310814_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: p'Com ' nce Inspection Q 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: / r Arrival Time: t(s Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Dc�sig�n
Current
De�sigpn
Cur rent
Swine
Capaerty
I
Pvp.
Wet Poultry
Ca�acity
Pop.
Catatlme
Capacity
Pop.
Wean to Finish
La er
Dai Cow
We to Feeder
Non -La er
iry Calf
eeder to Finish
2,SOD
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
lNon-Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ffNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
D N NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
.. of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection: Z..
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes o ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr at, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes Q o NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Lj 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes D40'___❑ NA ❑ NE
maintenance or improvement?
11. 1s there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ffNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes - �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ErZ7 ❑ 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
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
PO0 NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes�Zo
❑ 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 zo
NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 31 jDate of Inspection:
24. Did,the facility fail to calibrate waste application equipment as required by the permit? Eyes 0<0� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes LS'`'o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Ld"'H ❑ 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 ❑ NA ❑ NE
❑ Yes ❑'I<_o__❑ NA ❑ NE
❑ Yes ❑'No U NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA
❑ Yes 0 No ❑ NA
[:]Yes �No❑ NA
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Signature: Date: Z c( /
Page 3 of 3 21412015

(Type of Visit: d Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: Region:
'Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: JO-PgTao �ru_u_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Wean to Finish
I I Layer
Wean to Feeder
I INon-Layer—
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dr, P,oult ,
Farrow to Finish
La ers
Gilts
Boars
Non -Layers
Pullets
Other
Other
Turkeys
Turkey Poults
Other
Phone:
Certification Number: 57-
Certification Number:
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?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker'
Beef Feeder
Beef Brood Cow
❑ Yes © No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ YesV❑NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: 2 - Date of Inspection: r?
`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
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
Z
❑ 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 environment
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
0 Yes
No
❑ 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)
/No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
Waste Application
/Nc'
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Q o
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes WNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ZN o
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes 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
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge' ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment' ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: '!, f - Date of Inspection: I 7,6 (i,
`14. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes 0 - ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ Yes
No
0
f3�No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any$ YES° atiswers and/or, anyx additional fecommendations org "iiny other c6mments.
""` cejwingobeter;explain'itatiosueiddiU,sednantl+pagesaslnessary) !
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �7
Date: 6
2141 01 S

(Type of Visit: Q Con*liance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine Q Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: 1 — Arrival Time: j 16,X6 Departure Time: ® County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Phone:
Onsite Representative: �-,�/ A`f-�►� i�� Integrator:
Certified Operator: Certification Number:
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 Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dt, RTU'It
Ca aci
P.o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 ❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes Ej No ❑ NA ❑ NE
Page I of 3 21412014 Continued

r
Facility Number: - Date of inspection: 1,b4 I _
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes U�/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?
(i.e., 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 C No [DNA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ��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 CNo ❑ 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. C] Yes D No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10% or 10 lbs, ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ERNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
1:24
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
oNA
jNo
❑ NE
8. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required R_ecords_& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 2fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ' ]❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? C] Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: � - Date of inspection:
24. Di¢ the facility fail to calibrate waste application equipment as required by the permit? El No' ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes " N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
[] Yes I ,ENO
❑ Yes [/] N
❑ Yes [/] N
❑ Yes No
❑ Yes
❑ Yes
❑ Yes
❑ NA [] NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ No ❑ NA ❑ NE
[/]N ❑NA ❑NE
No ❑ NA ❑ NE
Date:
2/4 015

Type of Visit: ® CoOliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint C) Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
__ - nnrrrrn
Date of Visit: L Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Latitude:
Pullets
Turkey Points
Other
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
rent; Dry Cow
f Stocker
f Feeder
f Brood Cow
9 5g 4s-L—
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [] No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ Ner ❑ NA ❑ NE
❑ Yes V❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E31No
❑ 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): 13s
5. Are there any immediate threats to the integrity of any of the structures observed?
'es
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 env' nmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes VNo
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 ZNo ❑ NA ONE
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 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[� o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
V[:] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo 0 NA
0 NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
/No
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
U<o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather
Code
❑ Rainfall [:]Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall InspectiWnsOSludge 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
Io ❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: 31- Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes YNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
FtNo ❑ 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
Y - - ❑ 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 [;1 o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector.fail to discuss review/inspection with an on -site representative? ❑ Yes Rio [] NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes�/No ❑ NA ❑ NE
Ve.dra�'
mments (refer to'questiou'#):,Exgliin°any,.IYESIanswgei•s',,and/or:,any�idgdiytiohi "rec{oingmendations o"r�eany othe¢r5com rientsx yr
G'�$�i.i tTY'n...,.. i4Y. �: •. �k. @s�`o.�:1S"�'. `: tv 7 i ��, ..§"a..4..4'.Y. �.). .%..ffiT
ings o`f.,facility.to<better explain sttuations;{useaaclditEonal pages'ras necessary); <,,,:c;�t
Reviewer/Inspector Name: D u b �rJ�L Phon : D V
Reviewer/Inspector Signature: Date:
Page 3 of 3 2 4/20 4

Type of Visit: 0 Co�{pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: l I y 1 Arrival Time: Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: Jpn1WTUA*J Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
oLqq
Design
Swine Capacity
Wean to Finish
Current
Pop.
Wet Poultry
La er
Design Current Design Current
Capacity Pop. Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Q(}
DairyHeifer
Design Current D Cow
C>a aci Po Non -Dairy
Dr, P,oult .
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkev Poults
10ther
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation? [:]Yes ZNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) []Yes ❑ o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDateof Inspection: tt y 115
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure
Identifier: LA6iZ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., 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?
❑NA ❑NE
❑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 or7rcosn
mental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes �fNo ❑ NA ❑ NE
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 2(No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2�'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
es
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Vyes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[2/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
cn�4o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FZ/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
fNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L'J N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes hlo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facilit Number: -4R 114 IDate of Inspection; ti �j III
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesVNo
❑ NA ❑ NE
25As the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes gNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [2"'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
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 O/No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Q N [] NA ❑ NE
❑ Yes LJ ? ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
214,12 I

e-
Type of Visit: CD Co iance Inspection O 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: f n Arrival Time: Departure Time: t LLl� County: ax_4if� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: _r A--FigR,J Integrator:
Certified Operator: Certification Number: �Lj
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
F
Design Current
Wet Poultry Capacity Pop.
Cattle
Design Current
Pacity Pap.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
11
iNon-Layer I
airy Calf
Feeder to Finish
3S
airy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dry Cow
Dr P,oultr. Ca aei l;o
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
OtherI
Turkeys
Turkey Poults
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)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [21/No ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes [:]No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes [� ❑ NA ❑ NE
❑ Yes No [] NA ❑ NE
Page 1 of 3 21412011 Continued

Faeflity Number: Date of Inspection:
Waste Collection & Treatment
4. Is=storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA E] NE
a. If yes, is waste level into the structural freeboard?
Structure I
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes ❑ No ❑ NA ❑ NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes o ❑ NA ❑ NE
❑ Yes N6 o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or env' onmental 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 eNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, [] Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ 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
E3T o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
go
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Vo
❑ NA
❑ NE18.
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
5
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ga
❑ 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
❑ 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 dN ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 ❑ NA ❑ NE
❑ Yes 2�No ❑ NA ❑ NE
[:]Yes vo ❑ NA ❑ NE
❑ Yes /o ❑ NA ❑ NE
❑ Yes No
❑ Yes o
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain. any YES answers and/or.any additional recommendations,or,any other comments
f 9
Use drawings of,facili to;betEer ex` lain situahons (usc'addihonali ages�as necessa
Q) \0 6 F-lc of D:r"WALL, eA LL, LArE sP(�x/-xr
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone 6 Mb — 30
Date: `L'
14/201It

