1 _
Spillway?:
Designed Freeboard (in): ,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ElNE
maintenance/improvement? 4
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) e 2� r__ Op
13.
Soil type(s) "INS ALkTQS. , .31LLr_
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
[I NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
XNo ❑ NA
❑ NE
.Comments (refer,to question #)t'. Explain any YES'answ,ers and/or any.,recommendahons or{any otl►erycomnients t ,
y,. i
`Use drawings of facility to better explain situations: l(useiaddttionti;l4pages;as1necessary):
Reviewer/Inspector Name', j Si`A Phone:
Reviewer/Inspector Signature Date: "&�/6
Page 2 of 3 12128104 Continued

Paciliq Number: -� Date of Inspection 4
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
ANo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
X
[INA
ElNE
0 El Design El appropriate box. WUP Checklists b Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�4 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑/aste Transfers
❑/AAnual Certification
❑ Rainfall ❑ Stocking ❑/op Yield 0 120 Minute Inspections ❑ Monthly and 1 "
Rain Inspections
❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
gNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
kNA
[I NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ 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?
lbq
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
ANo
❑ 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
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
CCV_%?,9_PTI0xl 'tCA I_ D01
W ` R
V 9-YJ 0 /. C>
i
(3cr:1 �uC� �P g „$r w� s�P �t�►�.p
��mc+►�� ti=(ZC)� S P
AS �orvC S S�pC C L©� ENO
AFC - 1N5�� i�o�:c+At-L�n 1�R. WGL�S -TO C_F�i µlM 1447TOE:
VCx u 6 "1 IMF cou.c 1;'-) /40 ExCF, r p
Page 3 of 3 12128104

Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
n Reasofor Visit
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: U M Region:
Farm Name: Jt.1/1/t (Z Zi C)G C 1_Aarn Owner Email:
^,, ,� M9ro-
Owner Name: H4f-1 ezq P1 E (. C r Phone: �w ��p1
Mailing Address: _� 6�t1E S4+�'� EA E ,q -- I)CS `/co
Physical Address:
Facility Contact: .. Title:
Onsite Representative: �MAI C U3 L E U -S
Certified Operator: Q_DF—N a S'i t=�LC .-
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: j -4g$S
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ I ❑ Longitude: = o = 1 = tg
Design
Current
Design Current Design
Current
Swine
C+apacity
Population
Wet Poultry Capacity Population Cattle Capacity
Population
❑ Wean to Finish
❑ Layer I I ❑ Dairy Cow
❑ Wean to Feeder
I I0 Non -Layer I
I
❑ Dairy Calf
Feeder to Finish
d
I
I ❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
El BeefStocker
❑ Gilts
❑Non -La Non -Layers
El Pullets ❑Beef Feeder
❑ Beef Brood Cow
❑ Turke s
❑ Boars
Other
❑ Other
❑ Turkey Poults
❑ Other Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
p(J No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued
�I

i
Facility Number:
Date of Inspection LLLLLtJ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): .
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(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 X No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes *o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes (No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ElNA ❑ 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 XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to incorporate Manurc/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 5 C� co i1�edP
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
4No ❑ NA ❑ NE
t No ❑ NA ❑ NE
IM No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
I Reviewer/Inspector Name +fe�1"t` t'jV` — Phone:
I Reviewer/Inspector Signature II Date: p
12128104 Continued

fry •`�r -
Facility Number: Date of Inspection JD
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropriate box. El WUP ❑ Checklists Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )� No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Frceboard 0 Waste Analysis 13 Soil Analysis ❑ )/aste Transfers ❑ Onual Certification
0 Rainfall ❑ Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and V Rain Inspections ❑ Wcather Code
5
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�fNo
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes
!ANo
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
❑ No
"ONA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
DqNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
hNo
❑ NA
❑ NE
Additional�C,ommentsyandlor Drawings.
:oD)log
12128104

Division of WaterQuality,.P;li
W,
Facility`Number 3 MIS Division ofSoi[ and Water Conservation
QOther Agency: .
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical, Assistance
Reason for Visit A Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 9 t!f!p a Arrival Time: r5 Departure Time: County: / Region:
Farm Name: n
Owner Name: 14 �t E(Zc
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
�/j
Onsite Representative: t"�t2 ed ?I P_ zGE _ ,�
Certified Operator: {aME, G - '1 EiZC.E,
Back-up Operator:
Location of Farm:
Integrator: Operator Certification Number: Jk11 1 1WrS
Back-up Certification Number:
Latitude: F--I o = 6 = Longitude: = ° [= 6 0 f1
Design CurrentDesign' Current
Swine Capacity Population Wet Poultry. Capacity Population Cattle
❑ Wean to Finish
LN Feeder to Finish JbYWO b
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design. Current,
Capacity Population':.
Cow
❑ Dairy Heifer
❑ Pry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
❑ La er ❑ Dairy
❑ Non -Layer I El Dairy Calf
Dry Poultry
❑ Layers
ElNon-Layers
❑ Puliets
ElTurkeys
El urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 0 No ❑ NA ❑ NE
El Yes
❑ La er ❑ Dairy
❑ Non -Layer I El Dairy Calf
Dry Poultry
❑ Layers
ElNon-Layers
❑ Puliets
ElTurkeys
El urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 0 No ❑ NA ❑ NE
El Yes
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?
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 0 No ❑ NA ❑ NE
El Yes
El No
El NA
El NE
❑ Yes
[]No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
O(No
❑ NA
❑ NE
12128104 Continued
J

