310849_INSPECTIONS_20171231

NUH I H UAH..ULINA
Department of Environmental Qual

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ason for Visit: EYleoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Pbysical Address:
Facility Contact: %! Tittle:
Onsite Representative: T1r d j/ rot
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop. Wet Poultry
Layer
Design Current
Capacity Pop.
Cattle
Dairy Cow
Design C►urrent
Capacity Pop.
Wean to Finish
We -to Feeder
I jNon-Layer
I
Dairy Calf
eider to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , Iioult .
Lavers
Design Current
Ca aci P,o .
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Lavers
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?
❑ 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)
❑ Yes
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
F�400
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection: 2
Waste Collection & Treatment
4. Ls storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No [] NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t at, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 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 Q{ _o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E2-1 0� ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
�Noo 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
E6 N ❑ 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
YN�o❑ 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?
ElYes
�eo❑ 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 [/] No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes to
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

-1p Facility Number: - Date of Inspection: Z.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o NA ❑ NE
25 -Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o Q 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 PIONo ❑ NA E] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes EJ1Z ❑ 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 o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes lo— ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes L2��o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [z]`lTo__ ❑ NA ❑ NE
RCVICWCr1L11NPCGLUI nZ1111C: 1 1a_ ' -- 1, - -
Reviewer/Inspector Signature: �� r Date: 2 7
Page 3 of 3 21412015

Type of Visit: Co iance Inspection 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: 2 (2 4 Arrival Time: 1t Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 5 / ' I
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: "tow? " I r'�- z�
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pap.
Design Current
Cattle C+apacity Pop.
Dairy Cow
Wean to Feeder
11
INon-Layer
Dry]P.o_ultry
Layers
I
Design
Ca aci
Current
Plo ,
Dairy Calf
Dairy Heifer
Dry Cow
eeder to Finish 2� S, 0
Farrow to Wean
7
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
I
INon-Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
NJ
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes to ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes [:]No
❑ Yes [ o
❑ Yes ❑-No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: -Frq I Date of Inspection: z 117,6
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 0 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): / b
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ 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 ETNo ❑ 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 hreat, 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 [ o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [l"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ILJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or tO lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
[?I —No
❑ NA
❑ NE
❑ Yes
[/"No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes [jNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
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 <o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EJ-No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of inspection: /zz ir b
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes L� 1Vc 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No OINA ❑ 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)
❑ Yes No ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[dNo ❑ NA ❑ NE
EfNo
❑ NA
❑ NE
DINO
NA
❑ NE
❑No
❑NA
❑NE
Reviewer/Inspector Signature: �.r%-tii Date:
Page 3of3
12- (2 1f6
21412015

Type of Visit: UC�ance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: p Routine O Complaint Q Follow-up () Referral O Emergency O Other O Denied Access
Date of Visit: L- Arrival Time: 3 r' Departure Time: 3 3 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: C t` i CA I-.- n wt
Certified Operator:
Back-up Operator:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Lcourignt
C*a.ttle Capacity Pop.
DaiEX Cow
We to"Feeder
ceder to Finish
Farrow to Wean
I
iNon-Layer
I
Dairy Calf
k-
DrV P,iTu-I
Layers
Design
C•a aci_
Current
P.o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other Turkey Poults
Other Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [] NE
❑ Yes ❑ No
❑ NA ❑ NE
❑ Yes a< ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: Date of Inspection: i 4s
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L }
No ❑ NA ❑ NE
No ❑ NA ❑ NE
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 Jjj No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments 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? ❑ YesrNo ❑ 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 ElKo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists Design ❑ Maps ❑ Lease Agreements
❑ Yes
Ej No
❑ NA
❑ NE
❑ Yes
�N"o
❑ NA
❑ NE
❑ Yes
F�fNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ /j No
❑ NA
❑ NE
❑ Y
No
❑ NA
❑ NE
Yes
❑ No
❑ NA
❑ NE
❑ 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 V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection: U
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EJ - ❑ 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 Reviewerlinspector 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
ONo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes ' ❑ NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes No ❑ NA NE
Comments.(refer to question>#) ,Explain, any YES answers and/or any additional recommendations or any other comments.
of se drawuE s U g fad ityto.better a plain'situatious (ase additional pages as necessary).
r--c CQrj3`
�.- rne-- t
Reviewer/]nspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
Phone:
�In?Pc ?Jay
Date: Z-
2/4/2015

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: )6Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:zM
Arrival Time: ® Departure Time: County: Region:
Farm Name: S ►L96E N CA O g4tA6 i-4 ag¢( Owner Email:
Owner Name: (i.1S t 'i.L.(riE(�+ UCN4"CH Phone:
Mailing Address: I'MD IriNet{ CAUE/1 &tQ-J L WAuAt f ,NG 9E y1D �p
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: n ,,
Certified Operator: S M-FiLS_ Op';_ N41V �U�uAItiC� }g
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
9 61L!
Certification Number:
Certification Number:
Longitude:
crweD4
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish La er EEJ airy Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design Current D Cow
D , P■oul Ca aci_ Rio . Non -Dairy
Layers Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
F70ther
Turkeys
Turkex Poults
Discharees and Stream Imuacts
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)
❑ Yes CA No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes []No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 1% No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters []Yes VLNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

incility dumber: 4 9 1 jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
] No
0 NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
�C
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
A No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Rj No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CE�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
[] NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ 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): 1:i�� ,S G
13. Soil Type(s): V—p
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
tyNo
❑ 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?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
0 WUP ❑Checklists [:]Design [I]Maps ❑ Lease Agreements
❑ Yes No
❑ Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '0 No
['] Waste Application Q Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ 1 to Transfers
Rainfall ❑ Stocking Q Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Q Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facili Number: 1 jDate of Ins ection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CU 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 INo ❑ 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
�0 No
❑ NA
❑ NE
❑ Yes
CgNo
[DNA
[] NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
CA(,IC� V3»N Da►3
L').A-
t41,),y ate'
q1 pl1 Lf 1, LV
3
Sol is �_Cz �X
CAL uC �4 Ll
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date;
21412014

type of Visit: JU Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ORoutine O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Phone:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Integrator:
Certification Number: C1 D o d
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design C*urrent
Wet Poultry Capacity Pop.
La er
Cattle
DairyCow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design C**urrent
_a
lJ , PRoultr. C•aci PRo ,
Layers
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharces and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [A No ❑ NA ❑ NE
❑ Yes JZ No ❑ NA 0 NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
�6 No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
P No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[6 No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection: �
=j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PNo
❑ NA
0 NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
;0 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
6o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ANo ❑ 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 �j No ❑ NA ❑ NE
maintenance or improvement? !�
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 4No [DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 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
;2fNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
F No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Vr�4o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
V7 No
0 NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VTNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
KNo
❑ 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 Kr'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Vf'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facilitv dumber: 41 -7 IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[—]Yes
VNo
❑ 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
I �(No
Tff
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
VTNo
❑ 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 V 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 7f No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes 0 No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
J4
❑Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
(Comments (refer to question #I): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional paaes as necessarvl.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3A 1
Date:
21412011

Type of Visit: W� ompliance 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: Arrival Time:=J Departure Time: County: CLlLj/ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title]
Onsite Representative: C Ran/ 5yep
Certified Operator:}]Qd%�1�(��r S�
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Inte��grato��r:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pap.
La er
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish UIC�
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Cm-dr.
D , P,oult , Ca Wei P,o ,
I Layers
I I 113eef
Dairy Heifer
Dry Cow
Non -Dairy
Stocker
Gilts
Non -Layers
I 113eef
Feeder
Boars
Pullets
Turke s
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facilily Number: f - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ,5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ! No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Anplication
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
'A"
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence off f ind Drift ❑ Application Outside of Approved Area
12.Cro T es: �b
13. Soil Type(s): q`C�Le5� A[..C` qq A V ]ue
14. Do the receiving crops differ from those designated in 1hd CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
®WUP ❑Checklists QDesign [:]Maps [:]Lease Agreements
❑ Yes No
r
❑ Yes No
❑ Yes 1p�No
❑ YesNo
❑ Yes KNo
❑ Yes No
❑ Yes o
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �A No
❑ Waste Application Q Weekly Freeboard ❑ Waste Analysis Q Soil Analysis r ❑ ite Transfers
0 Rainfall ❑ Stocking 0 Crop Yield E] 120 Minute Inspections ♦❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Q Weather Code
e❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