Type of Visit: (Q 7Routine
pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 4' yQ Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Vo�,t'Q7wtj Mt1t-� _
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder1[_INon-Layer
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
3 U
DairyHeifer
Design Current D Cow
Dr. P,oultrt Ca aci i;o Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes No ❑ NA [:❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) [:]Yes ❑ o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

lFacilt Number: -gly Date of Ins ection: ►0 1 h
771
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2
Identifier: �G-0bly
Spillway?:
Designed Freeboard (in):
ZNo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
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
ZNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
onmental threat,
oryyi
notify DWQ
7. Do any of the structures need maintenance or improvement?
es
❑ 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
[2] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2No
[DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
C' No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
126o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
flo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EjNo
❑ 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.
OWLJP ❑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 YNo
ro ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 31 - glq Date of Inspection: /D 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes LJ "'U ❑ 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 ZNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes YNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document ❑ Yes �No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 [ dNo ❑ NA ❑ NE
❑ Yes d/No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
[:]Yes E�/No
❑ Yes do
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments ;(refer,to question #}: Explain any YES, answers and/or any additional recommendations ori any)other comments t
xi;.. i
Use drawings of facility to better explain situations (use additional pages as n�etcessary). , ,?_�,
7j Dxke (JALL. CtWS-Zdr CysnENT, �«b W° �CFFP 06CV CAotJ OF AC]rtanlf
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
J6 tit) ..� Phone: C916
Date: 10 /3 J!
21412011

'x " d'ka}���"!'� •2,
t Div�siori of Water Quality `, A.. i
O"DIVISIOII of $oil and Water Conservation
�x x t asp
_ ,; D�Other.Agency� Y
.."Ilt
Facility Number
$
type of Visit
Co fiance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit:Eq�:p Arrival Time: !00 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: k)R-tg,,z,j to z5_ �A-, Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = I =61 Longitude: = ° 0 ` 0 "
Design + CllrreRt,"» k rs :DeSln.g a a� a �t..3 t
Cuirrent,G,R Design Current
s 1 3,: a xgr
;Swine' tCgpacity Pbpulati.on;y a -;,;Wet Poultry Capacity tPo ulatton Cat#°lei' '� Ca act Po ulataan
❑ Wean to Finish ❑ Layer
❑Wean to Feeder ❑ Non -Layer
Feeder to Finish
❑ Farrow to Wean �
D'ryPoultry `
❑ Farrow to Feeder x
❑ Farrow to Finish ❑ Layers
i
❑ Giits _ ❑ Non -Layers
❑ Boars
❑ Pullets'
��� X :
❑ Turke s
°Other, []Turkey Pouets4�`t "
❑ Other ❑ Other t
It
k .ea .,, �- -. ., Numbe of45tructu s "t
❑ Dairy Caw
❑ Dairy Calf
❑ Dai Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NB
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
[I NE
❑Yes
❑No
❑ Yes
N
:No
ElNA
El NE
❑ Yes
❑ NA
❑ NE
11/28/04 Continued

Fieility Number: F— $ jq Date of Inspection l a
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 d Structure 2 Structure 3 Structure 4
Identifier: (AJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .31
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ONo ❑ NA ❑ NE
El Yes El No ❑NA ❑NE
Structure 5 Structure 6
❑ Yes N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envir7yes
ental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes eNo ❑ 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 Cl/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ENo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
ElNA
[:1NE
18. Is there a lack of properly operating waste application equipment?
ElYes
No
❑ NA
❑ NE
Comments (refer, to.question.#):; Explain any YES. answers and/or�any `recommendations or anyTotber,comments ., ,
Use drawing&of6facillty to.better. explain, situations. (use -additional pages as necessary)=
..
n ra7r WO IL A WO &k A55
Reviewer/Inspector Name ;: .. �. t_., 4 Phone: 77t 3 W
Reviewer/Inspector Signature: Date: JoLlhb
Page 2 of 3 1 12128144 1 Continued

41
Facility Number: g Date of Inspection 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Ch kl' ❑ D ' ❑ M ❑ O I,
El No El NA El NE
❑ Yes No El NA El NE
ec fists esgn aps t er
21.
Does record keeping need improvement? If yes, check the appropriate box below.
[Dyes
No
❑ NA
❑ NE
❑ Waste Application [:]Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
�❑
L�"No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IJ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
I[J, NNo
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
LT No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
01N.
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues �—��
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes D ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ld'lao ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility post an odor or air quality concern?
❑ Yes
ONo ❑ 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
,--,��
E tvo ❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Er5o ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�`No❑ NA
❑ NE
Addith nal Comments'and/6r'6rrawings " : # a� - r ' i ; ;; ►xs R t s r � se 4 i t s r
MZ
Page 3 of 3 12128104

Type of Visit 46 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit J Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0 Arrival Time: DD Departure Time: __j County: •W Ur..0 — Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Npi}# rn'�--' Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0 = { 0" Longitude: = ° = t = "
<�s• � 't' ., r � 4 '�. e e .l s .i`�' � r�
w : Desi n Current < =j a Des n; s Current ''Design 5��tCurrent
.. gi'x.r
^;:,Sw:ne<`'` ` }` Ca acit Po elation. Wet,Poult �:
p y P„�a� rY Capacity Population Cattle r �: Capacity Population
. . s� . att . . �� a �� ..__
#. El Wean
El Layer Dairy
La er i
❑ Non -Layer
�
Dry Poultry ` <° by . F}x r
r
�.
Turkeys
�ATurkey
s-
`❑Other
Other s Number`sofAll
fii
Structure'
4 R 1
.[.:k`:'�6'�.:.`�-'t,.. >:`4. n-.4`: .�.. b;..,tt#.4-.si •:zs�. _3:�:.,.-a..tr4:°i �`, a ..,a�.. _.�. x.'K. e`�s'x;.:.•.-�.'L'�$w ���t.:.�A�y:�iW�: °a'tiir.a `��°t sx �^�aH
Wean
to Finish
'Feeder to Finish SZb
El Farrow to Wean
El Farrow to Feeder
;. El Farrow to Finish
Gilts
❑Boars
to Feeder
Poults
❑ Layers
❑Non -La Non -Layers
❑ Pullets
❑
❑
❑
Cow
❑ Dai Calf
❑ Beef Feeder
❑ Dai Heifer
❑ D Cow
Non-Dai
❑ Beef Stocker
El Beef Brood Co
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation? [3 Yes No ❑ NA El NE
Discharge originated at: El Structure [I Application Field El Other
a. Was the conveyance man-made? ❑Yes ❑ No [3 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [3 Yes El No ❑ NA [3 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) [I Yes ❑ No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? [3 Yes ��lo ❑ NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes �f No ❑ NA El NE
other than from a discharge?
Page 1 of 3 12/28/44 Continued
Poults
❑ Layers
❑Non -La Non -Layers
❑ Pullets
❑
❑
❑
Cow
❑ Dai Calf
❑ Beef Feeder
❑ Dai Heifer
❑ D Cow
Non-Dai
❑ Beef Stocker
El Beef Brood Co
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation? [3 Yes No ❑ NA El NE
Discharge originated at: El Structure [I Application Field El Other
a. Was the conveyance man-made? ❑Yes ❑ No [3 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [3 Yes El No ❑ NA [3 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) [I Yes ❑ No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? [3 Yes ��lo ❑ NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes �f No ❑ NA El NE
other than from a discharge?
Page 1 of 3 12/28/44 Continued
Cow
❑ Dai Calf
❑ Beef Feeder
❑ Dai Heifer
❑ D Cow
Non-Dai
❑ Beef Stocker
El Beef Brood Co
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation? [3 Yes No ❑ NA El NE
Discharge originated at: El Structure [I Application Field El Other
a. Was the conveyance man-made? ❑Yes ❑ No [3 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [3 Yes El No ❑ NA [3 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) [I Yes ❑ No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? [3 Yes ��lo ❑ NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes �f No ❑ NA El NE
other than from a discharge?
Page 1 of 3 12/28/44 Continued
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation? [3 Yes No ❑ NA El NE
Discharge originated at: El Structure [I Application Field El Other
a. Was the conveyance man-made? ❑Yes ❑ No [3 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [3 Yes El No ❑ NA [3 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) [I Yes ❑ No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? [3 Yes ��lo ❑ NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes �f No ❑ NA El NE
other than from a discharge?
Page 1 of 3 12/28/44 Continued