Facility' Number: 31— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ 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: LA 6ocw_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes rVol
No [I 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 ❑ Yes O�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
O f No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations. or any other comments
Use drawings of facility to better explain situations. (use additional pages as.necessary):
Reviewer/Inspector Name I �}j�pF} �T W V ---� Phone: R jiJq (r
Reviewer/Inspector Signature: Date: 9 iP
Page 2 of 3 12128104 Continued

el
Facility Number: 31 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes oNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes %,No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I ° Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 9No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ;4 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
91 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PSNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
0NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
A No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
gNo
❑ 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
KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
§�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number r? "? 3 Q Division of Soil and Water Conservation
O Other Agency
Type of Visit Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit VRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Q 0 "i . Arrival Time: Departure Time: County: Z)uPLTO Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title Phone No:
Onsite Representative: A 2Drc14 2Uj e-_ I 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
Operator Certification Number:
Back-up Certification Number:
Latitude: =] c = « Longitude: ❑ ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
II ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`!
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy lieifej
❑ Dry Cow
❑ Non-Daity
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowf
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 (3 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
El Yes
VN
❑ NA
❑ NE
❑ Yes
L'7 No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — r]r13 Date of Inspection 9 a
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: iAG,6N
Spillway?:
Designed Freeboard (in): t ,1
Observed Freeboard (in): 34
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes UfNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes VNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes[ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Q No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes C& ❑ 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 Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
QNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
WN o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
L/ No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
2/N ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L.dNo ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
1%) se SURE to kSEe Nwst , Nkr C. .4 &rZw�.r w c.o2.oS
•
Reviewer/Inspector Name Ul.11,J trLl� Phone:( 4/6) I,% -'13sr8
y
Reviewer/Inspector Signature: Date: 51
12128104 Continued

"Facility Number: 31 —TI-31 Date of Inspection 9 ss o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? eyes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes eNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ENo
❑ 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 El
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
L'7 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L--` /NNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
M-!o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
dNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E NNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
P No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,
L� 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
/
2 o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,_,/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
ONNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Division'of Water Quality
facility Number Q Division of Soil and Water Conservation
O Other Agency
Type of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 1 O 3 1 Arrival Time: Departure Time: County: (QISL.% J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: AU60 ! .t: E2 L L Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = 0 ❑ I ❑ {I Longitude: = ° 0 6 = f4
Design Current Design Current
Swine Capacity "Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 67�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Soars
Other
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ La ers
❑ 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
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
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?
Page I of 3
❑ Yes O No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes E No ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
12128104 Continued

Facility Number: 31 Date of Inspection o L
Wdste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: L,Ae6 cyA)
Spillway?:
Designed Freeboard (in): 9, S
Observed Freeboard (in): 2�
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 E:fNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [7(No ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [3"No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2(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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 21 No ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) is � , N 4_(' ) S G O
13. Soil type(s) QA &�S A�JL��/.� • _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
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
[�o ❑ NA ❑ NE
�No ❑ NA ❑ NE
Wo El NA El NE
o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or:;any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Rxw Z0J-FP6C�-T-N AA/0 I►ti.L'r.MAt NF6v Tu OF �PDig7E0.Jk
Reviewer/Inspector Name Jj01w :: Phone: 9/O 9 ~73P8
Reviewer/inspector Signature: Date: a 13
Page 2 of 3 I2128104 Continued

Facility Number: —�'�� Date of Inspection bG
Reuuired Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JQf o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ p ❑ Ch kl' Mn ❑ h
WU ec Isis Design Maps Ot er
21.
Does record keeping need improvement? If yes, check the appropriate box below.
EYcs
❑ 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
Z
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
ElNA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
WN o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dNo
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
el
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
El 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
[I NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
VN
❑ NA
❑ NE
30.
and report the mortality rates that were higher than normal?
At the time of the inspection did the facility an odor or air concern?
❑
N
pose quality
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
No
❑ NA
❑ NE
General Permit? (ie/ discharge, frceboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,�
L1 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2 No
❑ NA
❑ NE
Additional Comments and/or
Page 3 of 3 12129104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Vis�it`-0 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 02�A
Departure Time: Z/YS County: Region: - �9
Farm Name:Owner Email:
Owner Name: z= _I_Zce_ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator -
Back -up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
teoo
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
[:]Boars
Other
❑ Other I
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c= 6 0 Longitude: a°= 1 0"
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
1.
Dry Poultry
❑
Layers
❑
Non -Layers
❑•Pullets
❑
Turke s
❑
Turkey Poults
❑
Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the�estimated volume that reached waters of the State (gallons)?
"'Jd. 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?
❑YesNo ❑NA El NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes �No
El NA
[I NE
❑ Yes/No ❑ NA ❑ NE
12128104 Continued

Facility Number: 31—
Date of Inspection
Waste Collection & Treatment
4. Is heavy less than
❑ Yes X No
❑ NA
❑ NE
storage capacity (structural plus storm storage plus rainfall) adequate?
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: .1410
Spillway?: lily
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/A
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes RfNo
❑ 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 'A 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 [IN E
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window
__ El Evidence
,, //o��f Wind Drifl ❑ Application Outside oof Area
12. Crop type(s) i1!340r A m4f'4Z.0 CA4V 1 . S, 6.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes /� No
/�
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',
❑ Yes No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes GdNo
❑ NA
❑ NE
VIV-7c /
f) eh' -A L /'�'405
5.
Reviewer/Inspector Name r ,*; Phone:- �X�
Reviewer/Inspector Signature: Date: /
12/2 9104 Continued