F%ciliNumber: J - g Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 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 I Xl No ❑ NA ❑ NE
4 If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �{] No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 77�� No ❑ NA ❑ NE
34. Does the facility require afollow-up visit by the same agency? ❑Yes I ❑ NA ❑ NE
Comments (refer to question #a): 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).
4qu
Reviewer/Inspector Name:
Reviewer/Inspector Signature;
Page 3 of 3
Phone:
Date: I1C90)0Q
21412011

• �Divi"sion of Water Quality
Facility Number 31 - N OO Division of Soil and Water Conservation
Other Age ccy
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ))6LRoutine O Complaint Q Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: �Ll pUn Owner Email:
Owner Name: _ E�� . S �At� Phone: lo- `ag5- 5�19 CD
Mailing Address: {J D� 1`-�—'_ VL-lGyLPuaS I / e— `1't�0S3
Physical Address:
Facility Contact: Title:
Onsite Representative: 14 EQW S f i E P XL h
Certified Operator: fj} �(i,�nl O . SH E Pl4Q.n 51(z,
Back-up Operator:
Phone:
Inte rator:
Ce fleahon Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Region:
CuenDesign
M�CC­'aacity Pop.
Finish
Current"ee
Wet Poultry Capacity Pop.
Layer
Cattle Capacity Pop.
Da' Cow
Feeder
Non -La er
Da' Calf
Finish
j 6O
DairyHeifer
Farrow to Wean
Farrow to Feeder
Design Current
D , g ultr. Ca aci_ Po ,
D Cow
Non -Dairy
Farrow to Finish
I Layers
Beef Stocker
Gilts
I
Non -Layer
Beef Feeder
Boars
I
Pullets
Beef Brood Cow
Other
Other
N
Turkeys
Turkey Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No
❑ Yes ❑ No
[:]Yes [—]No
[:]Yes [:]No
❑ Yes No
❑ Yes 9No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility dumber: 7 1 - IRL49Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes❑ ``No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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 �j(� No ❑ NA ❑ NE
waste management or closure plan? ]�
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes K 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 %(NIO
❑ 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 o Wind Drift ❑ Application
Outside of Approved Area
Sc-1�G�-
12. Crop Type(s):
13. Soil Type(s): T 6".371-tcw ALl"f(ZCJ�UIu-C
_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes o
❑ NA
❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
OWUP ❑Checklists 0 Design 0 Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis Ej Soil Analysis ❑ Waste Transfers
Q Rainfall ❑ Stocking 0 Crop Yield Q 120 Minute Inspections Q Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
Q Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: a f - g G/ Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o
34. Does the facility require a follow-up visit by the same agency? ❑ Yes9;0
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments., ' ,-.,
Use drawings of facility to better explain situations (use additional pages as necessary).
flEO_-� TCU ct34N6P_ ACV -ES (3/4 3- -TO MA7c14 WU.Q,
U (�9,jQ r /Onl 't� LAE gi6} S
SU_kK)GE_ RILE i LkXTIL 901LI
1
191F 0 Foy- ANAL sls
�I
AS 5 s teLE� NO Sol L R'T FOL -
A SO�t- S A1kPLE 1�S soart� o oR i
C�" "r (rl tµE w�E
IN coot) 5 NAQ�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:����'
21412011

acility Number ✓ `: g�`l
e(Division of Water Quality
Division of Soil and :Watet,Conservatron , a'
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1,2j7.I` i (t Arrival Time: Departure Time: County: LW Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: K411) s Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: =o =1 1
1 Longitude: El o =,
Design Current-
;. s Design
CurrentDest n Chrrent"
w� Swine
Ca acE -Po ufatron
�t p l i
Wet Poultry C-- aci
pa ty.
� lah u
Po�` ulation�� Caffle g'# P on:
R xCapa y s oRu a°.
7
❑ Wean to Finish
„aP
.
❑ Layer
❑ Dairy Cow
.
w
❑ Wean to Feeder
f- ❑ Non-Laye
❑ Dairy Calf
Feeder to Finish
Z ��
`1�
❑ Da' Heifer
❑ Farrow to Wean
D I',aiilt �"`
rye rY"y
,: ❑ Dry Cow
❑
❑
Farrow to Feeder
ElFarrow to Finish
❑ Gilts
❑ Boars
❑ Other
❑ La ers
❑ Non -Lavers
❑ Pullets
ElTurke s
❑ Turkey Pouets
ElOther
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?
Non-Da3ry
❑ Beef Stocker
y ❑ Beef Feeder
❑ Beef Brood C
�. z `
Number fo S
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 dNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ❑ NA
El NE
❑ Yes
❑Yes
YJN ❑NA
El
❑ Yes
No ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number:.3Date of Inspection t ►
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ 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: {ACM35iJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes zrNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes3No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Zwc ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes 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 ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes PTo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes P/No ❑ NA ❑ NE
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 ❑Ko ❑ NA ❑ NE
Comments {refer to•questiort:'#) Explain any YES.answervand7or any recommendations or apy other comments:
°Use drawings of facility to 6efter explain situations: (use'addttional pages:as necessary}
C'0WU2kjT dP &'^rC(Z .ptimPrlic- -rJ. C306 SPOT
Xj d &jZD ENGE ar IM . 4L1. PULL-5 L 6b k<.- `Tb K- UTr L ZeJ. S G- o
5'rR.a,UG— AC "15 ��► 6tr05 .
Reviewer/Inspector Namey � p� Phone: ��? -7 — 3Q
Reviewer/Inspector Signature: _ _ Date: yt
Page 2 of 3 1 12128104 ` Continued

Facility Number: 31 — Date of Inspection Y!
Rewired 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 ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes ❑ No ❑ NA ENE
❑ Yes ❑ 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 ❑ Stacking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
2�NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
W E
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[I No
❑ NA
L 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
[3/NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ff/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
AE
E
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
La"NE
If yes, contact a regional Air Quality representative immediately
3 L 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)
ENE
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ No ❑ NA
33. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No ❑ NA
/NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit ACompliance 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: f Arrival Time: Departure Time: County: L Ili/ Region:
Farm Name: L — ��}Q i Owner Email: p
Owner Name: -�� d �JEA/ S 2apR b Phone: -J 10- 025-Sy9 6D
Mailing Address: rQ,
Physical Address:
Facility Contact:
Title:
Phone No:
On site Representative: 59j3d S E RI�!, Integrator:
Certified Operator: Operator ertirication Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = g = Longitude: = ° = 4
Design C►urrent
Design Current
Design
Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle
Capacity
Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder ❑ Non -Layer
❑ DairyCalf
CK Feeder to Finish t�5 QC9
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non-DaiKy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
[I Gilts
❑Non -La Non -Layers
❑ Beef Feeder
[I Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑Turke Poults
❑ Other
Number of Structures:
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
*o
✓✓✓✓✓✓ ```"`
❑ NA
El NE
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
XLNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

]Facility Number:3 — 9q' 9 I Date of Inspection !O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
,Structure
'1 Structure 2 Structure 3 Structure 4
identifier: L
❑ Yes VV�/�No
ElYes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _..j
5. Are there any immediate threats to the integrity of any of the structures observed? El§ Yes 4No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) \
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑yesNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) jNo
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ NA ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) SG 14 . 13. Soil type(s) i—o�z[S Tciov Am
q �4y i C i (s - — —
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (J No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes , \No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No El NA El NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question#) Explain any YES answers andlor any�recommendahons oranyother eamments,,
-Use drawnigs=of facility to,better explain situations (use addrtronal pages as necessary)
Reviewer/Inspector Name Aim ! In': �. �,� � Phone:
Reviewer/Inspector Signature- Date:
Page 2 of 3 12128104 Continued