Facility Number: —
Date of Inspection S 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 2 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: I A,Llv&1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) dNo
6. Are there structures on -site which are not properly addressed and/or managed ElYes ❑ 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 th eat, notify DWQ
7. Do any of the structures need maintenance or improvement'? [IYes o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E:VN/0 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CfNo ❑ NA ❑ NE
maintenance/improvement? ,�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CI No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
F.,e(No ❑ NA ❑ NE
E(No ❑ NA ❑ NE
QNo ❑NA ❑NE
T � a,i '. x.. 9 _. -1,: �R ! 1`1"i"4. .i '4A'°�x.V4� �AV7-'w5'rYl �
Comments referjo uestion-# I;x Iatn an YESvanswers mmendatsons�orA_nft ther�,commentst ( � q ) p y and/or any repo
Use drawings of facility to better explain situations. -(use addthonal pagesas necessary} e ti� x. , 2 °
Reviewer/Inspector Name}��(, 4 T Phone:
r]
Reviewer/Inspector Signature: Date:
O
12128104 "Continued

Facility plumber: — j Date of Inspection 3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropiiate box, ❑ WUP ❑ Checklists Desi n g ❑ Maps ❑ Other
❑
❑ Yes dNo ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
t.! No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
{1J No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0"N'o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2rN.
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
21<
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
j:Ko
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C1 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2No
❑ 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{r Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
" o
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did ReviewerArispector fail to discuss review/inspection with an on -site representative?
❑ Yes
5N/oE1NA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yeso
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

ype or visGi V-plianCe Inspection V vperation Review V Structure evaluation V Technical Assistance
Reason for Visit 7Routine O Complaint O Follow up O Referral O Emergency O Other El Denied Access
Date of Visit: t i b $ Arrival Time: Departure Time: County: NPR rIV Region:
Farm Name: Owner Email:
Owner Name: I Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: _ lJ��'�tNHN /f I71,Lt li-__ _ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: e 0 1 = I{ Longitude: = ° = 6 0 «
-Design Current ; bDeslgn* Current i° 5G�;DeslgrzCutrent`'
Swore a Ca.'pa'city P,op01A, io, Wet Poultry Population ; 7, Caftle ' �5 - �1 Capacity P A
,;'Capacity pal
'
❑ Wean to Finish
❑ Layer
❑
Dairy Cow
❑ Wean to Feeder
❑ Non -Layer ❑ Dairy Calf -m
x ' "� �, 7 �`
� x El Dairy Heifer
a4, ❑
+� �+ 4 Y =:'� :� �, ,� �, D Cow
� �D,ry.Poultry ��• � � eax�''�+n-3, ti ��;��
�t �" ElNon-Dairy
�
® Feederto Finish
6 6
' €
❑°;,
Farrow to Wean
❑
Farrow to Feeder
�'+
` ❑ Beef Stocker
`� ❑ Beef
a�
El Farrow to Finish
;
El
Gilts
Feeder
>; ❑Beef Brood Cow
Turkeys
❑ Boars
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation`? Cl YesdNo El NA [I NE
Discharge originated at: El Structure El Application Field [I Other
a. Was the conveyance man-made? ❑ Yes El No ❑ NA El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? El Yes L� El NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes No ❑ NA El NE
other than from a discharge?
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection R d
sWaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ 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: LA %-d
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ENo ❑ 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 environmentalthr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes d ❑ 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 7No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L" i No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Lf�I NNo
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
ElYes
LT
[I NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
Z�NIN p
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
Yes
El Yes
❑ NA
❑ NE
Comments (refer to question:#}: 'l✓xplain�any YES answers and/or any recommendations ar any other comments.
Ue drawmgssetter ex plaintsituations,_(u_se add�tionalipages as necessary):
—�77-
Reviewer/Inspector Name LV ` `` Phone:
Reviewer/inspector Signature: Date:
Page 2 of 3 r 12128104 Continued

r
Facility Number: Date of Inspection !i v
`Required Records & Documents /�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El 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 ❑ Ma s ❑ Desi n ❑Other
g p
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
LJ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
4'J No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
i No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[Ko
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
o
❑ 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
CJ 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
0 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
c
[I NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
7No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 6 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: Arrival Time: Departure Time: County: L V Region:
Farm Name: Owner Email:
Owner Name: I Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative: d U nLy &
Certified Operator:
Back-up Operator:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = = Longitude: = ° 0 , = is
11-.IDell"ign urrent ign pracity Population Wet Poultry Capacity ,Population Cattle Capacity Population
❑
Wean to Finish
❑ La er
❑ Dairy Cow
❑
Wean to Feeder
❑Non -La et
❑ Dairy Calf
Feeder to Finish
flA I
Dry Potil
"" FAR:� "`
•r ❑ La ers
Non -La ers
El Pullets
❑ Turkeys
❑ Turkey Poults
❑ Dairy Heifer
Farrow to Wean
El Dry Cow
El
❑
Farrow
Farrow to Feeder
El Non -Dairy
Farrow to Finish
❑ Beef Stocker
P1__1
Other
Gilts
Beef Feeder
Boars
❑ Beef Brood Co
Numer of St 'uckures:
❑ Other
❑Other
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
❑ N
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection !
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes a ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ff 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 environmentalat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [I NA El NE
❑ Yes o
(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 LJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA ❑ NE
maintenance/improvement?
H . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑*lo• ❑ NA ❑ NE
[2 No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
�I �S El NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: 6
f 12128104 . Continued

