310851_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: fQ Com ' cc Inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: -z Arrival Time: D O Departure Time: County: Region:
Farm Name: / Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: T / Title: Phone:
Onsite Representative: r 'f Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number: f4 P
Certification Number:
Longitude:
Swine
W n to Finish
Design CurrentI
Capacity Pop.
11111111111"t-SIgUMMUrrent
Wet Poultry Capacity I,op.
Layer
liam I..---,- --t
Cattle Capacity Pop.
DairyCow
can to Feeder
-ZA0 o `�
Non -La er
DairyEl Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oult . Ca ac' P,o
Lavers
Non -La ers
Pullets
D Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Mi
Discharges and Stream Impacts
]. Is any discharge observed from any part of the operation?
❑Yes
dNo ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No ❑ NA
ONE
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
❑ N NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
I —]NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

I` Facilfly Number: jDate of Insection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
(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?
O Yes No ❑ NA ❑ NE
❑ Yes L3<o ❑ NA ❑ NE
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
to ❑ 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
l_ ,Ko' ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[jNV—__0 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[3'lTo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o� ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[?'No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3'lqo--- ❑ 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
nNo ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes E fqo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:)Yes ❑' ]�❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 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 Cant'

Facili Number: - Date of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 <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 ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
El -No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility.? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No_ ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�2 o ❑ NA
❑ NE
Comments (refer to question #.) Eiplaw any YES answers and/or any addtttonal tecommendat►ons or any ottier comments ; k
.
Use` -pages
e
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date: ( ��
Page 3 of 3 21412015

Type'of Visit: O rRoutine
pliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: $ Arrival Time: Departure Time: /li County: / / Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 1 -7f 6 q
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Capacity Pop.
Finish
7Feeder
Wet Poultry
La et
Design Current
Capacity Pop.
Design Current
Cattle Capacity Po
Dai Cow
Dai Cao
Feeder
Non -La er
Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
I) , Poultry
Design Current
Capachy P,o
Dry Cow
Non-Dai
IL Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
MOther
Other
Turke s
-I'urke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
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 21"No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑Yes
❑No
❑NA
❑NE
❑ Yes ZU
o
❑ Yes
❑ Yes YNo
❑NA []NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412015 Continued

FaciliNumber: I - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): CIS
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ZNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No [] NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): f
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
lLl No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ k to
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Z
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
F2 No
0 NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ;rNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facilitv Number: IDate of Inspection: r3,;
24. Dib 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 C�(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 VNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
N
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑ ❑ NA ❑ NE
and report mortality rates that were higher than normal?
4
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes C ❑ 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 r ❑ 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 O/No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:] YesE o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings:of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signa
Page 3 of 3
Phone:
tore: Date: �?
214 0I5

Type of Visit: Q Copipliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: /O j� � County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: (4741 '�� Integrator:
Certified Operator: Certification Number: 7 l 6 -T
Back-up Operator:
Location of Farm:
wean to Fimsli
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars I 1 101 1Putlets
Latitude:
Poults
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?
Certification Number:
Longitude:
Cy ow
Calf
Y Heifer
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [Z No ❑ NA ❑ NE
❑ 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 ❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes V
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ YesVN((o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

F*ility Number: - Date of Insection: J j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ZNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 1 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
❑ 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 INNu ❑ 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 [2f No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[—]Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes YN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes I �J
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes YNo
❑ 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 VNo
❑ 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 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes 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 21412014 Continued

I:
IFacUity Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [a Yes No ❑ NA ❑ NE
25. 19 the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E2,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
U4❑ NA
/No
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes W10 ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes E! '~
❑ NA
❑ NE
34. Does the facility require afollow-up visit by the same agency?
[3 Yes No
❑ NA
❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
'_ vgf CA e /3 g u., Phone: 10
) 196
re: Date: M .5
21412 J15

Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: y L Arrival Time: 1D„ Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: (, j A-rRAa.S Mom_,=-,&_ Integrator:
Certification Number:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design C«urrent
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Cattle
Dairy Cow
Design Current
Capacity Pap.
Wean to Feeder
11
INon-Layer
1
Dairy Calf
Feeder to Finish
Dairy Heifer
Dry Cow
Farrow to Wean
Design Current
D P,oult > C ,a aci_ P,o
Farrow to Feeder
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
ers
Beef Feeder
Boars
pLayers
Beef Brood Cow
Other
Other
oults
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
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes I ❑ NA ❑ NE
❑ Yes U No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:)Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):`
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
9401
❑ 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 reat, 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
VNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
hlo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
PNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Elf-❑
V
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
Eyf c
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
[o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F2/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
YNo
❑ 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 Y 0 ❑ 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 Q N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Zo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

FaciliNumber: - Date of lns ection: q
24. Did the facility fail to calibrate waste application equipment as required by the perm t? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Co ❑ 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 o DNA ❑ 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 [3 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 2N
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 C No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes DINo
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 zo
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
DNA ❑NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments:
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: ?II L 1 jy'
4