Facilit):Number: 3 Date of Inspection Lb
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. 0 W­Up ❑ Checklists 0 Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard Q Waste Analysis 0 Soil Analysis ❑/aste Transfers ❑/mual Certification
[] Rainfall ❑ Stocking 0 Crop Yield El120 Minute Inspections 0 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
U(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
)kNo
❑ 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
El NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
*o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
9k
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Bk-A i)CW DUCE �011
w.A
Page 3 of 3 12128104

I Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
1 Reason for Visit Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: �� County: Al Region:
Farm Name: �lZ-1� C S 1i:'QQM Owner Email:
Owner Name:�l1-RUN �e 1,� Phone:
Mailing Address: 9p EAR Pc-Wn `1��c�ti:AND s If, NC, 09$5-19-(oo53
Physical Address:
Facility Contact: Title:
Onsite Representative:%
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: �� E� �� E� �iz-' Back-up Certification Number:
Location of Farm:
a ojoob
Latitude: [= O [= I [= u Longitude: 0 ° = 6 = 4i
Design
Current
Design C►urrent Design C•urreat
Swine Capacity
Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
11 IE] Non -Layer I
I ❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
pry Poultry ❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El La ers
El Stocker
❑ Farrow to Finish
❑ Gilts
El Non-Layers ElBeef Feeder
El
❑ Boars
El Pullets Beef Brood Co
[I Turkeys
Other
❑ Other
JE]Turkey Poults
❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes] No
❑ NA
❑ NE
12128104
Continued

Facility Number: 3 1—
Date of Inspection 4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: &A 660IV
Spillway?:
Designed Freeboard (in): , 'S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
JN No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
I I - Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No [I NA [I NE
El Excessive Ponding El Hydraulic Overload [I Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift []Application Outside of Area
12. Crop type(s)
13. Soil type(s) _
EdS65-ar! fl(
i Q!A1J 1 L'LG
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ]
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes XNo
❑ NA
❑ NE
Reviewer/Inspector Name 44/ 1 �� :; Phone: 91(J" }ia -q'Ta�
ReviewerlInspector Signature: Date: IaAC>ioS
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes )A No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ANo
ElNA
❑ NE
0 Wthe appropriate box.
UP El Checklists ElDesign [I Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 0 No
❑ NA
❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑Xaste Transfers El)t�nual Certification
EIRainfall E]Stocking E]Crop Yield El 120 Minute Inspections 0 Monthly and V
Rain Inspections E]
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 4 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 p(J No
� \RNo
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes X No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes 4 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
12178104

Type of Visit 3& Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit P Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I UAL,* I Arrival Time: L'�_70 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: jt f 9,C S µFDAfZ b
Certified Operator: 14 F&W 0. 'SP4 r=
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number: tQO/ c@ to
Back-up Certification Number:
Latitude: = o = & Longitude: = ° = t
Design Current
Design Current
Design Current
Swine C*apacity Populatiop
Wet Poultry
Capacity Population
Cattle Capacity Popula#ion
❑ Wean to Finish
ID Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
I
❑ Dairy Calf
IV Feeder to Finish W9910 I cP
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
ElN Layers
El Beef Stocker
El Gilts
❑on -La Non -Layers
El Beef Feeder
El Boars
❑ Pullets
❑ Beef Brood Cowi
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Im acts
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
12128104 Continued

FacilityNumber:3 —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: ('"00)y
Spillway?:
Designed Freeboard (in): 1q. .45
Observed Freeboard (in): —/
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 0 No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑NA El NE
Structure 6
❑ Yes
❑ Yes
KNO
IRNo
❑ NA
❑ NA
❑ NE
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes t No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �] No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 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 VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a!� Gr,-rrmCI SG![_ FOIR-'og - 16-4 goicrt.Epov-T 14A15fXACEDq-A10
IN rvooXf A-Iw� ��' �� ` 10 5 + ' O Ll SOIL 9.r- z-TS (.Our- �Oo�
�9. Fovr_� GvPL�oe VIC(Lm1T (Ge)veft� ?S(L)KI-r) wpm?w f 9-Ec0(LbS
IF UNj4 L_r U FIND CG4LC Nt w1LL mAlc_ pNE C CT
ReviewerllnspectorName t Phone: QQ� �o iv
Reviewer/Inspector Signature: Date: 1)WOE
Page 2 of 3 12128104 Continued

Facility Number: —g Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Perm' readily available? ❑ Yes IV No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �(No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 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 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Pq No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
jNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[A 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
ANo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�kNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
ULNo
❑ 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
P 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
XNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
%No
❑ NA
❑ NE
Additional Comments andlor 4
Drawings:; - m a� M y = er.r
H
Page 3 of 3 12128104

_ 0 Division of Water Quality
Number 3 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
pliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
7Routine0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: q Arrival Time: ® Departure Time: �� County: F�UPLMAJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: I Phone No:
Onsite Representative: Tis c yLt tj 5H ea'40'n Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: [=] o ❑ ' = « Longitude: 0 0 = ` 0 "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
Non-L
Pullets
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current , I
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 [: o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes Zo
El NA ❑ NE
❑ Yes []NA ❑ NE
12128104 Continued

Facility Number: 5ENDDate of Inspection �G D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Z/No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
Vo ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: (j4&.z
Spillway?:
Designed Freeboard (in): r
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o ❑ NA
ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElYes
No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Elly/es
❑ No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement? .
❑ Yes LJ'No
❑ Yes E4o
❑ Yes
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
ZNo
E No
El NA El NE
El NA El NE
❑NA El NE
❑ NA ❑ NE
❑ 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
0No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes�ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
rNo
L ❑ 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):
} CLCAN—1oJIZDE pVfE kAt. J.
VPOAff MCKVJ& 68 %Zt EPY 6�Vf- Yea' 4A ALVSSs
1
RE fk6r L4$00N MAP-OX Aup G6r 2�PLACE/it {�/+ BIER_ Ater-� �,ditlk, (SNow
Pr
Reviewer/Inspector Name (; Phone: 1D
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: 31 Date of Inspection 4 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. ❑ WLJP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box elow.
El Waste Application ❑ Weekly Freeboard El Waste Analysis Soil Analysis
❑ Rainfall Stocking
❑ Yes d ❑ NA ❑ NE
❑ Yes 7No ❑ NA ❑ NE
I.JYes ❑ No ❑ NA ❑ NE
❑ Waste Transfers ❑ Annual Certification
❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections f ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes Ll 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?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NA
❑ NE
❑ Yes
ElNA
❑ NE
❑ Yes
❑ NA
ElNE
ElYes
WVX0
o ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
Z o
❑ NA
ElNE
ElYes
WNo
❑ NA
❑ NE
❑ Yes
dX0
❑ NA
❑ NE
❑ Yes
LdNo
❑ NA
❑ NE
❑ Yes
El NA
❑ NE
El Yes
7No
❑ NA
❑ NE
Additional Comments and/or Drawings: I
12128104

i, D1v1516n of Water Quality
Facility Number'' S Q Division of Soil and Water Conservation
—_ _ _ O Other Agency
IType of Visit a Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (?(Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 15 11 bio Arrival Time: I I Departure Time: County: ��U=� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical -Address:
Facility Contact:
Title:
Onsite Representative: TN uz'a r') S q__?A LD Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
R1 Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = = Longitude: = ° u
Design Current Design Current Design Cui
Capacity `Population Wet Poultry Capacity' Population Cattle � Capacity Popu
❑ Layer
❑Non -Layer
28 a
Other
Dry
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes EJ/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ N
❑ Yes
❑ NA
❑ NE
[IYes
Zo
❑ NA
❑ NE
12128104 Continued (A/

Facility Number: i — L
Date of Inspection 10hiloto
Waste Collection & Treatment
4. Is'storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: oD (
Spillway?: j
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes d No ❑ NA ❑ NE
❑ Yes [(NNo ❑ NA ❑ NE
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? ElYes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �N ❑ 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 IJ No ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t0 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) �- G} C"-0
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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
C2rN ❑ NA El NE
I;N ❑NA El NE
[� o ❑ NA ❑ NE
❑ NA ❑ NE
CJ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendatii ns or:any other comments .:t
Use drawings of facility to better explain situations. (use additional pages as necessary):
al,) uP©ATi SYbeKz6Ic- 1ZC c.aa p S
P e t— u r; s u.z rlf _ee c_0naa 5 C rA...o rw.
Reviewer/inspector Name 014 . Phone 910 G
Reviewer/Inspector Signature: JAAA6.24 Date: 1 d
n___ -1 _r3 r1Mo/n.4 I,- ,:__.--I
. -8-.. J I��. �... ., .