Facility Number: — Date of Inspection 6 0
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropirate box. ❑ WOP ❑ Checklists ❑ Design ❑Maps ❑Other
or
❑ Yes — No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
21,
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections
❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L✓I No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B"NNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0N
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
CJ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
WNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0No
[I NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
E No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes Q-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 B 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 FJ No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes E No ❑ NA ❑ NE
Comments and/or Drawings:
12128104

vision of Water Quality
Facility Number 3 L Q Division of Soil and Water,,Conservatio'n V .
- r) Other Ageucy
Type of Visit j2rcompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: GQ Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: a Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 = = Longitude: = o = ` = "
Swine;
Design Current: Design . Current Design Current
Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
�❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean {
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts {
Other
❑ Other
❑ Layer Ij
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
rrOther
❑
DaiEy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: �{
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number:2z ip
— Date of Inspection
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
24--Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ 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
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
4-c) coyrNp1,e t>y j ud 5u r
A6
'P1\ao�C_
/Nib N
Page 3 of 3 12128104

Type of Visit 7Routine
pliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: ! o Arrival Time, �DO� Departure Time: ®Q County: QVeLT4 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: C?E� '' rr ��p� Integrator: �7L (40"p"a-0
Certified Operator: QZb_l ._NT__LL� Jy' Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
o
Latitude: =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
3 Ld
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry ,
Non -La
Pullets
U 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?
Longitude: = 0 = ' =
Design Current
Cattle Capacity Population
❑
Daia Cow
❑
Daia Calf
❑
Dairy Heifej
❑
Da 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)?
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 Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑YesVNo
�
El NA
El NE
❑ Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: 31
Date of Inspection t o 6S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier: (jq tea I
Spillway?: a
Designed Freeboard (in): 1!
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 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes 2rNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Z No ❑ NA ❑ NI?
(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 Cl Yes KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LQ ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) GW S eca mljt)h LIQ EGO
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
14J (4ec_¢ cogv jF -.WD
Z1.) OeDfVr6 C"47
[ffNo ❑ NA
djNjNP-❑NA
Li o ❑ NA
'V ❑ NA
No ❑ NA
%s To ecunxs.
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Reviewer/Ins ector Name �3�s t-[ t' ' Fr��-n/ �' r s,„ Phone:
p ' ' �„ �' (pro) 391 S = 390 z.
Reviewer/Inspector Signature: Qa�.s,.�-, t Date: ?.Iw io y
12128104 Continued

Facility Number: Date of Inspection to 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WDP ❑ Checklists ❑ Design ❑Maps ❑ Other
RCJ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Week Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
[ZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E?,NNo�o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
LJtvo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
❑ No
[2NA
2NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
D<o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[2"go
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
PNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
LIy
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El
No
❑ NA
❑ NE
Ad:ditionul Comments and/or Drawings.
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit l) Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: Time:rO /d`3
Not Operational 0 Below Threshold
�} Permitted 13 Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: C— r74 / 0 �✓1ns County: 1521t .01L_t4_
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator. 16. Vwd v'
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' ° 0 Gi Longitude ' 1 0 u
Design Current Design Current Design Current
Swine K Capacity PFopulation Poultry Ca "aci Po 'illation Cattle Ca aci Population
❑ Wean to Feeder ❑ La cr ❑ Dairy
91 Feeder to Finish d ❑ Non -La er Non -Dairy
Farrow to Wean 11
--
❑ ❑ Other Farrow to Feeder j,,, �
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total 'SSL• W
Number of La oohs ❑Subsurface brains Present ❑ Lagoon Area ❑ Spray Field Area
g
HDldin _
g,Ponds 1 Solid'Traps ❑ No Liquid Waste Management System
Discharges !& Stream ImRacttj
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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: %
Freeboard (inches): 27
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Structure 6
Continued

Facility Number: 3% —a Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered 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
❑ Yes ❑ No
❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN El Hydraulic Overload El Yes ❑ No
12" Crop type t�W L ih t '!7 ,
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 wenable 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 or other Permit readily available?
❑ Yes
❑ No
IS.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design. maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑ No
(ie' discharge. freeboard problems. over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
© No violations or deficiencies were noted during this visit._ You will receive no further correspondence about this visit.
C'4"M '.f"Q 1��., .� . .'�i - /'A� '. Ei ` "ewt'"l9 h�f'iaNiii7W: r8s.: f 6..11j YJliy{..ad+i Ed.•,M,i P. j h
a� �;" nmmeas(rertignesioof)• prialYf { j
awesanlar 1'Eim,
Nn- s , •, 3` ":°i1 I ! -. i a`. , troll. , 'i�M'...W,-s:%N..._ ...::».....; ..-.L...�..w....d ,
eftlain
Use drawsrt�o��$..�t,�b�ier�.r� �"�'a��o�e�ddE.z�pi�p��+�r�>h.��gry��❑..F�ld Copy � Final Notes
r
a 44e Itnt o AQ# q= A 3
6ev' 4i140.1y lllcle Cdor 4ce"15- ih 'e,'Olth ' DWW-4'
i
44'4 ,. �/�A,oFjA4 ,o
Reviewer/Inspector Name n°T `' "" ' '"' ^E�' i�
Reviewer/Inspector Signature: Date:
O5103101 1 v Continued

Facility Dumber: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or la+aoon 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. NVere any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s). inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentltemporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ )es ❑ No
❑ Yes ❑ No
Additional Comments and/or Drawings:
A.
I J
05103101

Type of Visit 10 Compliance Inspection 0 Operation Review Q Lagoon Evaluation I
Reason for Visit J6 Routine 0 Complaint 0 Follow up 0 Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit:
Permitted ©Certified Q Conditionally Certified [3 Registered
00=4_Farm Name: �
Owner Name: J H.rLp,7 __ AMA R htZL a'i
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Time:
Date Last Operat or Above Threshold:
County: U I01—
Phone No:
Phone No:
Integrator: _ P _14-yLop z
Operator Certification Number:
(Swine ❑ Poultry ❑ Cattle ❑Horse Latitude 0a 6 Du Longitude 0' 00�
Swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current Design Current
: Capacity PopulationCale Capacity Population
❑ Layer I I ❑ Dai
❑ Non -Layer ❑ Non- airy
❑ Other
Total Design Ca` acit
P Y
:HoldingFoods�l Solid Traps:..
Total SSLW L
[] Subsurface Drains Present ❑ La oon Area
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in 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 theWaters of the State other than from a discharge?
Waste Collectian & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inchcs):
05103101
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes O'No
Structure b
Continued

Facility Number: 91— Date of inspection / / -
5. Are there any immediate threats to the integrity of any of the structures observed?•(iel trees, severe erosion, ❑ Yes . No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �No
Waste AMplication
10. Are there any buffers that need maintenance/improvement? ❑ Yes VfNo
11. Is there evidence of over application? ❑ Excessive Ponding] PAN El hydraulic Overload ❑ YesWX
12. Crop type (o, LAJe
(-} 5
13.
Do the receiving crops differ with those oleignated in the Certified Animal Waste Manilgement Plan (CAWMP)?
❑ Yes
RrNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
gNo
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
gNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
VNo
Required -Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
o
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
WUP,
El� Yes
//��
No
(ie/ checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Ces
❑ No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22
F .1 1DW f A G I
ai to notify regiona Q o emergency situations as require y enera ermit.
(ie/ discharge, freeboard problems, over application) ❑ Yes XNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ElYes PrNo
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ,� No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Y E , �. — v ^•y < g , , t 4 s- r 3 �Ssr" t'& it - :i i a rl r '3 if 3 E S 'a � i� 4 1
Comments'.(refer,to question'#)zplain seiyiYES a>assvers,iindlor, "any, recommeni(stions orany atherc©inments.�i -z 3i. s
Lase drawings oifacil_ity to better explain sttuattons (i sc addi#ional pages'asneccssary,rlO Field Conv ❑Final Notes ' ul
NRC& (�e%L NO tPOAPO 0 D RE ME r
w- aj, REquts-r FFcors CigfcK Fort DxAP>°c�C►�Tzo�,.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Wo
aaiosivt connnuea