CType of Visit: Q Cpliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: J Q Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine C*apacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design
Cattle Capacity
airy Cow
Current
Pop.
Wean to Feeder
on -Layer
airy Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dry $oult , Ca aci_ P■o ,
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Beef Feeder
Beef Brood Cow
Boars
Wither
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 u No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
Yes N0 ❑ NA ❑ NE
Yes EKN3 NA [] NE
Yes No NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: jDate of Inspection: t-ir r3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O/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: LA&"%0 N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ICJ N ❑ 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 Flo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes N
❑ 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 dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
1-11
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20.. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 2<o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes2Z[]
NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes 7'o
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑'1Vo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes NA ❑ NE
and report mortality rates that were higher than normal? T
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes Eff 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 BIC ❑ 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
ED-?<o
❑ NA
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E2'No
❑ NA
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes
'Qo
E��No
[3 NA
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
C
Io.
WK,
Reviewer/Inspector Signature: '1,`, ��J+�-��/j Date:
Page 3 of 3

(Type of Visit: Qj CoHance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance70
I
Reason for Visit: a Routine O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: lk= Departure Time: 14= County: akQdRegion:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
i Onsite Representative: j d Lffjr6d mlut
r(. Integrator:
Certified Operator -
Back -up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current Design
Swine Capaclty Pop. Wet Poultry Capacity Pop. Cattle Capacity
Current
Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder 011
INon-Layer I
El
Dairy Calf
Feeder to Finish
Dairy Heifer
Design Current Dry Cow
D , Pooutt . Ca aci P,o , Non -Dairy
Layers Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Other
Other
IN
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 2(No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [—]No
❑ Yes ❑ No
❑Yes YNo
❑ Yeso
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: 91 1 361
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I 1
Identifier: t 1gCsraAJ
Spillway?:
Designed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5
�No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
Observed Freeboard (in): 31b
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IZNo
❑ 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
0No
❑ 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 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
O/No
❑ NA
FINE
maintenance or improvement?
/No
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
/No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[—]Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ENo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[+`No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes WNo ❑ 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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 21412011 Continued

Facility Number: - Date of Inspection: e
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E No ❑ NA ❑ NE
25. its the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes 6/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 �zo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA FINE
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
o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 t. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAMP?
❑ Yes
No ❑ NA
�
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
EfNo ❑ NA
❑.NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments �, `
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�AAAU If C
Phone( JO 5
Date: d /
21412411

Type of Visit: (D C pliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: !Routine 0 Complaint 0 Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Q 1 Arrival Time:® Departure Time: County: 7,30 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: J&VJA W_r) 011-1—UAL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Sw
Wean to Finish
Design C*urrent
It. Capacity Pop.
Layer
Design Current
Cattle C*apacity Pop.
Dairy Cow
Wean to Feeder
U
Q
1
jNon-Layer
I
Dairy Calf
Feeder to Finish
Design Current
D , P, u-It Ga aci_ P,o
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Po its
Other
Discharp_es and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection: `
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): 53
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 WNo
❑ 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 Pl<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 [2'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ej No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P11<0 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes L 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes WNO
❑ NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes do ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E],, yo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes &<O ❑ NA ❑ NE
Page 2 of 3 T 21412011 Continued

Facility Number: 1 - Date of Inspection: $
24. Did t1m facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25.'Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
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 [f No ❑ NA ❑ NE
❑ Yes dNo
❑ Yes dXo
❑ Yes [/No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA [3 NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes Ldo ❑ NA ❑ NE
❑ Yes ❑✓ 'No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other, comments,-.- I
.
Use drawings of facility to better explain situations (use additional pages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C 91 d 71 G-73 D'
Date: og(4
21412011

Facility Number-. �5
Division of Water Quality w
D�viston of Soil and Water Conservahon
�Other.:Agency a ;.
Type of Visit O C pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: E4E Arrival Time: 45 Departure Time: County: DUPLsns Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
r
Onsite Representative: o N R'1-IJ O M,mLL&aL Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: p = = Longitude: [= o = g = «
5wme De aca Popuiat on Wet Poultry CurrentDepsegn C.urreat `
p ty ty Populations Cattle
❑ Wean to Finish
Wean to Feeder
D60b
110c)
❑ Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
�; ❑ Boars
7.
9a:
ier - s
Other
❑ Layer � ❑Dai Cow
❑ Non -La er I JE]DairyCalf
%Dry Poultry "
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef feeder
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 1 of 3
El Yes /No ❑NA ❑NE
❑Yes
❑No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ICJ No ❑ NA ❑ NE
El Yes PNo El NA ❑NE
12128104 Continued

Facility Number:
Date of Inspection q l
'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: L46,=o)j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S']
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 O No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes WNW ❑ NA ❑ NE
J
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) cat, 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 CNo ❑ 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 El Yes �No [I NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U(No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) /
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WN
o❑ NA ❑ NE
o ❑ NA ❑ NE
VL� I o El NA ❑ NE
V❑NA [I NE
No ❑ NA ❑ NE
Comments (refer to question #) Explaineany YES answers and/or any recommendations or any -,other comments''
Use. drawings of facility.to better: explain, situations. use additional pages as necessa x"
Reviewer/] nspecto r Name _),>_„ Phone: 916 -71a 6
Reviewer/Inspector Signature: Date: q
Page 2 of 3 . 1 12128104 Continued

Facility Number: <' — j Date of Inspection a 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Mans ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
12 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 "
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
MIX
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
&NNo
[I NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
d
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Z
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
WNo
❑ 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
El NA
❑ NE
If yes, contact a regional Air Quality representative immediately
VNo
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
. t✓J No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