Facility Number: 3 1 — g Date of Inspection ��4
RRehuired Records & Documents ,.�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes O 1Vo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
EYes
❑ No
❑ NA
❑ NE
❑ Waste ApplicEl Weekly Freeboard [I Waste Analysis El Soil Analysis El Waste Transfers
[I Annual Certification
El 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
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EfN
❑ NA
[I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
20
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
oo
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
,(��,
L�'N�o
ElNA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElD Yes
o
❑ 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
L;110
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,��,,��
[a o
❑ 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
ErNo
❑ 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
21<0
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

E
f Visit 0 compliance Inspection O Operation Review O Structure Evaluation
for Visit JO !Rooutine O Complaint O Follow up O Referral O Emergency
Date of Visit: / Arrival Time: Departure Time: County:
Farm Name: 2�Lf �� _r2gm' Owner Email:
Owner Name:-AO/J "�fo Phone: _
Mailing Address:
Physical Address:
Facility Contact: ! Title:
Onsite Representative: (,#/,IVA/ �f7 �� �" Integrator:
i
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
O Technical Assistance
O Other ❑ Denied Access
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = 1 Longitude: = ° = t
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer I�
11 . ..Non -La er -- - -- ��!
Other
[] Other --
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ DaiKy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 !" No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes1Z
No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection !8
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ 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?: 11149
Designed Freeboard (in):
Observed Freeboard (in): ,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PNo
❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 7o
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No
ElNA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes (/No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �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 Drifl El Application Outside of Area
12. Crop type(s) � RillQi���� CS.4. � a `�5ew
u�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
'IeNo
❑ Yes ;KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
'P
❑ Yes XNo
❑ NA
❑ NE
/� /r�ZL /F5i ✓aT DW�D l' jI �.✓sn��Df�D %C'.P. _
-� 1 •{ t�c
Reviewer/Inspector Name , /� , Phone: l0—
Reviewer/Inspector Signature: Date:
L L/L o/U9 1-UUUrU[CR

Facility Number: Date of Inspection
�r
Renuired Records & Documents
t9. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ SIP ❑ Checklists ❑ Design ❑ 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 l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VN o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes V(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 m No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes /❑ No ❑ NA 0 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 ElYes No ElNA ElNE
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 VNo ❑ 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? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes XNo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes LNo ❑ NA ❑ NE
Adihteonal�Coiumentsand'/dr,V awn s s g s
�z�/�- ��l�•J 5 rr� / g/ S /o Z/3/`, 5- 2/cr','— 0/`
�� /�n�i9-c `�� �r✓.D©ram ��CJ�A�S �r�zz,�' G�` /��..�
12128104

O I)1v15�On of Water Qualtty r
� �; � �;; °' .tad �" � Dtv�aitt Of SDI $IId Water�COnservat,Ort r � •��`��`,- �' � a � .., r
E_ �� ' = � `` --� � O�()theat' �► a �' � ~.� -_ ,.� .
-
Type of Visit .00ompliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit Routine Q Complaint Q Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number $ Date of Visit: Time: D
LO Not Operational O Below Threshold
Permitted 0Certifiied © Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
Farm Name: ..... 1L��. ]C 1� 1_...._._...... ...... _. �... - -- - County: . �!/1 _ ...............� ....__......
OwnerName: ---- -------- ------------------------------------ ------------------------------------------ ----- ----------- ----------- Phone No:
wiling Address:.. ...__............. - ...
Facility Contact: ... ................ ...................... ............. _ ._.......- Title: .................
Onsite Representative:.,{�Qy��
CertifiedOperator: ........... . ....... . ............. . . . ..... . .... �._._..�.....................� .......
Location of Farm:
...... ........... _............. Phone No: _....... .......... .........
Integrator:
`m.. c ..�_
Operator Certification Number:................. .............. ...._.
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude • ' «
Destgp w Currentl Current s Design Current
z
5' € otc�tonwne 'ca
-I Wean to Feeder
4 _
�
e
❑ Layer
_
�
❑Dairy
ceder to Finish
d
❑Non -Layer
Discharges & Stream Impacts
.1. Is any discharge observed from any part of the operation? ❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field [I Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [] Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes B 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 �o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -...........?.......... ...� _.__.._................................ .. ...................-----•---.. ._..--------------.........
Freeboard (inches): 3J
---------•----------
12112103 Continued

Facility Number:, S/ Date of Inspection
,5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [314o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes DINO
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 ,B'ko
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes OTo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Prfio
elevation markings?
Waste ADDUCatiOn
10. Are there any buffers that need maintenance/improvement? ❑ Yes eNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ONO
❑ Excessive PPo/o��nding ❑ PAIN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper
and/or Zinc
12. Crop type C.. OU S_/ 1f7/ _1,4 ) .4 t'2`/ �5W?7/sn
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ONO
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?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ORO
❑ Yes 0To
❑ Yes Of4o
❑ Yes -El No
❑ Yes Elio
❑ Yes Zf4o
❑ Yes 8 fqo
❑ Yes ZN' o
❑ Yes ,8 No
Comments (refer to questtcn`#) ExpJA aay YE5 answers and/or any r commendations or,any other comment-
'
_ �.�
°Use drawings of l'acil�ty to better explata stmatrons (nse add�tronal pages as necessary) Fteld Coy ❑Final Notes
FFc/ Is eve
ReviewerAnspector Name
1_eg
Reviewer/inspector Signature: Date: c�
12112103 Continued

Facility Number: - Date of Inspection ,SJ-
-Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ V", checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard XWaste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3l . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33_ Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 2T4o
❑ Yes ErNo
Yes ❑ No
❑ Yes Oto
❑ Yes ^2lo
❑ Yes Oggo
❑ Yes 0'No
❑ Yes ,B'No
❑ Yes ❑<o
. 'Yes ❑ No
❑ Yes 2No
❑ Yes 0 No
❑ Yes eNo
❑ Yes ETI�o
❑ Yes 010
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. I
Additional -Comments and/or i3rawtngs - -
3 /yd was aea/ys/s Y 1117103
'fJ
l e l,& /lave - b-P>°.�17 recol-e, a/
�uf heec/ 1 A- /u f 67,0 /2
lo1ea.S-P 6
r
12112103

Type of Visit 0 Compliance Inspection 0 Operation Review t) Lagoon Evaluation
w Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
b Permitted O Certified [3Conditionally Certified © Registered
Farm Name: 7 ZA
Owner Name: J F_ Sl�Ie�O
Mailing Address:
Time:
Date Last Operated Abave Threshold:
County: Ze) _
Phone No:
Facility Contact: Title: A Phone No:
� S .. t Stf�'—"Integrator:
Onsite Representative: �/�+ P
Certified Operator:
Location of Farm:
Operator Certification Number:
OSwine ❑ Poultry [:]Cattle ❑Horse Latitude 0 4 Du Longitude a ° Du
Feeder to Finish 1213 LJ Non -Layer I I IMU Non -
Farrow to Wean
Farrow to Feeder Other
Farrow to Finish Tntalt- Pei, [*Anari
Boars
Subsurface Drains Present
No Liquid Waste ManaQen
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Strurre i Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 3
05103101
Field Area
❑ Yes Id No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
O No
❑ Yes
No
El Yes
j1J No
Structure 6/
Continued