• . [
Facility Dumber: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Ye No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Y s No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt. ❑ es 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? ❑ es OrNo
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.) ❑ es o
31, Do the animals feed storage bins fail to have appropriate cover? ❑ Ye N
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
i i E i1 3 9 i
AdilitianalGammentaand/orI)rawin�s:,,.., Iz `.; ,.�,€:3; n�€ ��3 �`'�: ,E,,, ,.I
Co VALa ►IJ o [.ac PA LA- EQ U L 2��� �oc krnr
Sqcf+ f�S �i2�rP�o�r2p � Dz��-s l C-wR-P'"-r
f
tivr2y ELSE
v cr
-5 �IPLF :5� rGz 2003 .
) 5o o l 6
�I o 4-r-
375-,?ROO 24
05103101

Type of Visit 1P Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit 0 Routine Q Complaint 0 Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number I Date of Visit:
Permitted 0 Cer ified [3 Condit ally Certified © Registered
Farm Name:��7%/l�
Owner Name: .Dlt) <1'r -z,,.0 r z6zz-& dK
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Time:
Date Last Operate or Above Threshold:
County: 211zzd �r
Phone No:
Phone No:
Integrator:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` 16 Longitude 0 6 46
Design Current 3Design Current Design Current,
Swine Capacitv Po ulaiion ;P it Cii aci Po ulatlon, -_ Cattle „ Ca aci �.Po ��ulation
❑ Wean to Feeder I JE] Layer ❑ Dairy
ceder to Finish ❑ Non -Layer I n-Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts (a I
❑ Boars
E' Total SSLW
Number of Lagoons
b'
Holding Pondk] Soii[I T raps a I";
Discharges & Stream Impact�
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?
WasteCollection & 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): 23
05103101
q
❑ Yes
/YJ❑ No
❑ Yes
No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
;�No
❑ Yes
/0 No
❑ Yes
No
Structure
Continued

Facility Number: — EM Date of Inspection 2? D
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(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?
❑ Yes ;�No
❑ Yes ;dNo
❑ Yes X,No
El Yes �No
❑ Yes XNo
❑ Yes ZfNo
❑ Yes A No
❑ Yes gNo
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes E�No
❑ Yes )ZYNo
❑ Yes 0 No
❑ Yes
2fNo
Y
Yes
El No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
)ZNo
❑ Yes
ONo
❑ Yes
ENo
p No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
,Cornii�`ient Qefer to question;#) "Ezplain any YES answerd"ai d/a any recommendations or any other comments y.
,�.
';
7s drawings of fac%liky to better explain sltuations (use additional pages as necessary)
Field Copy El Final Notes
.�.>.n "i ...��
Reviewer/Inspector Name ,
Reviewer/Inspector Signature:
05103101
Date:
A z
Continued

Facility Number:, l Date of Ittspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes �INo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes y No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes VNo
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 VNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or --L/
or broken fan blade(s), inoperable shutters, etc.) El Yes PNo
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 omments and/orDrawings:
ICI� z�� /0
5100

otl
Dv c'ls oo n f Water uah �
r r z li
Division of Sand Water Coaservatton ;rl h k{p '
Other'A enc....
g Y.
-. r-- - _. H.�_�.1 -�l it air. �: �1 ,r4rt P. ',�i�.'•f:`v�r���ift:.�klt. �'�k_�M.Iawr,'
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ' ❑ Denied Access
Facility Number Date of Visit: % 'Tirne: ® Printed on: 7/21/2000
10 Not Operational Q Below Threshold
13 Permitted © Certified Q Conditionally Certified 0 Registered Date Last Opera d or Above Threshold:
( ZAM.Vlre.
FarmName: ......r��1
��...f�l.(f�.� . &-i- County !�1� .... fl ........................... G�......
fl
Owner Name: ........ ,„�.frt/lTj.......L.......... t,............* Phone No:......J( .....SGI.....................
I'itic ..... .. Phone No:
Facility Contact: ...... ,�o�....G.' /�jLJ�`. Ste`' �iu/•1•LJ.�..... .. ......'c:..................
..�.........................r....{... ..........................`-2...1-...Mailing Address:.... .......
64�-
Onsite Representative:......r............ .,...................Integrator:....ja...... .�....... �!..iiS..
Certified Operator: � .� Operator Certification Number: •..AZ Z �'.......
Location of Farm:
S 12>t- S4 1 !�S PAP-Q'r 70fit ! s2 I SS
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ���° Longitude 1715• ©< «
Design Current
nwrne
❑ Wean to Feeder
,Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW 1 4Y'7S 7-
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagn n Area I0 Spray Field Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System .
Discharges & Strearn Impact
I. Is any discharge observed from any part of the operation?
❑ Yes ko
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. II' discharve is observed, what is the cstilnatcd [low in gal/lain?
d, Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 5
Identifier: ..................... .................................... ................................... ................................... I ............. ,......................
....................................
Feeehoard (inches):
5100
Continued on back

Facility Number: — Date of Inspection /15Q1 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? '((ii'e'/ 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? ❑Yes 9No
(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 ,,1 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes jo 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 ,J No
11. Is there evidence of over application?
❑ Excessive fPonding ❑ PAN ❑ Hydraulic Overload ❑ Yes VNo
�n
12. Crop type �`( . l�ae&dc r�
� kq� j�
I3. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(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?
10 yi6taiioos or Mciences mere i6ted-ftfig �his'visit- Yoo wll-teeepe 1J6 rufft:
correspondenceabout: this visit.. • • . • •
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):
VI.M17-tz) uJif - lrl I60,ef !/CE9%
❑ Yes ,o No
❑ Yes No
❑ Yes , No
❑ Yes AI No
❑ Yes Vc','jfNo .
❑ Yes jo No
❑ Yes 4 No
❑ Yes No
❑ Yes No
❑ Yes ,� No
❑ Yes eNo
❑ Yes k No
❑ Yes 1� No
❑ Yes No
❑ Yes No
A.
Reviewer/Inspector Name lYl 0(141G!A"W _
Reviewer/Inspector Signature: Date: A ' 5 / 5100

Facility Number: — Date of Inspection f / Printed on: 7/21/2000
Ajdor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes A 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 Z No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes JP 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 AeNo
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 JO No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Jr No
32. Do the i7ush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes A(No
5100

+one r r 'at lit .In:fo r�na on
.�
Facility Number 31 814
Colin
Duplin
Owner
Wight Lamar ill, Jr.
Manaser
Address
Certified
Farm Name
Cotton Top Farms
Phone Number
919-658-9824
Lessee
Re ion
108 Albert Grady Road
0 ARO
0 MRO
0 WARO
0 WSRO
t. Olive NC
128365
OTRO
0 RRO
0 WIRO
$
Location
Northeast of Calypso. On Northeast side of SR 1559 approx. 0.25 miles Southeast of SR 1558.
Certified Operator in Charge
Backup Certified Operator
Comments
LO Inactive operation 0 Lagoon Closed Date inactivated or closed
Type of Operation
® Swine 0 Poultry 0 Cattle 0 Sheep 0 Horses 0 Goats 0 None
Design Capacity 197
Total
SSLW
Subsurface Drains Present Lagoon Area
No Liquid Waste Management System
3,520 Swine
475,200 Feeder to Finish
I
Lagoon Total Capacity ft
Spray Field Area ']
709,920 I