E
f Visit Co liance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
n for Visit 0 Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
® Departure Time: L� 1 �t2U Region:
Date of Visit: � o Arrival Time: County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: CJ,j �+Jj-a<1�Qt`
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = i 0 « Longitude: = 0 0 t = 4f
Design Current
Design
Current Design
C►urrent
Swine Capacity Population Wet Poultry
Capacity
Population Cattle Capacity
Population
❑ Wean to Finish ❑ La er
❑ Dairy Cow
Wean to Feeder ZAop ❑Nan -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Da Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish ❑ Layers
El Stocker
❑ Gilts El Non-LayNetsers
ElBeef Feeder
El
❑ Boars El Pullets
❑ Beef Brood Co
❑ Turke s
Other ❑ Turkey Poults
❑ Other 10 Other
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑�N'o
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
LI No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
9 to
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Q Date of Inspection la J
waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfatl) less than adequate? ❑ Yes ONo ❑ 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 R No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes N ❑ 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 D/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 O No ❑ NA ❑ NE
❑ 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 of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
El No El NA El NE
[3'N' o ❑ NA ❑ NE
L� o ❑ NA ❑ NE
y ElNA ElNE
No ❑ NA ❑ NE
Comments`(refer. to question #): Explain any YES'ans: and/or any recommen and or, a othe111", ments, -
Use drawings of facility to better explain situations. (use additiotial pages as essa"ry,=):`�
AL
*r
Reviewer/Inspector Name J d Phone:
Reviewer/Inspector Signature: Date:
12128104 ontinued

1
Facility Number: — Date of Inspection
Required Records & Documents ,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes L�J N ❑ 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. ❑ WISP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E3 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Wcather Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2 NNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LEI No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
I No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Eko
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
NNoo
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
,E3
IdNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
❑ Yes
,_,/
Lam( o
❑ NA
ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
U No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�,�
CJ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
dNo
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ 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
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�rNo
❑ NA
❑ NE
12128104

M
Type of Visit C mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: jJ2&1Ud Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �J a N+�f A� ,'!�-1:E—E1Z Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = f = « Longitude: 0 0 = 6 [= I{
Design C►urrent
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
Wean to Finish
ID Layer
❑ Dairy Cow
Wean to Feeder
1K6
❑ Non -Layer
I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
El Boars
❑Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Turkey Poults
❑ Other
JE3 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?
Page I of 3
❑ Yes M No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I Yes
❑No
❑NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
ZWNo
❑ NA
El NE
El Yes
❑ NA
❑ NE
12128104 Continued

Fdcility Number: — , - 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 I Structure 2 Structure 3 Structure 4
Identifier: (A (,.0 N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ _ `T `f
No ❑ NA ❑ NE
ENo ❑ NA ❑ NE
❑ Yes 040 ❑ NA ❑ NE
❑ Yes [--]No []NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
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 t7heat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes 7No ❑ 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Analication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ld No ❑ NA ❑ NE
maintenance/improvement?
1 I . 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 ❑ 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
eN
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] YesYes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E�`No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ETNo
❑ NA
❑ NE
w. uye GX STol-&vG RE ak-PJ AaM -rN r C 6mro , 0 /-M Or ET 1-e-5 till AT
Z2,0 ,$vr rj?tA t' ftXin'Ztty rd2 ;4 ara
Reviewer/Inspector Name I p t` " 41J l . J! Phone: 7/ 7 73 M
Reviewer/Inspector Signature: Date: N q d
n___ '7 _r 2 17/92/014
.-b- - J ..

Facility Number: — S 11 Date of Inspection
Re uired 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 E�No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
2 Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall VStocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[Z N
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El YesrNp
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[-INA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
1Vo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ej<o
❑ NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[2/No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3/No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3/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
ZNo
❑ NA
❑ NE
if yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
O 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?
El Yes
D No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J2 No
❑ NA
❑ NE
Additional Comments and/or Drawtn'gs:`;
Page 3 of 3 12128104

[Facility Number g� 1
tj Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Q'—compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (2 Routine 0 complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 9 a 7 Arrival Time: ® Departure Time: County: LS� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ronp1 r ML.t_G P
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c 0 S Longitude: = ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
'L(,rro I 7.e�6 ❑ Non-Layet
Dry Poultry
Non-L.
Pullets
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?
Cattle
Design Current
Capacity Population:",
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: F ` 'I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El Yes
❑No [I NA
❑NE
❑ El NA
❑ NE
❑ Yes
❑Y
'❑NA
❑NE
ElYeses
VN❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection 9 ^t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: bq&- iJ
Spillway?:
Designed Freeboard (in): 3
Observed Freeboard (in): (�Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�,/
PT No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
IJ Igo ❑ 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
ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
ElYes
VNo❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
��
[] No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
LJ 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 Drifl ❑ Application Outside of Area
12, Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
04es
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
L�1,No
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
El/NNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
LEI No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i1) f]3cLos PCCOf 4EC-O CAf'1V Wo or G'tt. 5YU,
JJL C� IJE 1�/ WUP dNO4E' t.IE b.� 0�..)Iti(�.A__ ►4wlp QY 7,oNfcJ,
ECn N19 �✓ Ca C PEn �„, sr 1,✓.Z L)N Al of .
NfjC 60�fulpGC a PAoC141NG
a
ReviewerlInspector Name �JNe Phone: [9Y�a
Reviewer/Inspector Signature: ju
Date:
12128104 Continued