Facility Number: 51— Date of Inspection D
Required Records & Documents
19. Did the facility fail to have 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 PfNo ❑ NA ❑ NE
the appropirate box.
❑ WUP [I Checklists [I Design ❑Maps [I Other
21. Does record keeping need improvement'? if yes, check the appropriate box below, ❑ Yes JVNo ❑ NA ❑ NE
❑ Waste Application ❑Weekly Freeboard ❑ Waste Analysis ❑ Soi] 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?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
[INE
ElYes
No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
XNE
❑ Yes zNo
❑ NA ❑ NE
❑ Yes �No
❑ NA ❑ NE
❑ Yes 10 No
❑ NA ❑ NE
❑ Yes 9No
❑ NA ❑ NE
❑ Yes ONo
❑ NA ❑ NE
❑ Yes ZNo
❑ NA ❑ NE
Addetionaf Comrr�ents and/or.Drawlugs .
4
.,
12128104

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit A"A'outine p Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: I
3 .3
)Erpermitted,O"Certified 13 Conditionally Certified 0 Registered
Farm Name: .....i..� Cd t'1»�.Qi,E ..........1(,.... .f....................
Owner Name: -------------------------
7�Time: % r�
Not Operational O Below Threshold
Date Last Operated
or Above Threshold: .........................
County: ...1r...../1pl.ln...............................................
Phone No:
MailingAddress: ............................................................. . .. .................................. ............... ..................................................................................... ..........................
FacilityContact: .............................................................................Title:...................................................... Phone No:................
Onsite Representative:.. %�. a' )-.. .e.:E.............................................. Integrator: pfeiyaurn. ..rLda.4
Certified Operator :...................................................
Location of Farm:
Operator Certification Number: ..........................................
❑'Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 66 Longitude • & «
f . Design tCul
❑ Wean to Feeder
Q'Feederto Finish
al
O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
[] Gilts
❑ Boars
PLi
rira a ,,. Wl
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 2114'o
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
Stru lure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..........7...... ..........................................................................................................................................................................................
Freeboard (inches): . _7
12112103 Continued

Facility Number: 3 — Date of IRLspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Z No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes V40
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 O'Flo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes C3'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ONO
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 21"No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ *0
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type `�Crv')e_��ad)
13. Do the receiving crops differ with those designated in the Certified Aimal Waste Management Plan (CAWMP)? ❑ Yes 2rNo
14, a) Does the facility lack adequate acreage for land application? ❑ Yes , rNo
b) Does the facility need a wettable acre determination? ❑ Yes 'Emo
c) This facility is pended for a wettable acre determination? ❑ Yes 2No
15. Does the receiving crop need improvement? ❑ Yes 2'No
16. Is there a lack of adequate waste application equipment? ❑ Yes 2"No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes Z NF o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes O No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 21�0
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 ;3190
Air Quality representative immediately.
a" :W!f, 4'f .;,e;1� tq t;=.CUz�i ,sai:Ee.a.. €at,dtid,ueEa�.r,,xtrPa�e#�;i3-.wn�Edti€,snia3i gi(aFtir8is.�eje�P .°{?%ai�f,`fr!ie'"f "r. �+:cf:i:3 a�Fcf• g3il�rtvr,t:° .sl<<�1orEt.-i!:t� 5o6ta6..`. `�" < �e .Efls't'dei:"Pri:!6"F 0"9'i4BiY.'k�!�,�g{v".:.'TsY{)'x•;-:F.fs5�. :"!-"'':'t1;�; 35e8 '?es, ¢-n;h#St?'#i?fIii"1 :' '�c�s':. PisaBod,.l1,.:af;;tk+taitd '4��a'.e•�L�'a!l('e�w�d.`'+iri::1p?Pi,;?P3-ik u,';:fa:i3;:RiCo>a� a,�.�.L �.If..1.: W.)::lfSSr.l'B+d;((1�'� ,a-❑<,.�s,w. �n,w. ,@ !es:..u��ul.:.1.� 1 ucY,,.6'�A:�.:,.:., .i..ei.Ww+ a�:FV #i :d
a(tF,t'ii3!e':aa 7F a �yi's '
!!:
.
ytanyY,athtioEquesLon! i;
� pasrtlyr
'¢y t&,WttersapI9 sitad6&.' (dii additlonapages'as necearyField Copy Final Notes ,
;
}it , ! >, ,;# # �7z .; a f € •E. € € ,€q ! , ¢. n zt: ' <b rt . T " # p.n
.,3.3i.1�${gi.,?�iE!.a,fia• �€.,g.d,.ar#�i�;.i,.�-�1.l�Fa@a.u„�.�.L._ii..-.196�._°>i.1 @a�._..i.�..r�BSErn.a pl� .a �.9r as _�S€F�i�}Icai�e.�aaeli,�i'.tti ;� , , �o.£�P¢ R,.��.�w E�, �7.dss.P .i���,�(,(�, �14;,a .. ?�i,$' �.��§ii. �,ila-�'if'�. a€t t,:".'i„�r.�ss, ..•s�at:�:��.- r�, ��, ta.aa€
mode �Iay 1611es nwa-� (n <6
FT)ects IT
(I-r ouer a year O)CO
HvraSng€i!{,Si3 i;
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: S—/_1 710
!L/1L/U1 Conanuea