Latitude
35.1881
35 11 11 17
Longitude
78.0131
78 00 _ 47
{'
69 •33
hfi`�.4i:'�A'
MUM i
�
• •a'i•�
nr...>.t.,i E
5 0.6
',
Michael E Sugg
�
01
A
3 C Howard Farms
Request to be removed Ij Removal Confirmation Recieved
.................................................................................................................................
Comments
Regional DWQ Staff
Basin Name: Icape Fear

© Division of Soil and Water �Conservatton Operation Review
s
M
: F { r, iE�
t
: , €. 11 ":€� 3 r @- u r .' :. d� -'�1 s,
[Division of Soil aiid Water3Conservagon ;CoR]pliance €TnspectIQ" N Ej,;
i
�a ti4 r
;p
'
[ f
t
ty -, Coi
;Division of Water Qualinphatiice Inspection ;
i
Other,Agy`Sop�Review:> �[�,i I E - S
ypt
-��
,' f FE i
'
143 Routine Q Complaint O Follow-up of DW ins ection Q Fallow-u of DSWC review Q Other
Facility Number 1]att of Inspection
7 ime of Inspection =24 hr. (hh:mm}
ermitted [ Ce hied © Conditionally Certified © Registered E3 Not Operational Date Last Operated .
�Lp
`\
FarmName: ..... .... � .......'r! ................ �.[[.' it ........................................... County:....../. .G1.l%fi.................,......... � ..:...
Owner Name: ......... ..W! IJT................L...'..L.IL. s l.f....: Phone No: :./...It L.9.Q....r..i!M`........................
Facility Contact. ...1. .. .. ............../Wk . ............... Title: ........ // M.- .... Phone No: ...................................................
Mailing Address:
....��..................�:... ..,...D..l ..../ ... �-
Onsite Representative:... . .. ..... .....................1l.............................................. Integr tor:..1:1..... :.......... ......................
Certified Operator:......./ ,/1 .................. ....... .............. Operator Certification Number...........................................
Location of Farm:
................................................................................................................. ...................
Latitude 0 6 •' Longitude • 6 CA
Design Current ;"! DCsignn Current �;' Design Current _ >
.Swine; , Capacity Population Poultry Capacity-
pPo oulation Cattle" Capacity Population.
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
1❑ Layer ❑ Dairy
E] Non -Layer I Non -Dairy
❑ Other
Total.DiAgn„Capacity
Total.SSLW
Number 6 , , , i Subsurface Drains Present ❑Lagoon Area
s Holding�Ponds/,Solid.Tra p � ❑ No Liquid Waste Management System
E ,
Discharees & 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 Stale? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/tnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
Spray Field Area �.
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 adischarge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure i Structure 2 Structure 3 Structure 4 Suructure 5
Identifier:
Freeboard(inches): ...,5).157 .....................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes [j No
❑ Yes Po
❑ Yes No
AIM
❑ Yes' 3� No
❑ Yes �No
❑ Yes �No
❑ Yes No
Structure 6
❑ Yes !back
No
Continued
3/23/99

Facility Number: 3I — WWI
Date of inspection
6. Art; there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'? El Yes *fNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes <No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [VNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes gNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes KNo
12. Crop type CWv . ,S4 9If
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 IV
No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes N No
15. Does the receiving crop need improvement? ❑ Yes "XNo'"
16. Is there a lack of adequate waste application equipment? ❑ Yes XNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ;kNo
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 pkNo
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) /( Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes IQ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes to No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 14 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes A No
24. Does facility require a follow-up visit by same agency? ❑ Yes M No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes gNo
')'Vq •viol'aiiQns'or• ft icjenndps #erg doted. Ooring this,visit: - ;Y;Oir Wiil•reoiye 06 furtli0'
�cor'res• 6fidence' abatit' this visit.. ..... .
any YEStanswe'rs and/4'�any;recgtninendations araany�ottier comments ,�, _ { Comments; refer to uestiniit# E plain situations (use"additionaljpages as ne"cessaryf) F E'rr'
Usedrawings of facility to better ex ��. �` �'�r ,
Mxf
G� � � � �' �S Y �r��� �' ►qua .
/20a/�/�
pector Name
Reviewer/Inspector Signatures ,///j ,, Date:
3/23/99

Facility Number: , — Date of Inspection
Odor IsWes
N� Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below es
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,
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?
A/ 1�3 . o the flush tanks lack a submerged fill pipe or a perm anont/temporary cover?
7-
Additi6nal CommexAs.,iind/or,`DrAiWings'
� p%`E� wa-�(-
a� /�r a,
❑ Yes No
❑ Yes 1�-No
❑ Yes�10
❑ Yes -9fN0
3123/99

.!
V, 0 Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality��
10 Routine 0 Complaint 0 Follow-up of DW( ins ection 0 Follow-up of DSWC review 0 Other
L— I Facility Number D—
Date of Inspection Z 4
Time of Inspection � 24 hr. (hh:mm)
0 Registered ® Certified D Applied for Permit 13 Permitted
[3 Not O crational Date Last Operated . .......
Farm Name G +�
Count .
OwnerName: ...... V.V4 �. A......................Lk.,1...3...;.....................................
Phone No: ....C.g...l.1.....b ...................
Facility Contact: .......................................................... ..... Title:..................
. Phone No:
Mailing Address:...` ." .......Li.k%.;S�.......I...................
.iUl.r.....Q.1..t..v.......O„1.G.............................. .Z$,. .6 .
-
Onsite Representative:....�.tin�.;.�.1�1.�...... .1.1. Sr .
v..............................................
..... Integrator:.. �,
,...�. �...... ,6r. u� u�..Y.....................................
Certified Operator................................................................................................................ Operator Certification Number;...................
Location of Farm:
i,�r, ....t n..r. hr,.� ,a.s....... �.i. �..e .....c........ 5. 1..� ..�.`i.t.....�.�,..4..► �,..y ..L , , ..... Q Z ... t..t.�.u.� .... s...s �.s.A.Xj.... A
0%:...,^..[�-^..es.1.D,......tn1.�.t1r ...5y.r✓'..i7!..............................................................
Latitude ©• ©4 © 94 Longitude • aD f 4�
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes JR No
Discharly originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made' ❑ Yes ® No
b. if discharge is observed, dill it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min? 4 1A
•d. Does discharge bypass a lagoon system'? (if yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ® Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes CR No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes H1 No
7/25/97 Continued on back