Facility Number: 31 Date of Inspection �7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?�r_�Yyes❑ No ❑ NA ❑ NE
20. Does the facility fail to have components of the CAWMP readily available? If yes, check ❑ No ❑ NA ❑ NE
the appropirate box. EVrUP ❑ Checklists
❑ Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. LI Yes ❑ No ❑ NA ❑ NE
❑ Waste Applica n El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis El Waste Transfers El Annual Certification
❑ Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ff NNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes LL No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes Vo ❑ N ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes El No �I NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes C No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes Lj o ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes CjNo ❑ 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 CPC ❑ 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 01d 0 ❑ NA ❑ NE
Comments and/or Drawings:
12128104

0 Division of Water Quality %
Facility Number, i 0 Division of Soil and Water Conservation f/
_ — 0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: - w Departure Time: County:
Farm Name: i�s -r`- Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ZW46::;��
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator• "
Operator Cer, fication Number:
Back-up Certification Number:
Region: j
Latitude: = c 0 f = Longitude: = 0 0 d=
Si
Design Current. Design Current
Swine 'Capacity Population" Wet Poultry Capacity Population
can to Finish ❑ La er
71
ElWean to Feeder [] Non -Layer
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other _
Dry Poultry'.
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
ElTurkey 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'=A
Cattle Capacity .Population-..
❑ Dairy Cow
❑ Dai 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?
Page I of 3
El Yes El No El NA El NE
El Yes El No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Stru7e 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
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 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 ❑ Evidence of Wind Drift ❑ Applicati n Outside of Area
12. Crop type(s) S Q
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA ❑ NE
Comments (refer to question #}: Explain any YES answers and/or any recommendations or any other comments
Use drawings,of facility to better explain situations. (use additional pages as necessary)::
Reviewer/Inspector Name f Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP El Checklists ❑ Design El maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 'Monthly and i" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility -fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments andlor Drawings:
V171b6 l-
Page 3 of 3 I2/2$/04

Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit P-90- utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: g G Arrival Time: lC�_Gt� Departure Time: County: sv !'L Region:
Farm Name: L OCo Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o= I= Longitude: a o= 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
l
❑ Beef Feeder
❑ Beef Brood Co
I I
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
L_ - -�
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes ;ZNo
❑ NA
❑ NE
❑ Yes ZNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — g
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: y
Spillway?:
Designed Freeboard (in): .�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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 ,ErNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes U-No ❑ NA ❑ NE
❑ Yes ErNo ❑ 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 ONo ❑ 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 J:allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,ONo ❑ NA ❑ NE
maintenance/improvement?
I l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,gNo ❑ 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 Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0No
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z ivo
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes o
17. Does the facility lack adequate acreage for land application? ❑ Yes 0 No
18. Is there a lack of properly operating waste application equipment? ❑ Yes 21 No
El NA El NE
❑ NA ❑ NE
❑ NA ❑ NE.
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question, #) Egplam any YES�ans�rers_and/or, any ommenda� ons�or�aay othe"r comments ��
��d�raw�ngssof facility to¢better egplam stfuahons y(use addtho�nal pages ry).-
Reviewer/Inspector Name �U� `Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: ���� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Z Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ W`Up ❑ Checklists -ODesign ❑Maps El Other ,�
21. Does record keeping need improvement? If yes, check the appropriate box below, El Yes .LJ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑-&o
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
❑ No
-ErNA
❑ NE
❑ Yes
❑ No
CVA
❑ NE
❑ Yes
f'No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
_C�NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
2'No
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
[:]Yes
,EJ-No
❑ NA
❑ NE
❑ Yes
JZNo
❑ NA
❑ NE
aG earse [ Yl G C� C C a j��l eS��rl
OV1 51 recor dS
1 1 s V
-5 ba -F
C� ✓� ark sus
12128104

Type of Visit S6 Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit A Routine O Complaint O Follow up O Emergency Notification O Other ❑ denied Access
Facility Number Date of Visit: EMiFAI Time: Ld 6
C Not Operational 0 Below Threshold
PermittedXCertified ©/C_onditionAaily Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ---.._ _ _�. ! ... ogs.C. ....�._..�--- -- County:... ��4 ':l''............... ....... ...» .......
Owner Name: _________---- _-------------------------------- _______ Phone No:
Mailing Address:
Facility Contact: ......................... _..... _............... ......... .............. . Tide: Phone No:
Onsite Representative: �fl.NT..iLtihe..{.t!^» -! Integrator:..._..... .i...................................
Certified Operator:..-.....�....�.�.�.......�.�.�.�.�.... �.� �....�....� �.�.�.�.� ............�... Operator Certification Number: ................. . .. . ....... . .... . ....
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 66 Longitude • 4 «
`Design==Curr,eiit ¢ = - e Desiigri Ciirreat Desrgn=Cnrreittt
Swine Ca ara s Po ulat.an _ ;P try -Ca ,.Po nlatian- _Cattle Ca ad rPo tion
Wean to Feeder
2
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? (I€ yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes XNo
El Yes El No
❑ Yes El No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �To
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? [I Spillway ❑ Yes /No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......... _.t..................... _._........... ....._� _.... _._._.. _.
Freeboard (inches):
12112103 Continued