Facility Number: 3% —7 Date of inspection o?
Reriiured Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 21"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 O No
23. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes PVo
❑ 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
ONo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
J�No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
2 No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O'No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
ErNo
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, skip questions 31-35) JeYes ❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E`No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
;2rNo
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
Q No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
La"Ko
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

f'
(Type of Visit 91it
Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit it Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
©Permitted O Certified Q Condit' pally Certifzo e24ied 0 Registered
Farm Name:
f4e /YIN
Owner Name:
Mailing Address:
O Time /%
rO Not O erati nal 0 Below Threshold
Date Last Operated Above T'h5eshold:
County: )414V ._
Phone No:
Facility Contact: Tit e• h-o`ne No: �I _
Onsite Representative: Integrator: _ / lyf�1 _elf �t�
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0' K Longitude 0a 04 0 •�
Design Current Design Current Design Current.:
Swine Capacity Population Poultry Capacity Population Cattle Capacity Po ulstion
El -Wean to Feeder ❑ Layer I I I[] Dairy
La Feeder to Finish 0 Wj 11-1 Non -Layer I I 1E1 Non -Dairy
El Farrow to Wean T
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
- -- - - - -
Holdtn Ponds I Solid Traps ham„ g p ❑ No Liquid Waste Management System ti
Discharges & Stream lmuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes XNo
❑ Yes VNo
Structure 6
Continued

Facility Number: 3j — qn Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
PdNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
ONo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
ANo
Waste Anmlication
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
9NO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ydraulic Overload
❑ Yes�N0
12. Crop type
13. Do the receiving crops differ with those destg aced in the Certified Animal Waste nagement Plan WMP)?
❑ Yes
o
14. a) Does the facility lack adequate acreage for land application?
ClYes
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
A, No
16. Is there a lack of adequate waste application equipment?
El Yes
RNo
Reguired R je2rds & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
El Yes
�(
,2J 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
o
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
ElYesNo
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
X_�No
21. Did the facility fail to have a actively certified operator in charge?
El Yes
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
XNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to?guestion #): Explain any YES answers`andlornany,recommendations or_any o her comments.
Use drawings of facility to better explain situations. {use additlonaCjes pages a§' necsary) Field Copy ❑FFinal Notes
f
0F r/j�GLr r
- 3 9�n��/fzi ✓��Tz/
Cp �� Q or�rJb �A on1.
Slo, pAyf z 6 s L019K r�
©F
70
-����
PUL IM1107.41lig
�31?_5_
ReviewerAnspector Name
r' h
Reviewer/Inspector Signature:
Date:
05103101 (_�r Continued

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

of Visit QrCompliance Inspection O Operation Review O Lagoon Evaluation
for Visit j"outine O Complaint. O Fonow up O Emergency Notification O Other 1 ❑ Denied Aocess
' Facility Number 3 3 Date of Visit:
13 Permitted © Certified 0 Conditionally Certified 0 Registered
Farm Name: .......... ❑❑ y.!::C�„ �pC.'�..L� c{.`�C.... F.—A '. -V.... ...........................
OwnerName:..........!:.ten. ....,........................................................................
Facility Contact:
rI
30 0l Time: j • S
r Not O erational Q Below Threshold
Date Last Operated or Above Threshold: .........................
County:. ..!...! k*........................................................
Phone No:
Title: ................................................................ Phone No:
MailingAddress: .......................................................................................pp................................................................................................................. ..........................
OnsiteRepresentative:.., /Yleon P,eece larr+dQ,',t:.1.,..!orc'�:. Integrator: �--I�Ur^-3�tc''�Gi�'',Qf
................
.............
Certified Operator:
Location of Farm:
............................................... Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' " Longitude • 4 64
[ � " ' ' , I ' , r ' Design .- ` Current , r I ;.. 1. Design : Current Design
Ca aci Population ,Poultry - .Capacity :;Population. Cattle Capac�ty,:rP
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑Farrow to Finish
❑ Gilts
❑ Boars
+ Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area JOSprayField Area
3 3 i
F Holding Po 'nds 15olid Trags . ❑ No Liquid Waste Management System
DischaEges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If' discharge is observed, what is the estimated flow in gal/ruin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ..........................................................................................................................................................................
Freeboard (inches): 3
5/00
❑ Yes
�No
❑ Yes -i No
❑ Yes A21"No
h /a
❑ Yes ONO
❑ Yes _[3`No
❑ Yes ONO
❑ Yes / o
Structure 6
Continued on back