Facility Number: —g 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?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures Iack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
1 I . Is there evidence of over applicati ' //? ElExcessive Pondin ElPA El verload
12. Crop type Ae,Eef71e/,0$ 67A S� C lyi�ft mve5�C/�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ 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 No
❑ Yes VfNo
❑ Yes No
❑ Yes /No
❑ Yes ANo
❑ Yes �No
❑ Yes A No
❑ Yes o
[IYesfo
ElYeso
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes / No
❑ Yes o
ElYes ffNo
❑ Yes Ao
No
Yes
❑ Yes o
El Yes 7No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
:z`._ .-.. -. (. PCim- -$ :. .db ;u'+�'✓ ,oC- y-�_ .#T'a� a�
'" ..� -
Cotnntents (refer to question'{ Eplam any YES answers and/or,any recommendateonsPor�any ather comments �.
Use di a °wings of facility to better egplavi situati6ns:_(use additronaDpages as -necessary)
R Field Copy ❑Final Notes
7)11f Z-14C0oW *,-p
�/r%fGff AD '71"11"e r
Reviewer/inspector Name
Reviewer/Inspector Signature: Date: DZ
05103101 Continued

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional Comments andlor,Drawinss:�: ' �:
❑ Yes Q�No
❑ Yes �No
❑ Yes No
❑ Yes YINO
❑ Yes I
❑ Yes No
❑ Yes ❑ No
n /�I
4601 OR /J fin% Q6�D � /QED LO/t'Il�G 7 . Qcd�lrz� /�s
5
'//moo
A'VOZ����oiQ7GG/
z 5 7,9
y�
CAuJA1i° � �,C2y�Fz�O i7�'�mft� !J`95�E /i/gdAl��E„J�
O5103101

G
Type of Visit OCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 date of Visit: S 2 I Time: 1�3 S
� Not O erational Q Below Threshold
13 Permitted 0 Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold: ---- ----
Farm Name: r 1 ................._......_ ....._.....��.
.:.xe e.._ ....�`............................................................. County:. V _._.?}^_...
OwnerName. _l e- ► b.� S l p�rOs............................................. Phone No:.................................................................... »».. •...........................................................!
FacilityContact: ............................................................................... Title:................................................................ Phone No:
Mailing Address: ......... ..... _.................. .......
Onsite Representative: 7�t.... r:°' ` 4 S1z; ( e-1 A Bpt�P.4 Integrator: „ p�'� i v � Tit +��y `s4
Certified Operator : ................................................... ............................................................. Operator Certification Number: ...... ............. ......__. _
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1 64 Longitude • d Du
Desdga ,`,-Cuirrent
5wute -_ _ .�Cai�arity Pnnnlatinn
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number: of Lagoons
�...__...._._ r
L
Design Current Design=- " Cui
Puul
_ Ctte ..Ca acity'-' Po ` u
❑ Layer ❑ Dairy
❑ Non -Layer 10 Non -Dairy
❑ Other
Total Design Capacity
1 Total SSLW 17
❑Subsurface Drains Present ❑ Lagoon Area . JE1 Spray Field
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes W'No
Discharge originated at. ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes J2No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ZNo
c. If discharge is observed. what is the estimated flow in gaUmin? IG
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes JaRo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 014o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes)2fNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes,,dNo
Structure I Structure 2 Structure 3- Structure 4 Structure 5 Structure 6
Identifier: ................................................................................................................................_........
Freeboard (inches): 3 ?
S/DO Continued on back

Facility Number: 3*1 —8 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes j� 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 J'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 '0 No
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes PrNo
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes )2[ No
11. Is there evidence of over application? ❑ Excessivee�Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes JZNo
12. Crop type-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ YesNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
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?
T61101; ttiggs.oF ft. rle jlcte.g •were h0 ed• ¢><x°ifi this'visit; - Yoit w ll teeeiye #o fut tb
conies orideirce about: this visit:
(refer to gaestion #}: platn' any answeis , - r any. a
`sedi awings of facility_to.better. explain situations. (useygd!itional pages as neces§ary}
❑ Yes ❑ No
❑ Yes RfNo
❑ Yes J'No
❑ Yes j2fNo
❑ Yes Ei No
❑ Yes ,EfNo
❑ Yes ,fNo
❑ Yes P No
❑ Yes oNo
❑ Yes _'No
❑ Yes j2fNo
❑ Yes 'PINo
-7-?,e App1 6 a4 on s -ILtg4 occurred 41 gjrr,'1 2 oo l are 4o 6e co,4 0ed - o w,'D( Ae
6e:�'w►v��-rc�l,,e,r -�i�4� -�l,e SrnalJ.�f�''he�yf qie cv��'e�l at��e�r�ed�D
-h(;s S%la�tfd be done at'4L,P /�CArd 3 Soak, Te 4Qrt kn2'krt,. r4VA /I,)r>JPJ) oc,
hawe 1e-Fl . I 1
` e-leeQ 11sl qere 94A1 Lv.14 be ar)a Rex 1,9 xmr,II 9r�►�+, 4e►) 46e
;4 ot­Nee LVAem U be lolloG✓e W
Reviewer/Inspector Name rleti/t`'%%� J _ffi
Reviewer/Inspector Signature: 2446-� Date: 'e- Z Q 5100

Facility Number: J Date of Inspection Z el
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 'Q'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes'0No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes _ErNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes_,O No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes _JZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments an orDrawings: '
ro f-r, Rvid reGDrdf eve me,711 ke fl. 1'�. �tQriA�Ol hot j
recen�li cle4 1aykd. 411 lqr\,,! will �e planked w+A s"111-4;"
4�►J h,;nley q�� rXw9rvkr�d �s -�� to qr1 9c�( 'n .�p>^;� 2-oQ2r,
f n,r 6 4 t Pt i. l i 4 d p, a n i oA/ ,1 4'o ►� des ,` h tO r > r rn .
y � 5 �
J
5100

Division of Water Quality
O Division of Soil and Water Conservation -
- O Otrier Agency
Type of Visit Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit +Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number
q I)ale of Visit: Time: '= Printed on: 7/21/2000
O Not Operational O Below Threshold
Permitted © Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name �`� ....................... Count':..... �.V!-_.._.........................._..............
_''�............................I........................ ........_...
Owner Name: ............................................ ......... Phone No:
FacilityContact: ...................................... _...................................... Title:................................................................ Phone No:
MailingAddress:....................................................... _............... _............_................_....................................................... .........•................
Onsite Representative:.. ....... ................. Integrator: .....................................................
Certified Operator : ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm -
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Weeder to Finish J❑ NonLayer ❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other
Farrow to Finish Total Design Capacity
❑ Gilts Ej
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste ]Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes JNo
Discharge originated at: ❑ Lagoon ❑ 5pray 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, noti)v DWQ) ❑ Yes ❑ No
c. ll' discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑Yes trNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ,rNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier. .................................... ..................................... ......... ...........
Freeboard (inches): 3
5100 Continued on back

) 166ty Number: 3 — 9 Date of Inspectiony Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ,KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes )krNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes kNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes DKNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ANo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes kNO
12. Crop type UX ,c al
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 1'No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes A No
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?
Rectuired 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?
.. yi...... .... . r�... mere noted cl . .. g #his:visit, - Ydix m iti •reeeiw fio fui-th r .
correspondence: about this visit.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes k No
❑ Yes ba�No
❑ Yes JXNo
❑ Yes XNo
❑ Yes WNo
❑ Yes �S(No
❑ Yes b(No
❑ Yes ;-')RrNo
❑ Yes bTNO
❑ Yes �? No
❑ Yes ONO
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings off faciliityto better explain situations. (use additional pages as necessary):
AID
Y,�� L-J" 5:eK�4 6sAP,
Reviewer/Inspector Name
Reviewer/Inspector Signature: �, _ Date:
5100