Facility Number: 3 1 — C
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 maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste A heation
10. Are there any buffers that need maintenanceltmprovement?
❑ Yes ?No
❑ Yes Yf No
❑ Yes Y No
❑ Yes V(No
;ZrYes ❑ No
❑ Yes XNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes KNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload 6❑�\� F,�ro_,zee,❑ n Ground Copper and/or Zinc
12. Crop type M UD A W SM'P LL' CFL� aEgLe n
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [dNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? [:]Yes ,f No
c) This facility is pended for a wettable acre determination? ❑ Yes )6 No
I5. Does the receiving crop need improvement? ❑ Yes ONO
16. Is there a lack of adequate waste application equipment? ❑ Yes �dNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below []Yes L�`No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ONO
Air Quality representative immediately.
,Comments Ere#er to gitn4an) Faiplarn any YFS`a veers a/or a recom>�eadtsous or any ntermsients: '.
'Use"da�awrags of iaiciLt7+�to better explain sitssa6onuse�addrbogai�pages ass pecessary) � ❑Field Cop ❑Final Notes =�:'
qLeved WrAt- iS leanInG
Sev�/'a� bexte s of o ICL �
Rc UG
Reviewer/Inspector Name 11,25-. 6 C.�
7 .. _`s ... - vA
Reviewer/Inspector Signature: Date: v
12112103 Continued

Facility Number. '3 —9511 Date of Inspection ^ 1
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes XNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes XNo
23. Does record keeping need improvement? If yes, check the appropriate box below.
ElYes 0 No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes UrNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes XNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
XNo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes )ZfNo
28. Does facility require a follow-up visit by same agency?
❑ Yes XNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes YrNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes XNo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

O'Division of Water Quality
Q Division of Soil and Water Conservation
O x
Q .. =
Other Agency
Type of Visit to Compliance Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit 16 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number I I Date of Visit: [
Permitted 4 Certified [3 Conditionally ertif'ied 0 Registered
Farm Name: ... 1..J�+D.......... 4,-............. E%L4.17.�.................
n. ,tt �C
Owner Name: ....ZJAQI.y.�.... ......... .1
M'f ime: ��Printed on: 7/21/2000
Not Operational O Below Threshold
Date Last Operated or Above Threshold:
County: ,,� 4."r-.,l........
Phone No:..
Facility Contact:................................................................ . Title .. Phone No
MailingAddress: ........_ ................... :.................................I ..._ ...._. ......I.......... .......................................... ..........................
`,
...... &
Onsite Representative FI",R. L.: ..... .T!•!�'� ... �I grator: '/�Gw 7f�.........................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:
Location'of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 i6 Longitude ' 4 66
Design Current
Svvtoe. _ - Canaeity Ponulation
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
v Boars
Design Current
Poultry
Capacity Population Cattle
❑ Layer
❑ Dairy
❑ Non -Layer
1
10 Non -Dairy
❑ Other
Total Design Capacity,
Total SSLW
tgn _ -`Current
se rF"«.'e.
Numbeir,ofTLagoonts ❑ Subsurface Drains Present ❑ Lag�xue Area ❑ Spray Field Area
Hodtnug Poems / Solid.Traps ❑ No Liquid Waste Management System
=ram
Discharges & Stream Impacts
1, Is any discharge observed from any part of the operation?
❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -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)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure S
Identilicr: ...........
Freeboard (inches):
5100
❑ Yes ❑ No
❑ Yes 1No
❑ Yes No
❑ Yeso
Structure
Continued on back

Facility Number: — Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes JJ�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidenceAf over application? , ❑ Excessiie Ponding ❑ PAN ❑ Hydraulic
12. Crop type �kg;_ 5RNM? % G � �✓
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA (p)?
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?
19. 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? (iel 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 ReviewerlInspector 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?
�'Vo violatiQsis:or deencies were ngted irrtnii this'visit.-Ydik Will -receive A6 further
_ cOrre.19M ideWE AOU thNs visit- - - - - - - -
❑ Yes No
❑ Yes No
❑ Yes P�No
❑ Yes [IVo
❑ Yes )dNo
❑ Yes No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes A No
❑ Yes No
❑ Yes JVNo
❑ Yes �No
❑ Yes A No
❑ Yes X-INO
❑ Yes No
❑ Yes C'No
❑ Yes No
❑ Yes No
❑ Yes XNO

+ Facility Number: — Hate of Inspection Z
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
INO
28. Is there any evidence of wind drift during land application? (i.e, residue on neighboring vegetation, asphalt,
❑ Yes
�NO
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
/
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
XNo
Additional Comments and/ors rawings:.
y0a y