Facility Number: 31 Date of Inspection ?D dl
5."Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes .0'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 �`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 ONo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 21"No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes _P'No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes JZNo
11. Is there evidence of over application? ❑ Excessive Ponding ePAN ❑ Hydraulic Overload fd'Sfes ❑ No
12. Crop type &Er,- udlq NA x,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 1314o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ,214o
b) Does the facility need a wettable acre determination? ❑ Yes J2,No
c) This facility is pended for a wettable acre determination? ❑ Yes J2.90
15, Does the receiving crop need improvement? ,ETYes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ZNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes JZNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ YesZNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ,PfNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes )2rNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes eNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ZNo
24. Does facility require a follow-up visit by same agency? ❑ Yes ZNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes J'No
Ca: Y......... ref ... i •ire .. e0, 0,�t1ag'11is;vjsjt; • Y_ op_ rv' AI-teC'0*e'0o; f itt* ' ' .I
ctiriespori�ence. abotilt this visit.
0.
Coianments'{refer tn`gaes#Hill #) fEzpiain:any,, answersi andlor any; recommenidatiaas orE any otheir,cotnineats° ;; ` ' ,, a l', i3
Use'drawm 'f tlacili to.beiter.,ex lain situations Oise ddidonal es as necessa
11- TL,eM Wr.,S a gwta)l amaL,nf 01 PAIQ ovcrgFfII cA4."oi, o, One pvl! rh -�L,e
2 00 a- 400/ s• #..,-4 11 J.-a,, n
IS. Die rall,-Ke Goa14Al ke pe,,%41, g4r oLdi s r�41�►Gd►'t-j �'ti�%` eF'FOr 41
�b el;-►,;,.�l a &4ker �e e�a�i -G res
ja. r3e r U,e 40 L.sc A Lv,� e grtaryJ,-r 444uY L-1;4I,Iv, 60 ok S C�r V-rf cr&vT ,
Q•vGil }S. !
Eve,-&t 11 , -t e ?rv,6 1.4y, reG,rd S' 16^4 Craps Are well kcpt. .._
Reviewer/Inspector Name f0 C/� %�`,
Reviewer/Inspector Signature: _ / ',2 Date: /,��/�/ 5/gyp y�/

Facility Number: 31 —1,731 Date of Inspection 117 1 0
WLO l
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 _QNo
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 -ErNo
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 10,90
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ['-�fi10
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Ona pmmentss all ort ran f 'r1 I It,_`r v li ii N 3
♦J
J
5100

�- *Division of Water Quality..
O Division of Soil and Water Conservation
O father Agency
:,.
Type of Visit A,Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date or v isit: Gt3 'rime: UU Printed on- 7/21/2000
Facility Number
O Not Operational O Below Threshold
P(Permitted 0 Certified ❑ Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: ... ��''�t r 1�. ........ County:...b..�t`.�................................. ........ I ..............
OwnerName: ............................. Phone No:.......................................................................................
Facility Contact: .............................................................................. Title:................................................................ Phone No:
...................................................
Mailing Address:
Onsite Representative: C,lnri-.2.............................................................. I .... I ... I ... .. Integrator:...... Gr i,aJGcA
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farnt:
A.
_I
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �j �•� Longitude ��• �� �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer [:]Dairy
Feeder to Finish IC3 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑Far -row to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars I IN - Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lng,-nn Area 10 Spray- Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharpes & Stream ImpacLti
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach eater of the State'? (If yes, notify DWQ)
c. li'discharte is observed, what is the estimated flow in gal/min?
d. Dries discharge bypass a lagoon sysietn? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway
Structure I Structure 2 Structure Structure 4 Structure 5
IdentiFier: ...............................................................................................................................................
Freeboard (inches): 3
5/00
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes )<No
❑ Yes ,�rNo
❑ Yes XNo
Structure 6
Continued on back

:._
F-AcilityNumber: Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes gNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes )i�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? - ❑ Yes XNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes kNo
11. Is there evide ce1of over application? ❑ Excessive Ponding ❑ PAN ❑ �
Hydraulic Overload ❑ Yes 'No
12, Crop tYPe
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
' 18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Gel discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility requiree-a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
' No. iola(iorjs o� iiefpe*nd0$ •W're inn ed. O(Wing � his'visit; • :YO wiii •reeeKce oo; fui•tW • • •
correspondence. about this visit. • • •
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facHity to better explain situations. (use additional .pages as necessary):
16
�tt1 ���e ' �-� n � ��� fie. 5 t���r �- �4 c.��-.e�-�•--� ,
❑ Yes
❑ Yes
❑ Yes
❑ Yes
XfNo
9No
❑ No
❑ No
�rNo
�No
❑ Yes allo
❑ Yes kNo
❑ Yes gNo
❑ Yes ❑ No
❑ Yes 4w,
❑ Yes
❑ Yes
❑ Yes
❑ Yes
Reviewer/Inspector Name u-, o —3 60 X--a-14-6
Reviewer/Inspector Signature: Date: U--n--cap 5/00

Facility Number: 3 Date of Iuspection t L!''=' J Printed on: 7/21/2000
Odor Issues
25. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge hYor 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 ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) _ ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional'Comments and/orDrawings:
V zw ate o "" CJAJ
V, tvL�S Z5:�L�� Y-�\t�
�11, ,ems. t.� GV 11
At,
ems.
5/00