Facility Number;
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lauoons.Holdinu Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Stnucture 2 Structure 3 Structure 4
Identifier:
Freeboard (ft):........L.15.............................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes
No
® Yes
❑ No
Structure 5 Structure 6
❑ Yes
No
❑ Yes
No
12. Do any of the structures need maintenance/improvement? ❑ Yes 0 No
(if any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes RNo
Waste Application
14. Is there physical evidence of over application? ❑ Yes ® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type W.ln.a.....................................................
.. .............................................................. ..................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ® No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
❑ Yes
® No
19.
is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
19 Yes
❑ No
21,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
® Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
® Yes
❑ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
® Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
® No
[3 No.vitilkions:or deficiencies were-noted_during this:visit:.You:will recei've-nti:flirt er::;
c6rrespohd6ke about this. visit-,: .
Corninents (r fer to gaestron #) " xplain any Y);S answers and/or nny recommendations of any other cgrntnen
Use dwogs of facthty to better explarn srtuatjgitrs� (use addrti4nal pages as necessa y) Nq"
.h.."i! r. : ,d &4
V% � � � o (rp�,,-r A e` S y r,�w W � •rv�, , t r,p,
• ,A vT' `+�+.-p aQY�. V �-A� 4 1 � d W d S � rD "I t Q-<L T.. � , 1 Q , ✓l J73 , � ; S ; p i
p1 � �,,.� : „� u ...•. � f� � a t-• ci+t � , P ��;�
S 1M v t tl� kz ,f e " V t-ael . 7tn t -L a � V r-. �� ✓h t'_ i a f O�•r-gV 'H�r` k O.-S 1"-a^'.1 I
i-+ (_a r c {- tKn'� K; at vo L e ,.,�
`. Ma t "3o o^ s 1� u LAL k.e. p v oAems- rig a.fr i^ e- a es p a- s t b UL._ w.>ti~ N
2z. S ko v -ci v r
3 R S _ r 1 0
. y c 0 r
f O'. - S i (-2 cL t- aft f + ✓h tS
.
re c o .-r� 1 , .tia r ,TJ a� �C L- 1. k Y s J X C XA'LA.J_ r V^ "
�
i t �Ld tt b +� 1 Cl , t 9 1 t m., 4-, 8..fd_ m, Ll b 3. r3 z t 6 i . E
v r`e- t~ E a WtIrt, tc1, f-i 0 � d �S t^.o J- o ccV v- 01 ek 7/25/97
r >:zw
Reviewer/Inspector Namc------------
Reviewer/Inspector Signature: Dale: Z q
V

Facility Number:.., l..... —. �`.�. .. Date of Inspection-.1 2. S Ilk
Atdditional Comments an or Drawings 'r ;r
GCN���VDv/"+ 0.
tke 1r(JG,[ �Q✓L) �OQ 1JLd1GI [11�0V �tivbe
o V\, a 4 a -v ray t-a-vt a 1 fi1n.e 0 V f 'Sep a� a� y-p t
L.L tt� t t s I d o e s v, ¢ n e, c v Y- t J 0.-I .•, .
A S e c-o ,r.d i J a 44 c e a � �� t�i ttw+ c. � U ; i 1 � � �wt f =d�..
4/30/97

a :- . ':�?iI� S'I a,rrk:�t9➢�,lr' .i..,_.. -L �y.��•. -f . .- •. v wf ,���
. Divisir►n (4 Soil gild Water Conservation 00therAgency .
13Division orNValcrQuality
P
p Routine p Complaint p i,rl-il m—p nl UNvQ rnspec:lwn p Po o►r-up o review p Other
t)'OC of Iirspection
Facility Number '�"�tT-�
Time of Irispectiou 1 13:00 1 24 hr. (hh:mrn)
p Registered M Certified Q Ahl►lic!d fnr Permit 0 i'cr•mitted 10 7ot )7------ M Date Last Operated:
Farm Name: Colton...T•o{a,Ii.'atrals......................... ............. County: Duplin WIRO
Owner Name: Dwight ................................... I:LillAr............................
Facility Contact: Dwjghl.hlillJx................................................'Title O.wiier.
Mailing Address: ..7.4.4,Kinsvy.i Jill.li.ci..............................................................
PhoneNo: ..........................................................
...................................... Phone No:.............................................
.. I!L.Olixe..NC..•...................................................... 28.165 ..............
Onsite Representative: A►ligh.1..I:I.tit.11............................................................................. lntegr.itor:J.C.Ro.War.d..F.arms,.............................................
Certified Operator: Dwight -I. MillAr................................................ Operator Certification Number-.20214.............................
Location of Farm:
n.nor, eas .. e:!�..........:.:..-... ;,tllitrox.::..r:..::nir s.so.ut t.c:askI. .:1,11ursu n.n.m.i a.
x.... +�H Nnx'••
Latitude Lon-iturlc: ®•
etitgn _cIVI'cn
swine Capacity !'opnlaiinrt
p Wean to Feeder
®Fee erto Finish
>>_.
_
p Farrow to Wean
p Farrow to Feeder
p Farrow to Finis
❑Gets
p Boars
Design current,-.,
esigm€ urren 7: 77
Poullr
Ca acit, . Po elation''°'Cattle ' `,`
Ca iie t "Po iii, nt
0 Dairy I
I:.
s
l] on- airy
her
• •Total Design:Capa.6q,1;
,
Total SSLW475,21)0
Number offLagoons / Holding fonds ❑ .. n isui ace rains Present ji p agoon rea 113 Spray Fie rea
>�r ii �r�llt � � �[d�r.*t7 zl •_E '.„J' �3a� t 3 0 o Liquid aS l' Management yS em i 'a4�t s - '
4 €rt �, i� di ;� �p I75� e �,. f aj.j p n4E ° d e g lfa
General
1. Are there any buffers that ncecl m iifitcnancclimprovenlent'? 0 Yes ® No
2. Is any discharge observed fn)m nn%, ol'111c. operation'! p Yes ® No
Discharge ori,i,r: r,-1 w, p Lli000n p Spray hide! p Other
a. If dischai-c iti ni:'WVVC' 1. %V*, the cnn';c%`nncc: ;iioiri-made? p Yes p No
b. Ifdiscliar,,,t is nl,.,; ccl. slid it reach Surface WiteO (lfyes, notify DWQ) p Yes pNo
c. If dischar;i,: V, t lr r crl, what is the csli;rmled flow in gal/min?
d. Does discluliv,: b:l r;tis a Ial,.nirn systt:ni'? (II'ves, not il'v DWQ) pYes pNo
3. Is there evidence of past disclmi ec f,om any part of the operation? p Yes ® No
4. Were there any adverse impact~ I0 the walrrs of the State other than from a discharge? p Yes ® No
5. Does any part of the waste ummi-cnirnl system (other titan lagoons/holding ponds) require p Yes ® No
maintenance/improvement?
6. Is facility not in compliance with <wy xisplicahle setback criwria in effect at the time of design? p Yes ® No
7. Did the facility fail to have a r.01-1 i I toil c1pc•.rnt01- in responsible charge? p Yes ® No
7/25/97