Divts>ion of Water Quality Zj
= h�
Dtvtsion of Soil and' -Water ConservaL
Agency on
:E Other
s _
35�
Type of Visit Compliance Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit `Routine Q Complaint 0 Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Bate of Visit: Time: © Printed on: 7/21/2000
NNot Operational Q Below Threshold
Permitted [3 Certified E3 Conditionally Certified E3 Registered Date Last Operated or Above Threshold: .......................
FarmName: ... .. ?.... V' 2` ... ............................ County:.... .'i ...................................................
Owner Name: ..........................
Facility Contact: .............................................................................. Title:
MailingAddress: ........... ................ ...............................................................
Onsite Representative: .
Certified Operator: ................................ ...............
I.ocation of Farm:
Phone No:
Phone No:
....... Integrator:.......►-�h.. .................................................
...... Operator Certification Number: .............................. . ..........
w
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 0` �& Longitude ' 4 «
Design Current Design Current Design Current
Swine Capacity.Population Poultry Capacity Population Cattle Capacity Population
Stwean to Feeder GU ❑ Layer I I ❑ Dairy
❑ Feeder to Finish JE1 Non -Layer I [,E] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lags_ Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream 1mRact5
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ElSpray Field ❑ Other
a. if discharge is observed. was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [] yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'' (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes rv(No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes "No
StrUCIUro I Structure 2 Structure , Structure 4 Structure 5 Structure 6
Identifier:-•................•---..................................................................................... .....
Freeboard (inches):
5/00 Continued on back

Facility Number: — Date of luspcction 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 AYNo
(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 tgNo
8. Does any part of the waste management system other than waste structures require rnaintenance/improvement? ❑ Yes kNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ti�No
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes tg�No
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes XNo
12. Crop type VJ0 r CQ
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ,Yes [:]No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
Iallo
b) Does the facility need a wettable acre determination?
❑ Yes
ONO
c) This facility is pended for a wettable acre determination?
❑ Yes
124,No
15.
Does the receiving crop need improvement?
❑ Yes
14 No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Required_
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
OYes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
ONO
(ie/ WUP, checklists, design, maps, etc-)
❑ Yes
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
)kNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
b�No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes MNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes �KfNo
24. Does facility require a follow-up visit by same agency? ❑ Yes RNO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes MNo
�: a-yiolafiOos;ov- Oflciendieg *ere noted- 0iWing this:visit' - Y:ou Will-,i eceive do further -
.. correspondence. a'baui this .visit... . ... . .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
13) plat+-. ��� �Q ���,�� -'> �.�.� . Ve��
�e l•.r�r�e %te e c 4-ci r4tk-_� �]r
kn) L ct�
v 1V�.
r•
Reviewer/Inspector Name
Reviewer/Inspector Signature:
o r39s 3�0o X--a�
Date: 0 0 5100

Faeiliiy Number: —S Date of Inspection ti0 Printed on: 7/21/2000
Odor Issues
25. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor hplow ❑ Yes No'
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes] No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29: Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ' No
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ONo
'Additional :Comments: and/or rawtngs:
LA,
t
5100

Name of Farm/Facility
jocation of Farm/Facility
,u
Owner's Name, Address
and Telephone Number-
Lagoon Dike Inspection Report
31_ Sit
Date of Inspection!
Names of Inspectors
-
Structural Height, Feet
7
Freeboard, Feet
41
Lagoon Surface Area, Acres
Top Width, Feet
Upstream S1ope,xH: IV
✓
Downstream Slope, xH:1 V
�� * - ✓
Embankment Sliding?
Yes _ L No
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
V ve Cover
QV,reel} .
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
Yes ^� No
Yes Z_ No
Yes No If Yes, Depth of Overtopping, Feet
Yes No
Yes _ No
Is Darn Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes. >C No

Facility Number Date of Inspection
Time of Inspection 0 24 hr. (hh:mm)
M Permitted 13 Certified E Conditionally Certified 13 Registered 113 Not Operational I Date Last Operated:
Farm Name: Much.Loco..Nursexy........................ .......... County: Duplin WIRO
OwnerName-. danet.P._................................. demkins.......................................
Facility Contact: ...............................................................................Title: .........
Mailing Address: ZIR.Clarles.Waad.Road................. .................................
Onsite Representative: ............................................................... ......
Certified Operator:damic..E................................. Bxoxa ...............................
Location of Farm:
Phone No: 911I-324-2099..........................................................
PhoneNo: ....................................................
...... ChiuquatpirL C.................................................... 28521 ..............
.............. Integrator:i.1 arphy..Family.Farms..
Operator Certification Nttlnbei-:1801&....
almEway-41-itofflRoxhinitzapttu.�tn�ar ell xa twat .out. mtt aut.a .xntxl0..t e. txay.. r... .m es.an .xurn.rt t...
tnta.SR.�.$,1.7...(�u�li�.>ftxax��u.�ntarl�,.go.xhraugh..2..cra�sa:cads:.#,a.stogy.si:gla,.�kuxn.ri�ght.�nto.�SR.d.7.a.S..get.i.A.an�ile.s.to.farna............... �
Latitude ®9 ®4 ®C° Longitude
Design Current Design . Current Design Current. -
Swine Capacity-Papulatson Poultry Ca aci .. Po ulation. Cattle
p ty p Capacity Population_
® can to Feeder
2600
❑ Feeder to Finish
p Farrow to can
p Farrow to Fee er
p Farrow to Finish
p Gilts
❑ Boars
Number of Lagoons
❑Subsurface tarns resent C]Lagoon rea ❑ pray ie tea
Holding="PondsIs old TTraps ❑ o Liquid aste anagement ystem
- 1�1
Disci._ ar�tes & Stream Impacts
1. Is any discharge observed from any part of the operation? [3 Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑Yes []No
c. if discharge is observed, what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) p Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? p Yes []No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes []No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? © Spillway © Yes []No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier
........ ............................ .................................... ................................... .................................... .................................... ..... I_ -..........................
Freeboard (inches): ...............4.8..................................... I............ .
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Yes []No seepage, etc.)
i. 3/23/99 Continued on back