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up • O Emergency Notification O Other ❑ Denied Access
Date of Visit: ]0-17-20t1U Time: 14[?U Printed (in: 1 Q/20f2000
Facility Number 31
O Not O erational O Below Threshold
Permitted HCertifiLd DConditionally Certified D Registered Date Last Operated or Above Threshold
Farm Name:.Iuniper.Rid„c.Earm................ ..... County: D.uRlitt.................................... WJRQ.._....
Owner Name: .A.xti=............................ P.icctt......................... .................. Phone No: tl]<(> -Z85 3 .9_._.....--
Facility Contact: _ • - - - - -- -- - -- -- -- ---- -- -- -- -- -- -- Title:. -- -- -- -- -- -• -- -- -- -- - -- -- -- - - Phone No: -
Mailing Address: x2.G�wnx:c.D.akatAx.l7uat� .............. I.............................................. Wapart:._NC........................................................... .2$46.6..............
Onsite Representative:.wria.................................................................... . Integrator: D9gK49.d.FaMj.......................................
Certified Operator: AXdea Operator Certification Number: 1289
Location of Farm:
North of Cypress Creel. On West side of SR 1826 approx. 2.2 miles Last of Cypress Crk Crossroads. ; +
Ntimber ofLagoons 1 J❑ Subsurface Drains Present 11❑ Lagoon Area I❑ Spray Field Area
:Holditi Ponifs /Solid?Trans ❑ No Linuid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: C] Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. B'discharge is observed, did it reach Water of the State? (If ves. notify D WQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a Iagoon system? (If yes, notify D WQ)
2. Is there evidence of past discharge from any part of the operation?
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 9 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .._--_-._.._.. .... _.._.._....._.._.._.._.
Freeboard (inches): -- -- -- -.32.- -- -- -- - - -- - - - -- - - - - - - -- -- - -- - -- - - --

--ltJdl C,(1lII1111fC'(1 111i t�(l.Y�
Facility Number: 31-713 Date of Inspection 10-17-2000Printed on: 10/20/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Q yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? [] Yes ® 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 F&I No
8. Does any part of the waste management system other than waste structures require maintenance/improvement`? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive P6nding ❑ PAN [—]Hydraulic Overload ❑ Yes No
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 0 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 Q No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
No violations or deficiencies were noted during this visit. You will receive no further
correspondence about this visit.
El Yes L4 No
❑ Yes 0 No
© Yes 9 No
❑ Yes
9 No
0 Yes
19 No
❑ Yes
® No
❑ Yes
® No
❑ Yes ® No
❑ Yes 10 No
❑ Yes ® No
❑ Yes No
0. Farm has some tight fields & wetland areas that buffers should be watched. I y
4. Grower should look into having Wetted Acres determined ASAP — it will determine if farm can be grazed & to what
15. Continue efforts to improve bermuda. Keep pH between 6-6.5 with lime -- apply when 1 ton/ac or more is
recommended.
18. Obtain new aerial photo of farm from soil & water district office.
Cont. > Ir
--
Reviewer/Inspector Name Dean iunk6i395.3900 '22G ;;. ....

anc.ICINUrr]Lit Lace•
;s 0u
Facility- Number: 31-773 Date of Inspection 10-17-2000 Printed on: 10120/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 9 No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? 0 Yes 9 No
28. Is there ax jy evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Z, 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 19 No
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes [9 No
32. Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover? 0 Yes ®No
te: Grower should try to rotate overseeded fields each year if not all acreage will be needed. If at stop purring point by
i-October, then have tech specialist evaluate amount of overseed in a fetter. Try to apply waste early in season to hest
ds & mow other fields every 2-3 weeks until needed. Stop mowing once application starts.
No copy left on -site — will send copy within next week.
8

Facility Number Date of Inspection
Time of Inspection ® 24 hr. (hh:mm)
0 Permitted 0 Certified p Conditionally Certified p Registered 10 Not perattotta Date Last Operated:
Farm Name: .Juniper..RidgF.Eaxn0.................................................................................... County: Duplin W1RO
OwnerName: Arden ..................................... Pierce .......................................................... Phone No: 9.10-.285.-3834 ..........................................................
Facility Contact: ...............................................................................Title:................. ... Phone No:
Mailing Address: 298.Genrge.D..S.hnIar..Ro,ad............................................................ :uV.allaere...N.0.................. ......................................... 2846fi..............
011sileRepreserrlative:.......................................................................................................... Integrator:.......................................................................................
Certified Operator:Ar.dm.G................................ pierrx ................................................ Operator Certification Number: l.?.885.............................
Location of Farm:
Latitude ®* ® ® Longitude ©0 ®4 F
Design Current 'resign CurrentDesign' Current
Swine Capacity Population Poul3try ` Capacity" Population Cattle" Capacity -Population
[3 Wean to ee er
ISI Feeder to mrs
p arrow to Wean
[3 Farrow to ee er
Farrow to Finish
p Gilts
p Boars
iNumber of. Lagoons pSubsurface rains resen p agnon Area C] pray re re.r
`�
Noldm .,i'on�is "IiSoltil Traps 0;1 NoLiquidWaste Management System
g
1. Is any discharge observed from any part of the operation? p Yes p No
Discharge originated at: p Lagoon p Spray Field p Other
a. If discharge is observed, was the conveyance man-made? p Yes p No
b, If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes p No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass it lagoon system?"(Ifyes, notify DWQ) p Yes pNo
2. Is there evidence of past discharge from any part of the operation? p Yes p No
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes p No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? p Spillway [°] Yes p No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure G
[dcnlilicr:
lrcci7o<rscl (inches):...............24............................................................................................................................,..................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, p Yes p No
seepage, etc.)
3/23/99 Continued on hack