Facility Number: —� Date of Inspection b' QG }Tinted 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 helow ❑ Yes ONO
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ,(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes gNo
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 gNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) _ ❑ Yes eNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes EINo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes KNo
Additionall• omments and/orDrawings:
0,eeS
5100

----- --- ---
QU iLity,
tefc.
rViit W.ii onse
.......... . ... ... 0, Aho:....
Dmgi4n ton I
of Visit @ Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit @)Routine 00omptaint OFollow up 0 Emergency Notification 00ther E3 Denied Access
Date of Visit Time: tS3U Printed on: 10/2012000
Facility- Number
0 =Not Operational 0 11elow Threshold
Permitted Certified E2 Conditionally' Certified Registered
Date Last Operated or Above Threshold:
Farm Name: IrlakS.Earat................................................................................................. County: D.Uplin .................................... I RQ__
Owner Name: ThuQn-Q ------------- ...... -IrIl - --------- -------------- -- - Phone No: 2j(L-.Z8.5.-_5 59 14 ....----- ---
Facility Contact: Title: Phone No:
Maiiing Address: ZZ(v.&az.RaixdF.,Q.ad .......................................................................... jjjjVhjan&._NC .............. ......................................... ..............
Onsite Representative: (hamuz Integrator: ................................................................... t, De—ok,09AEMU . .......................................
Certified Operator: 37herQjL- Operator Certification Number- 2,012fi
Location of Farm:
East of Cypress Creek. On North side of SR 1827 approx. 0.8 mile East of Cypress Creels.
A.
Swine ❑ Poultry
s:j Cattle 0 Horse Latitude F­T_11 4-5 —,, J_­__40 Longitude � 77 F
.. . . ........ . . . . ............... .. s
"' `:­:-­!` - -
t: sion:::::Current pie, mmmm i ... m.­
. ..... . . ..... _1 .. ........
S!gn ::Currentrm:
... .... . .......
.. urmut
'Swiue
. ....
Wean to Feeder
❑Layer
;,:,F0
1:1][] Dairy
,IN
Feeder to Finish
2880
Non -Laver
JE1 Non-DairyV
❑ Farrow to Wean
mm.: ....... ........ . ... ..........
------
E] Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Desr�rr Ca ac1<::
ty:.::
2,880
❑ Gilts
Boars
:.,: 7 11
......... ...
..... .......... .
..........Total S5LV4
388.800...
0.
10 Subsurface Drains Present
X
ClINo Liquid Waste Manager
--Holdin,i--Po,hd0.Sohn:7-Tfiti I
Dischar,-es & Stream Impacts
I - is any discharge observed from any part of the operation?
Discharge originated at: ::] Lagoon -'--! Spray Field 0 Other
L_j
a.
Udischarize is observed- was the convevance man-made?
b. If discharge is obscned, did it reach Water of the -State? (If yes, notify DWQ)
L:. If discharge is observed, what is tile estimated flow in gal/min?
d- Dots discharge bypass a lagoon system? (If yes- notify DWQ)
I Is there evidence of past discharge from any, part of the operation?
Area JE1 Spray Field Area
I adverse impacts or potential adverse impacts to the Waters of, the State other than from a discharge?
Were there an� - I
Waste Coliection & Treatment
[3 Yes Z. No
El Yes D: No
_7 Yes D No
17 Yes LED No
[I Yes No
El Yes No
ti
h Spillway
-4. 1,; stora2t� opacin, (freeboard plus storm storage) less than adequate? Yes RINC,
structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
F I retboard (in-ches):

J Utly (l/l:7lf!!i=l: lilt r%Ci.
Fxcilin'\umber: 31-849 Date of Inspection 10-18-2000 Printed on: 10/20/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, jI Yes No
seepage, etc.)
6. Are there structures on -site winch are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 1 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 am of the structures need maintenance/improvement? ❑ Yes No
8. Does anv 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 N- No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes R No
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 9- No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 01 No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? C) Yes ['_;No
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
Required Records & Documents
17- Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
No violations or deficiencies were noted during this visit. You will receive no further
correspondence about this visit.
Yes 1Z. No
❑ Yes E, No
❑ Yes 9- No
❑ Yes 10 No
❑ Yes 9- No
❑ Yes ® No
❑ Yes No
D Yes 9 No
❑ Yes ER No
❑ Yes 0 No
❑ Yes R No
9. Current waste plan requires all applications to bermuda cease between August 31 & Sept. 15th. All applications after
iat point count toward overseed -- 50 lbs until end of Oct and 50 Ibs Feb -March. Suggest getting updated waste sample
,SAP. Suggest getting file box with dividers or 3-ring binder with dividers for records. This will organize them better & keep
ems from being lost.
Revise current records of October applications to rye overseed records.
jNo copyleft on -site — will send copy within next week. "
Reviewer/Inspector Name DeaiHttnEiele39539(1() X:226.,. :. ....

tXc�rcrticriur�EreeLiI r Or-ri:riurc:
Facility Number: 31---849 Date of Inspection 10-18-2000 Printed on: 10/20/2000
Odor Issues
26_ Does the discharge pipe from the confinement building to the storage pond or lagoon fail 'to discharge at/or below- ❑ Yes C9 No
liquid level of lagoon or storage pond with no agitation?
27. Are there anv dead animals not disposed of properly within 24 hours? ❑ Yes JR: No
28_ Is there anv evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, Yes. X. No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 19. No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) - ❑ Yes Xi No
31. Do the animals feed storage bins fail to have appropriate cover? 0 Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes C9 No

Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:1V
Embankment Sliding?
(Check One, Describe if Yes)
Lagoon Dike Inspection Report 6 �`
/v
�r ne k Cina s s ro < Ji &,, o, � �e *
®•
Names of Inspectors (t- - AJQAJ
0 _ 10� Freeboard, Feet
f / -
see Top Width, Feet
d , S Downstream Slope, xH: IV
Yes ^ No
Seepage? Yes ??No -..doe h o � Q� c
(Check One, Describe if Yes) I I ! j I Y%ell I? W C7 U <
Erosion? Yes A No
(Check One, Describe if Yes)
Condition of V C
Vegetative Cover I
(Grass, Trees)
Id Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
ollow_ p Inspec on Needed? Yes No
Engineering Study Needed? Yes ,� No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
�, j
Other Comments D te we- I I r,, )< C. 1. j s� g o r'
)dam\ O Jr `", Q r'QC 0,—,01f1t �i�i�

ffirmi
Facility Number Date of Inspection
Time of Inspection ® 24 hr. (hh:mm)
M Permitted M Certified p Conditionally Certified p Registered 113 Not ZIperahona Date Last Operated:
Farm Name: Triple.S.Earan.................. ... .......... County: Duplin WIRO
.................................................................
OwnerName: Theron.Q.............................. Shepard ..................................................... Phone No: 9.1A.285-.54»R,i............................. .............................
FacilityContact:............................................................... ..Title: . Phone No: ................................................................................................................................
Mailing Address: 22fr.Bear.Rond.Road......................................................................... Ric-blands...NC ....................................................... Z857.4 ..............
Onsite Representative:
Integrator:
Certified Operator:Thelrwx.0 ............................ ShepardSr.............................. ....... Operator Certification Number:20.126i.............................
Location of Farm:
Latitude ®• ®� ®�� Longitude ©• ®4 ©11
_..
Caesign 7C.
urren esEgn urren _ �:
Swine - paetty Population =Poultry Capacity Populatroal Cattle
D Wean to Feeder
® Feeder to Finish
D Farrow to can
D Farrow to Fee er
D Farrow to Finish
p Gilts
D Boars
2,880
388,800
1. Is any discharge observed from any part of the operation? Yes [:]No
Discharge originated at_ D Lagoon D Spray Field D Other
a. If discharge is observed.. was the conveyance man-made? []Yes D No
b. If discharge is observed, did it reach Water of the State? (If yes, notiA, DWQ) ❑ Yes D No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) []Yes [:I 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 D No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? D Spillway p Yes []No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ...............2.4...............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
p Yes D No
Continued on back