. .
Facility Number: 31_814
8. Are there lagoons or storage ponds on site which need to be properly closed?
p Yes N No
Structures La oons Holdiw.,
9. Is storage capacity (freeboard phis stnrnr storage) less than adequate?
Sn-uc 1t 1'. I .rlwhtv 2 "• ruc:r, rc 3 Structure 4
Identifier:
Freeboard (il): 2
10. Is seepage observed from tury of'thc structures?
11. Is erosion, or any other threats 10 the integrity of any oi'the structures observed?
12. Do any of the structures necci mainfenancc/improvcnront`?
(If any of questions 9-12 1%as answered yes, and the situation poses an
immediate public health or cnvir-onnrcnt:tl threat, notify DXVQ)
13. Do any of the structures lacl, adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of -aver application?
(If in excess of WMP, or nmol"l' entering waters of the State, notify DWQ)
p Yes ® No
Structure 5 Structure 6
15. Crop type ......hc.at,..BarIcy.,........ Coxn.(Sxlage.&Grain)r.......
NIiIo, QaIs)
16. Do the receiving crops dilTor with those deli-natec in the /1nimal Waste Management Plan (AWMP)?
17. Does the facility have a lack ill' adccluatc acreage for land application?
18, Does the receiving crop need im prnvemcnt?
19. Is there a lack of available \~•caste application equipment'?
20. Does facility require a follow-iip visil by same agency?
21. Did Reviewer/Inspector Fail to discuss review/inspection with on -site representative?
22. Does record keeping neccl improvement"
For Certified or Permitter) t'> ors; , "^ %
23. Does the facility fail to have �t c(�py of-Il:c Animal Waste Management Plan readily available?
24. Were any additional problems anted which cause noncompliance of the Certified AWMP?
25. Were any additional problems rwCd Which cause nomconIpliancc of the Permit?
Q.. o via1ons.or ttrtt!g.t s visit: ouwi receive further.
•;�;�;�:.'..,'. . . . . .
p Yes ® No
13 Yes M No
p Yes ® No
13 Yes N No
p Yes ® No
. Soybl"arts....................
p Yes
N No
p Yes
M No
® Yes
p No
p Yes
N No
p Yes
® No
p Yes
M No
® Yes
13 No
p Yes ® No
M Yes p No
p Yes p No
¢mute %Vr�pfor� to queNstroil �,xp ,r ill any ranc��Cl'S and Ur -ally,„ Y�B,iCO�.jn15n1ed l�yl�9 a. r�Yin.s .ol _.a>tiy (1 erg mm-en
�tt k goo Vh"I 95 3 F '=§F -0t%1t6EetpE � MUM �^
=Usaa�:drawingsroffacllrty`tohcttcr c-xl+I rtn srfu rlrcrns (utic ulthlranalpagcs'as n0cesa Y`
18 Continue working toestablish 13cr111uda(irass.,' ti r
2 Doesn't have records on -site For Bermud wr-ass Application and summer Annuals Needs to have records on site Needs`to use
irrigated'acres ratherthan total acres nnc(:n !=goring N per acre, Do IRR-2 by pull or field and adjust4, a d'+:acres as appropriate
4Fiffout Emergency Action flan (Gave InscctlOdor & Mortality Checklist).
eeY
d to.�work'with District to add snmtmcr <innna!s on Fields I A and 3 to waste management plan if owner: wants,to-°apply,waste to, :
tlieillslecrops:.
eed to have owner agreement included in A WNI P for acres not o',+riled by operator.
OTE: Need to work with District In gel records correct so operator will have an accurate of how much N to applyWinf&25/97 t
ReviewerlInspector Name 'Ver•nou Cox :' `trt €r' F84 ,i = ° ��... '+i e,aa,%p ORION t : NOW
.,-- �E
�:�.a,...., H.. E st ..
ReviewerlInspector Signature: Date:

❑ DSWC Animal Feedlot Operation Reviewa�Jigl
m
x : °[aDWQ Animal Feedlot Operation Site Inspection
"M
0 Routine 0 Complaint 0 Follow-up ofDW0 inspection 0 Follow-up of DSVVC review IWOther
Date of Inspection a !'
Facility Number 1. Time of Inspection 24 hr. (hh:mm)
13 Registered ® Certified (l Applied for Permit [3 Permitted JE3 Not Operational I Date Last Operated:.,.....
t
...
Farm Name: +� ......i`.0. C.ounty.�,t,n,..................... i.,.
(honer Dame: T).w.i , �1..r...................! !'L.S.�... 1r................................ Phone No:..k..�.,,).�,)....�:Ss......_.....,....... - j.....................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
f ,
Mailing Address :.... .....................!�-t. . i... i..�:I..... d.,................ ...p t Phi..�..-........................ ...ZtICS.
Omite Representative:....D.L,?..!.. .�4.4'.......... ......r....c?e✓.c............................... Intet;raEor:.. ,.. ......1�5O.aN.t x!t..........................:....
Certified Operator;............................................................................................................... Operator Certification Number...................
Location of Farm:
Z. ......... S..i.A.V.......ot..... 5 ... ..�. �a . .. .x-n. l� l.�nra..Pr.. .. ... 0. .2 � ....v,,..r . �1.r� ...,.�.a.u..i 1.........
tl x.......tr ........1 N.'+'S-C..�'i.Q......4s.!.�..L.....5 �. s �� g...... ..
Latitude a ' " Longitude • 4 44
bwme
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Current
roputatlon
- — ---
Design' Current Design: Current:
Poultry Capacity Population Cattle Capacity, Population
❑ Layer ❑ Dairy
❑ Non -Layer I I JE1 Non -Dairy
❑ Other
Total Design Capacity S v
Total SSLW -, Z - n ��
Number of Lagoons / Holding Ponds _�, ❑ Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
❑ No Liquid Waste Managentent System
General
1. Are there any buffers that need main tenance;/improve ment?
2. Is any discharge observed from any part of the operation?
Discharge: ori4ginated at: ❑ Lagoon 0 Spray Field ❑ Other
a. If discharge is observed, was the conveyance nian-made?
b. If dischar-e is observed, did it reach Surlace Water? (If yes. notify DWQ)
c. if discharge is observed, what is the estimated flow in Oal/ntin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge'?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
0 Yes ❑ No
ETYes ❑ No
❑ Yes $[ No
❑ Yes allo
Yi1 N .� • r�
❑ Yes No 'ISO
k-1-
❑ Yes 59,No
❑ Yes
0 No
Yes
❑ No
❑ Yes'
® No
❑ Yes
®.No
Continued on back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (I,a goonsMoldina Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes 5QNo
❑ Yes E) No
Structure 5 Structure 6
Identifier:
Freeboard (ft): .......... ................ .......................... .
10. Is seepage observed from any of the structures? ❑ Yes RNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes gNo
12. Do any of the structures need maintenance/improvement? , ❑ Yes RNo
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes 5'No
Waste Application
14. Is there physical evidence of over application'? ❑ Yes CjNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...p,�rw�.,t...5} a.....................t.4.,r...,!5 ............................... ............Vv�a �.....! `.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 9NO
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
[K No
18.
Does the receiving crop need improvement?
RYes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
IN No
20.
Does facility require a follow-up visit by same agency?
OK Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
54 No
22.
Does record keeping need improvement?
1qYes
❑ No
For Certified or Permitted Facilities Oril�
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
J&No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
E4 No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
KNo
0-No.violatioits or deficiencies were -noted -during this.visit.-.You.W'ill re'cei�e-no ftirth�er
coerespondepce about •this'.visif.
�v�
Comments (refer to question #) :Explain: any YES answers and/or any=recommendations or any other`catime>tits.
Use drawings of facility to better explain situations. (use additional pages as necessary
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„.M w ww ,
Reviewer/Inspector Name t
Reviewer/Inspector Signature: Date: q 17 a '7

Facility Number: .2­1 ...... DHte of Inspection: 1 I I 1 -1 1
Addli'ti6na!:Omments and/or Drawings -
c-,, e_ t—,L Ou r.
tL
4/30/97