Facility Number: 31-851 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
p No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
p Yes
❑ No
Waste Application '
10. Are there any buffers that need maintenance/improvement?
❑ Yes
ONO
11. Is there evidence of over application? ❑ Excessive Ponding p PAN
❑ Yes
p No
12. Crop type
13. Do the receiving crops differ with Those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
©No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
p Yes
p No
16. Is there a lack of adequate waste application equipment?
p Yes
p No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
p Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
p Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
© Yes
p No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
p Yes
❑ No
Na.via'tations:or.-daficieircies-wereil�oteri:during-t4[isvisit.:Vou.-wiII-r'eecivt'riafurther .
-.c6erespblidenc6. ab:out this:visit:.:::::::::: ::: :
ssessment
cient freeboard available. No problems detected.
Reviewer/Inspector Name ,Ian=Johns©n C Koontz (ULQ)
Reviewer/Inspector Signature: Date:

Revised AprU 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number --3�--�--- �S - Operation is bagged for a wettable
Farm Name:. U�ld��c,Gc�-s. acre determination due to failure of
On -Site Representative: Jo,, g gu m Part 11 eligibility items) F1 F2 F3 F4
Inspector/Reviewer's Name: C-1
Date of site visit:
Date of most recent WUP:
Annual farm PAN deficit: V9 15 pounds
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation System(s) - circle #: 1. hard -hose traveler, 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system wlpermanent pipe; 5. stationary sprinkler system wlportable pipe;
06stationary gun system wlpermanent pipe; 7. stationary gun system wlportable pipe
PART 1. 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 D�D3 irrigation operating parameter sleets, including trap
depicting wettable acres, is complete acid signed by an l or PE.
E3 Adequate D, irrigation operating parameter sliest, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part III. (NO T E:75 % exemption cannot be
applied io farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part Il ; F1 F2 F3, before completing computational .fable in Part 111).
PART Il.75% Rule.EiiaiWity Checklist and. Documentation of VITA Determination
Requirements. WA Determination .required .be cause _operation tails :one of the .eflaitAity
requirements listed below:
_ F1 Lack of �c.r--age:-.whichT=-sultedin:over:applica tion-mi--wasta-water, (PAN) on:spray_
field(s):accordingio:Farm'sdastfwo�earsmf rimuabonu-ecords.-.
F2 Unclearjliegible,-fir lack of informationimap.
F3 Obvious--r-jeld-}imitations-(numerous_stitches;.faiiurLtoxieduciTaquired_..__-
buferlsetback-zcrAage;mr25%Q :oftotal:acreagejdeniifidd: it -GAWIVI RJncludes =
small, irregularly-shaped.fields-ields:less-fhan-5:acres7ortravelers-or.lessfnan
2 acres-for.stationarysphnklers).
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 Par lit.

Revised April 20, 1999
Facility Number _-
Part 111. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
FIELD
TYPE OF
TOTAL
CAWMP
FIELD
COMMENTS3
NUMBER
NUMBER'S
IRRIGATION
ACRES
ACRES
%
SYSTEM
F1cLD NUM13-t-W - hyoranL pull,zone, or -point numbers -may he used in piece of field nurnbers cependiny on (:AWMP
and type of irrigation -system. If pulls, etc. cross Tnore -than one field, inspeciorireviewer will have to combine fields to
calculate 75% field by field determination for exempt10n;m3therwise operaiion will be subject to WA determination.
FIELD NUMBER' - must be clearly delineated onTnap.
COMMENTS'- back-up fields with CAWMP acm..age exceeding`7a io of its total:acres -2nd havingTeceived Jess .than 50%
of its annual PAN as documented irLihe f2rm2sprevious:two years' (1997 & 'la98) o; irTigabonTecords,-'cannot serve -as -the
soie basis-for-reouirina a WA Determinationrack-upfields -must -be noted in the -comment zecbon znd must -be accessible
by irrication system.
Part IV. Pending WA -Determinations -
P i Plan :lacks :following information:
P2 P ian Tevision -may-satisfy-75% rule based on adequate overall PAN deficit and by
adiusting all timid -acreage --to below 75% use rate _
P3 Other Galin process of installing new irrigation system):