Facility Number: 31_773 1 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? []Yes []No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
[]Yes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
p No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
©No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
p No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
p Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
p No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
11: •N.o:vial *tio'ns,or. -deficieucies.were'noted -d3uring. this visit. ; Yaa, will :receive no: further ' • :
........ .................... ...... .. .. .............
. . .Ckresp6tiden e. aboir(tliis:visit, • : .
urricane Flovd Assessment w
is in tact with sufficient freeboard.
n- DSW): No seepage observe, lagoon is line, dike is not saturated, no erosion observed, grass cover is good all
dike.
z
---------- - - -- - -------
Reviewer/inspector Name Greer'McV>Icker y: rBrianGann n` rr �` �� ;1�'j=� Ill'`,. ieE"' �E�r ;E€
I'.i �'. ��fi'��en�;a?snnnnfinner isrs;i ! fi IE.,it 4,$:?!€,.
Reviewer/inspector Signature: Date:

" Division of Soil and Water Conservation - Ope`ration Review
©'Division of Soil and Water Conservation - Compliance Ingpectron
10 Division of Water Quality -Compliance Inspection t
' -0 Other Ageficy'- Operaiion`Re.vieW �I .•1 EI ! q dit ! f , i kI 'I to
J® Routine Q Complaint 0 l+'ollow-up of DWQ inspection Q hollow-uL) of DSWC review Q Other J
L - Facility Number '7 2
Date of Inspection ![ Rg
Time: of Inspection 24 hr. (hh:mm)
(� Permitted IN Certified J] Conditionally Certified 0 Registered [3 Not () crational Date Last Operated:
Faun Name : ............ c]lU!til lr i,.'��g .................... ... .. County: V��%►-�.................
/. ........ r ...... ...........................
Owner Name: ..............1. �Yf!.-....................... C.eYCL............................................... Phone No:...��LLQ.�...�$S"�..�.` 5....... ..............
FacilityContact:..................:.........................................i......E............I'itle:......:......................................................... Phone No:...................................................
Mailing address: ..... `1�.....�?4QflrSCt .... ,........'S ..... .:............................ ...... 1jj;LLg.1...NIL,.,........................................... ... ........
Onsite Representative: .............. . ....... ................................................... Integrator ..........
a,w0a�
�y II`` � J
Certified Operator: ........... J'i�ft ...... :................Yi.t; ��(;,................................. Operator Certification Number:........................................
Location of Farm-
............... DX......1+.) ......5 .>C......a.........5. It". ...M. ......nor... E... �.2 7.:l............--I........ r.,.... o.......
................................. ...... ......... ......... ......... ............................................... ........................... w
Latitude 0 4 « Longitude • ° 64
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity Zwo
❑ CL
❑ soars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds I Solid Traps JE3 No Liquid Waste Management System
DischaEges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance main -made?
h, If discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed, what is the estimated flow in gal/ruin?
d. Does discharge hypass a lagoon 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 & 'rreatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Identifier:
I-reehoard (tllches):
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ? No
[:]Yes 14 No
❑ Yes 54 No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes W No
Structure G
74
-...................................................................................................................................................................................
1/6/99 ' Continued on back

Irapility Number: — -) Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement'?
❑ Yes R No
❑ Yes 9 No
[1 Yes ❑ No
❑ Yes FnNo
❑ Yes N No
❑ Yes KA No
11. Is there evidence of over application'? ❑ Ponding ❑ Nitrogen ElYes No
v
12. Crop type p_....................l[�dil.�Y*.......................... ........................ ............................ ............. ......... .................................
:..........
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)
15. Does the receiving crop need improvement'?
16. Is there a lack of adequate waste application equipment'?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ 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 certified operator in responsible charge?
Yes ❑ No
Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes CO No
,RYes 49,No
Wul es ANo
❑ Yes ® No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application) ❑ Yes (� No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes ONo
lVu.viaiations ar. clef ciencies .were noted dtirin.g.ttiis-visit-.. Y.ou Vail receive nar Nrit ier .
eQt•resparicteuce.. . . .this .visit. . . . .............. . .... ..
Comments (refer to question.#): Explain any YES answers and/or any.recommendations or any other comments.
Use drawings of,facifity to better explain • situations. (use additional pages as necessary):
14. 1=arm "M 1 e �4,Sj r] qvr wA Kturn-w, io, v U1% �v �ai�io�.]41•� rc�r. toe �Y>�V►�dF� �
- OuP JALL�- vy CLutto. e, c+ Lis-, +((�k.., I`7,M o� {o++�a� o.e c,ca �i h. vt5�ee.�Ne Alifl . I
_0. Yh'°`� Slewt� o.li 4,,.-- �iiIdS U•v,.0 ir ,re$PQt,�Lv� u�CfrtgS `kj- hUw1� 0
S r s tv, eo.,rk Zoe,
1a. �.> l l�R-Z be t t- c.�v 'tt.� L4vvLt� �A� �evle� 1'abL�J
re.f-�ds ice. �W\�
t[a _1�-I . t -I sWUQ b1z tol4gj 4o S�OLJ e0vtVa 6. 0' t
ReviewerlInspector Name %nan. /A hV n w '
. E.,
Reviewer/Inspector Signature: Date: j j' Qq 1116/99