Facility umber: 31-849 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
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?
U : XO'Vitulutioits.or de 'eienc e's.were,nnteri during: this visit.: Yaif 'will -receive, nofur' ther
...c6r�es v>4dence: about this:visxt;: . ..... : :
w
freeboard available. No problems observed
❑ Yes ❑ No
p Yes []No
❑ Yes p No
❑ Yes ❑ No
❑ Yes p No
❑ Yes ❑ No
❑ Yes ❑ No
p Yes []No
❑ Yes p No
❑ Yes [:]No
p Yes p No
(]Yes []No
❑ Yes p No
❑ Yes []No
[]Yes []No
❑ Yes []No
[]Yes ❑ No
[:]Yes []No
[]Yes (]No
p Yes p No
[]Yes ❑ No
n-DSW): Lagoon does not appear to be lined, however dike wall is not saturated. Dike is in tact with no damage of erosion
No recommendations at this time.
Reviewer/Inspector Name tCr ee r cVicker; Brian Gannon (DSWj u
Reviewer/inspector Signature: Date:

. ..... s.....�_,-_ .�.... �.- skYwr�.��..... .......: ... ........ ........ -... .JG-f' ��s. .ter........ - .... r_rTi .. �s>_.'::=1__�...-v_.r.. _.....�....�..c. �..r�_.a. �_..s ...r ........ _.. ,.
LE
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:1V
Embankment Sliding?
(Check One, Describe if Yes)
Lagoon Dike Inspection Report 6
�r ce k czo �c row
Pt_ck.bn s � AjC ).P S%Sy9-6
Names of Inspectors 6 %11 AJUOJAI!
1 D ` r o� f Freeboard, Feet L/ !�
f
See tc k Top Width, Feet
d , S Downstream Slope, xH_ IV
Yes _ No
Seepage? Yes _� No- . Ile o Qv � c
(Check One, Describe if Yes) / X 1 k
� f, 1 � � �0. j� '
}ne -Pwcaer _< ��•a H� y
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Yes A No
Vif r- 7
a I t a. Grd f kl-
d Dike Overtop? Yes >� No If Yes, Depth of Overtopping, Feet
of ow -p Inspec 'on Needed? Yes 1�1/_ No
Engineering Study Needed? Yes %� No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments �� Fri we
t/OS row ^4 If s /CJO f 4C Or.r, 0^_ :U"

ti
ti

Revised January 22, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 31_-g_ Operation is flagged for a wettable
Farm Name: 1 r 4 S acre determination due to failure of
On -Site Representative: < Part 11 eligibility item{s) F9 F2 F3 F4
Inspector/Reviewer's Name: ktkkA% L v%k, Operation not required to secure WA
determination at this time based on
Date of site visit:_ 4j�99
Date of most recent WUP: 0 3
exemption E1 E2 E3 E4
Annual farm PAN deficit: - pounds
irrigation System(s) - circle #: hard -hose traveler; nter-pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system wlpermanent pipe; 7. stationary gun system w/portable pipe
PART i. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part III. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part Il. Complete eligibility
checklist, Part I1- F1 F2 F3, before completing computational table in Part III).
PART 11. 75% Rule Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because operation fails one of the eligibility
requirements listed below:
F_ 1 Lack of acreage which resulted in over application of wastewater (PAN) on spray
field(s) according to farm's last two years of irrigation records.
F2 Unclear, illegible, or lack of information/map.
F3 Obvious field limitations (numerous ditches; failure to deduct required
buffer/setback acreage; or 25% of total acreage identified in CAWMP includes
small, irregularly shaped fields - fields less than 5 acres for travelers or less than
2 acres for stationary sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part 111.

Reviscd January 22, 1999
Facility Number 51 - V_
Part 111. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBER'S
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS3
Z
FIELD NUMBER' - hydrant, pull, zone, or point numbers may be used in place of field numbers depending on CAWMP
and type of irrigation system. If pulls, etc. cross more than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption if possible; otherwise operation will be subject to WA
determination.
FIELD NUMBERZ - must be clearly delineated on map.
COMMENTS' - back-up fields with CAWMP acreage exceeding 75% of its total acres and having received less than 50%
of its annual PAN as documented in the farm's previous two years' (11997 & 1998) of irrigation records, cannot serve as the
sole basis for requiring a WA Determination. Back-up fields must be noted in the comment section and must be accessible
by irrigation system.

- Division of Soil and Water Conservation - Operation Review
Division of Soil and Water Conservation - Compliance Inspection
Division of Water Quality Compliances Inspection
Other Agency =Operation Review
IQ Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-u caf DSNVC review 0 Other
Facility Number Date of Inspection L ) I qj
I'ime cif Inspection Woo 24 hr. (hh:mm)
© Permitted I� Certified 0 Conditionally Certified © Registered JE3 Not Operational Date Last Operated:
Farm Name: ........ .rS.. ...............r-PIKe................................. .... County......0., ?.r .......................
Owner Name: No.................`Van......5.,............5........... Phone o: A(. a6 Z
ks:xe..���/ ............................................
Facility Contact: ........ Title: Phone No: ...................................................
flailingAddress: ....: .3.:......&j.,t......�r.Y................................................. .......�T..................................... ..;...........k4.
Onsite Representative: ......
......................... CIntegrator:........w.................................. I...................... 3u,t9v�..........................................................
Certified Operator:.....ar. 0 : ............. .. a1.......tn .................. Operator Certification Number: ..........................................
...
Location of Farm:
.....Ral.........5t�4......4...... S...gy....�....rtii.....�iS. ....Q......`...-$.........................................................................................
........................................... ........... .:............................................................ ................................................................... .... .................... ................... IV
Latitude • 6 :° Longitude • ° 66
Design Current
Swine Capacity Population
❑ Wean to Feeder
® Feeder to Finish
Z - 6
Li$8
❑ 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 ❑ Non -Dairy
❑ Other
Total Design Capacity Z b gib
Total SSLW
Number of Lagoons j ❑ Subsurface Drains Present 110 Lagoon Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made''
h. II' discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If dischargee is observed, what is the estimated flow in gal/ruin'?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier:
Freeboard (inches):..............&3........:........
1 /b/99
Structure 3 Structure 4 Structure 5
Spray Field Area
❑ Yes IN No
❑ Yes
® No
❑ Yes
EP No
❑ Yes
No
❑ Yes
[ No
❑ Yes
j No
❑ Yes P No
Structure 6
Continued on back

Facility Number: — Date of Inspection trn
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ 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 [' 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 (A No
8. Does any pact of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes (9 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [KNo
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen Cl Yes No
12. Crop type ..............�.............................................................................................................................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. Does the facility lack wettable acreage for land application? (footprint) Yes JoNo
I5. Does the receiving crop need improvement'? ❑ Yes [9 No
16. Is there a lack of adequate waste application equipment? ❑ Yes ® No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
[A No
I &
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
W No
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
tj 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 certified operator in responsible 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?
[I Yes
ONO
0. NO'violations.or. deficienciies .were noted during this:visit:. Y.ou will.receive nay further .. .
cdtrespgaideh4t e:aboiit:this visit.: .:.:.:.:.... .:.:. .... .:. ................. .
.....................................................
Comments (refer to question#): Explain any YES answers and/or any recommendations orany other comments.
Use.di awings of facilityto better explain situations. (use additional pages as necessary):,..
tjal � ���Se� � � � defarm v�,cv
rI ,p 1
— WU\1) �i" t'� tLe C�g isAug 1S_010 o�_ � 0kct"t0_y_ i Ct'�T z-I LS-/q l ;
R(Z-Z. • Cmvtt[ Ott)
z11a .
Sk'Js tpe USe3``Wi
Ca[C.V(af
tkA `���
r,itFogtw `4a�av►c�j
COS; e% _1k0 /�ci
6.Q--
jaJ�
(�� I r►��
a�Y�
� fib (Il;. �V
Reviewer/Inspector Name
Reviewer/Inspector Signature: �L _. Date: 1 1/6/99

i.�
Division of Soil and Water Conservation [3 Other Agency
pivision of Water Quality
IQ Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other 1
Facility Number
Date of Inspection
Time of Inspection
24 hr. (hh:mm)
0 Registered 0 Certified 0 Applied for Permit 0 Permitted 10 Not Operational Date Last Operated:
� 11
Farm Name: S.irk ... ...... County:... t 1........................................................
.................. .......... ...............................................................
OwnerName: . ........ ............................................... Phone No: .. ` ......................................
FacilityContact: .. ................................................................ Title: ............................ ............................ Phone No:...................................................
.....
Mailing Address: �.-•.........1�s..tl�L ���................................................ ..........................
Onsite Representative:. 'r.l `�1° '-��P�L ........................ .. Integrator:......!%. �.................................
i.............V.. ..... .......
Certified Operator:
Certification Number:
Latitude ' ' " Longitude • 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 V�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes b(No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes KNo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes C�No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 'ONo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ONo
maintenance/improvement? ,,,,((��
6. Is facility not -in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes t> No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes Xo
7/25/97

r
Facility Number: `3 — TT�
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes [(To
Structures (Lagoonsfflolding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier: 'lr.............. ..........................................................................
Freeboard(ft): ..... I........ ��` ...........................................................................
10. Is seepage observed from any of the structures?
❑ Yes t9 No
Structure 4 Structure 5 - Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of [WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .....�.` 1... t..g.........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted; Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[3. No.violations;or deficiencies.were.noted-duriiig this.visit., You:will re'ceive-ii6-fiirther
: c6rresjp4nde to about �this,visit., : :
❑ Yes C,No
❑ Yes No
MYes ❑ No
❑ Yes VNo
❑ Yes (9 No
❑ Yes KNo
❑ Yes V10
❑ Yes XNo
❑ Yes Wo
❑ Yes (9 No
❑ Yes MNo
KYes ❑ No
❑ Yes Wo
❑ Yes No
❑ Yes No
�
'VCRS2 ✓�� Ql a�QG� L CGV**�� y�6 '4-Q�
VG rTt'vn�
`.ZUr�+rC.�y� t� �)vvzs1 �. Vt ��%� A11.4-Jm J�14 '__(�,�{] ell 0'L5[-.�L
AU rr�d .712
. , yr7
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

h�[]DSWC Animal Feedlot Operation Review �
[)J DWQ Animal Feedlot Operation Site Inspectiontj
Routine O Complaint Q Follow-up of DIVO ins ection 0 Follow-up of DSWC review O Other
Date of inspection b rG 7
Facility Number 3i rF
Time of Inspection � 24 hr. (hh:mm)
0 Registered 10 Certified © Applied for Permit © Permitted 113 Not O erational Date Last Operated:
Farm Name: ..... �..%.i� S ... County.�itr.k+......................
`...{.. 1 ...............
Owner Name:J................... .... Phone No:...� � iZ .�.2 ��.�t. ..........
Facility Contact:............5�. ................................ Title: ........ R.t«. Q.QAAx ......................................... Phone No: `�ij0 $`��.� �t�r...........
Mailing Address: .... k.4.....�...t?n�... LC4 ............................ Z l .u.�..................................... .. 4....
Onsite Representative: ......••;....---S.kizi...................................................... integrator:..... &li0t._".— :1..........._................ .
Certified Operator; .................................. ..................................................... Operator Certification Number-, .........................................
Location of Farm:
s.a ........ ..... 5-3.... .-ask..... fimr.r��\in�...J.-,tw.y.... ..x1or..... A..Ti��n...rti�r......i7r.).... sK,tS"�,1�,.,.......
51........... .....x ....r._i. gin ...... .
Keze
Latitude �•���" Longitude �• �` °° s`lOe f+,. miles aK nr
Design Current Design Current Design . Current'
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder 10 Layer I ❑ Dairy
® Feeder to Finish MU ❑ Non -Layer I I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons/ Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes Ig No
2. Is any discharge observed from any part of the operation? ❑ Yes JONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes EFNo
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If dischar-,e is observed, what is the estimated flow in oalimin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yeses IN No
1 Is there evidence of past discharge from any part of the operation? ❑ Yes 10 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 lagoonslholding 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 IN No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes EANo
7/25/97 Continued on back

Facility Number:-
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes i2 No
Structures (Lagoons,Iiolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes Q4 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(#t): ............�..... ....
........................................................................................................................................................
........ :...........................
10.
Is seepage observed from any of the structures?
❑ Yes
0 No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
E4 No
12.
Do any of the structures need maintenance/improvement?
&Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
RbYes
❑ No
Waste Application
14.
Is there physical evidence of over application?
Yes
[I No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type .............bt!%. G............................................ ........................................ --...........'�rwj].... 5^V!.1..................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
Q No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
U1 No
18.
Does the receiving crop need improvement?
❑ Yes
® No
19.
Is there a lack of available waste application equipment?
❑ Yes
C4 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
Dd No
21,
Did ReviewerAnspector fail to discuss review/inspection with on -site representative?
❑ Yes
JBNo
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
RNo
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
VhNo
No.violations or deficiencies.were-noted during this'visit. Nou. -ill receive no ftirther
' corr606ndeitce about this -.visit:

•
•
Site Requires Immediate Attention: /ve)
Facility No.�.�
DIVISION OF ENVIRONMENTAL MANAGEMENT.
ANIMAL FEEDLOT OPERATIOmIzSITE VISITATION RECORD
'DATE- Zl , 1995
..Time:
Farm Name/Owner:
Mailing Address: 3 r1
County: l/ L
Integrator. W 1 /¢ c-Phone:
On Site Representative: Phone:
Physical Address/Location:
Type of Operation: Swine V Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number:
ACNEW
Latitude: ttLongitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of i Foot + 25 ear 24 hour storm event
(approximately 1 Foot + 7 inches) Yes. r No Actual Freeboard:n�Ft. Inches
Was any seepage observed from thi agoon(s)? Yes r 1� Was any erosion observed? Yes 00
Is adequate land available for spray? Yes or No Is e cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?Yesr No
100 Feet from Wells jYes,fr No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters �offtthe state by man-made ditch, flushing system, or other
similar man-made devices? Yes If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: _ _ _W660r or G r
• LGG//ITT �
Inspector Name
cc: Facility Assessment Unit
Si
Use Attachments if Needed.

• ^lYa.•..F'�� l�'a'S ^qr r•.:r�;jirvr';: ,i; �7:.:��� v:_ - ��• - �F: ,�.:. �+.,..
05
Requires Irrimdciiata:AUdntton ' -
,....,
Facility Number:
SITE VISITATION RECORD,
�f J DATE: _ : - 1995 ..:
Owner_ ' ��'0 ^- /� �'� Farm Flame:
County:
Agent Visiting Site: r• Phone: !p
Operator: Phone:
•
On Site Representative:
Physical Address:
Mailing Address:
Phone:
Type of Operation: Swine � Poultry Cattle
Design Capacity: a 9 Po Number of Animals on Site:. r� g- k
G
Latitude: fl " Longitudes '
Type of Inspection: Ground Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately.l Foot + 7 inches oYe
or No Actual Freeboard: Feet Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the.
comments section.
Was any seepage observed from the Iagoon(s)? Yes or No Was there erosion of the dam?: Yes or No
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments:
Fax to [phone] Signature of