L
Lagoon Dike Inspection Report
I L
I
Name of Farm/Facility j ✓� er P. ct 5 e �
r Cl
Location of Farm/Facility �ror, (l �S S �� P �'� _�� S S (C) ct
sg r 9) 6
7:�, � � i � s d �- r-e 0 ---
Owner's Name, Address
l rl ors 1 " P r l C
�t orb; e IJ SL
and Telephone Number
Date of Inspection
'Names
of Inspectors
mO
f1 r
~ ��
Structural Height, Feet
Freeboard, Feet
Lagoon Surface Are Acres
g a,
�P �] ! c
Top Width, Feet
Upstream S1ope,xH:IV
' _
Downstream Slope, xH:IV
Embankment Sliding?
Yes _ No
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(GIass, Trees)
Yes 'C No- � G t. CJd'—
Yes No O e, 1 0,yt
,,'V good r- l ? G:rp,, j d,`%0-
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes No 1 t
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments 0 r k C I r�, 4 E.
C r e
Yes j Nno
C ZjL/ n,---')

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11
Lagoon Dike Inspection Report 0
Name of Farm/Facility _„ l e ^ , � � �� e .�t � � " T? 3
r I J
Location of Farm/Facility rlo, [/� y tyes S �l P ek _ _6 o S S / oc
sX ,19)G
S ^" r-e��--
Owner's Name, Address
or, 2 � sL
and Telephone Number
�h«
Date of Inspection
'Names
of Inspectors
doh !A) AJOA) -
Structural Height, Feet
/0
Freeboard, Feet
�-
Lagoon Surface Area, Acres
5 r �rc_k .
Top Width, Feet
l\
Upstream S1ope,xH:1 V
Downstream Slope, xH: I V r o
Embankment Sliding?
Yes No
(Check One, Describe if Yes)
IJ' kSeepage? Yes 'C No_
(Check One, Describe if Yes)
4
Erosion? Yes No � d - C>/r,_ r 0
(Check One, Describe if Yes)
Condition of '1 � car v Q O 6 � r- / ? r, r o , c{ Cj"GC C_
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes X No
Engineering Study Needed? Yes Nc�,
i
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments (r k C I r. C
C r P i-30G r
Ail
_Yes No
I ,
C,t
f { C C 0 1,, r P. e-
C '?) Lj n,--')

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111,01,�
1
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. .. �{%. _ • -7�'.tii.^}7.:.:=.a..�.. ;�x. r ,�i., .. :X'�:;t%GCS=.-`'. ..., ,tix,�,...-.:•:�{�;�'%���... ..

Division of Soil and Water Conservation 0 Other Agency
61 Division of Water Quality
JR.Routine O Complaint O Fallow -up of DWQ inspection O Follow-up of DSWC review 00thher ...
Facility Number Date of Inspection
Time of Inspection C1 24 hr. (hh:mm)
13Registered pfCertified Applied for Permit [] Permitted FCj 'Not Operational Date Last Operated:...
......................
Farm Narrte. �� 11. y �.. � f .... !�F.... ........................ County:.........�"�`til!-�..........................................................
..............� ......... Q
Owner Name: ]� ............ .... .. .... .......... 1+G` q
I.• ��, `-� � � '� .... Phone No: l �`t1� a Q1..
Facility Contact:A....................................................................... Title: ....... Phone No: ................
............................................................................................
Mailing Address: ...... ax.....C..�!.......1.........................
/ ..................... ..
Onsite Representative :..`"/-` �..�.�1....� �. £ ! .................................. Integrator:....... �+�cit `mod r!'................................
Certified Operator;............................................................................................................... Operator Certification Number:.....-.
..................................
:.oca 'on of Farm:
�/1s..` .. .. .. r l,5 ....G... K.....1....4....................................
Latitude • ' " Longitude ' �' �"
° 3 Design .:
Current._`;-,,. Design Current. t Design Current
a
Sivrne Capacity
PoputaUott,`" Poultry Capacity Population Cattle x 'Capacity Population
❑ Wean to Feeder
❑Layer ❑Dairy
Feeder to Finish (J
. ❑ Non -Layer ❑Non -Dairy
'
❑ Farrow to Wean
❑ Other,;
r
❑ Farrow to Feeder
«.
x Total Design Capacaty y
❑ Farrow to Finish
❑ Gilts
,
x Total SSLW
El Boars
Numlter . Lagoons /%Ioldmg Ponds ❑ Subsurface Drains Present ❑lagoon Area❑Spray Field Area
�.�
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
O�No
2. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at, ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
V(No
c. If discharge is observed, what is the estimated .Flow in gaUmin?
KZA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
t9No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
CffNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
tgNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
04 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
D4 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
UNo
7/25197

Facility Number: —
8.
Are there lagoons or storage ponds on site which need to be properly clotted?
❑ Yes
51No
Structures (Lagoons.Holding Ponds blush fits etc.
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
CKNo
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
............ T ...�.....................................................................................................................................................
Freeboard (ft): ..I.....".3.b...........I ......
......................
..........
10.
Is seepage observed from any of the structures?
❑ Yes
M No
11,
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(1f any of questions 9.12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
UrNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
N No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type{...°....., ...................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
RNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
lH No
18.
Does the receiving crop need improvement?
K Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
W No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
IXNo
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
I9 No
22.
Does record keeping need improvement?
f� Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
N[No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0 No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
9 No
E• No.violutions•or. deliciencie's.wer'e noted-duritig this:visit:- Yodwill rece'i�e`no.furth•er
corresppWepce about tttis:visit:
G� � % - k
\e�-1C he e� �thQ Eck.
SAS
7/25/97