Division of Soil and Water Conservation - Operatio&Review
Division of Soil and -Water Conservation -Compliance Dlspecion _ R:
Division=ot Water Quality :Compliance Inspection
- S
©Other Agency.- Operatton Review
10 Routine O Complaint Q Follow-up of DWQ inspection
Facility Number
Follow -use of DSWC review O Other
Date of Inspection L%}
Time of Inspection 24 hr. (hh:mm)
Permitted JO Certified E3 Conditionally Certified E3Registered Not Operational Date Last Operated:
Farm Name:Or._...... � Count .J`.!.............I............ I ._.. l�O..........
....
Owner Name:...... 1./.�:/ /—1........R�......._.4...>�1Li�/1✓�.................................... Phone No: ..... .q1 ............. I.............
Facility Contact: ........... e............... .... Title: ............. Phone No:...................................................
Mailing Address: ��U.... `�Y.�"r�:�r. .. Y...V. (J...... . L.aY �.11l.'�1 �1......_./1(.!.`✓+..:... Z
Onsite Representative: .......JkA ..>I�d'.f Y. �....................................... Integrator.......... J............................................
Certified Operator: ,�iPa1.... ......... 3z lCf �S Operator Certification Number:..'
,AW..1b ................
Location of Farm:
._........ AM"*. ..... dl...
11c .t.... �4 1....15......d �.7.....r7�....:$1 ....j lJ � ..81?a ..:! P... 19 Jif
Latitude EZ�D* a—M' [Z�­ Longitude U 7• � E30«
Design Current ' = Design Current, - Design -Current
S..iytne Capacity Population _poultry Capacity - Po ulation : 'Cattle -Capacity Population
Wean to Feeder pQ ❑Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer I Non -Dairy
❑ Farrow to Wean
❑ ❑ Other Farrow to Feeder
❑ Farrow to Finish Total •Design Capacity
❑ Gilts
❑ Boars Total,SSLW
Nbr berof;Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes AWNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2
Identifier:
Freeboard (inches): .............
Structure 3 Structure 4 Structure 5
❑ Yes A No
❑ Yes IM No
❑ Yes No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc_)
3/23/99
❑ Yes N No
Continued on back

' Facility Number: Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) .
7_ Do any of the structures need maintenance/improvement? ,Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenarice/improvement? Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes X No
Waste Application
10_ Are there any buffers that need maintenance/improvement? ❑ Yes KNo
11. Is there evidence of over application? ❑ Excessiivvve Ponding ❑ PAN El Yes No
12. Crop type Udl K y;i ��- J
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes 9No
15. Does the receiving crop need improvement? ❑ Yes X No
16. Is there a lack of adequate waste application equipment? KYes ❑ No
Renuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes No
,\
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑Yes No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes �9—No
24.
Does facility require a follow-up visit by same agency?
❑ Yes KNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes M No
0 �Vo yRAati6iis:oir• &ficienc;tes were noted• during this:visit: • YYoer Wiil-reb Kcy Rio: f'ut•th&
...... .............
c6rreSO61i fence. ahvuL this visit.
_ a
Comments (refer to.questi6nft- :E?tplain any -YES answiversr -an. &or any recommendations ar=any other comments:-
Use.drawtngs of facility.to better -explain situations, (use addiitional'pages as necessary)
I. Cdf NtcW Vww-Tiod oN InlWO- Stogy Or- 44Wd &C6- x)WtL •
��612 PIi-ice , p�R�t PUMP �(JJL APPt leh-rlp`I OF
&,tAO,C,r SA.A4PGe )Wt_ A-Alkt� f tS — t4-0- LfM P( 0 e/&/41��
Reviewer/Inspector Name 1C .
Reviewer/Inspector Signature:
Date:
3123/99

Face ity Number: 3 Date of Inspection
Odor issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
AM
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
VNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
kNo
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
W-No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? �f
❑ Yes
❑ No
Additional, Comments omments an or,, _ awrngs.
.&I
3/23/99

13 Division of Soil and Water Conservation ❑ Other Agency
0 Division of Water Quality
Routine
Facility Number 1
Follow-ut) of D«'O i
© Registered E3 Certified 13 Applied for Permit Permitted
Follow-up of DSWC review O Other_ J
� rrrr
Date of inspection
Time of Inspection 24 hr. (hh:mm)
13 Not Operational Date Last Operated:
FarmName: .................Vi&........... Low .......... N�uj................... ............................................ County: ........... bLAO in ................................ .......................
Owner Name: .....1.31rum-............ ......... �Cz.)&�aS................... .... Phone No: �g.�a� g ..... �.�r � ........
Facility Contact: ............................................ Title: . Phone No:
MailingAddress: ...... ZA&........ G�D_C.U5.... W....... ,........................................ .........C+.I.tyiKq . i .::............................ . MI .........
Onsite Representative :...............�4sna. ........ h4- 45................................................ Integrator: ...... N . .......................................................
Certified Operator........................................................ .. Operator Certification Number
Location of Farm:
.......... h..Sevik..... S ..... ° :...... 1.. tSr..bt..l�..o.it,.�4�.....�; s► .. Q. ... 1.4.17...............................
......I ............... .... ........................... ... .............................
Latitude ' 6 46 Longitude ' ` "
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes 99 No
2. Is any discharge observed from any part of the operation? ❑ Yes q No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Jj No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
Q No
4. Were there any,adverse impacts to the waters of the State other than from a discharge?
❑ Yes
[P No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
1p No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
§4 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
03 No
7125/97
Continued
on back

Facilif�r Numher: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structures (Lagoons,Ilolding Ponds Flush Pits, etc)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (ft): ............. -. Z..
....................................
10. Is seepage observed from any of the structures?
[3 Yes
] No
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes
® No
12. Do any of the structures need maintenancelimhrovement'?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public fi health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate: minimum or maximum liquid level markers?
❑ Yes
[� No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ay.�kA%,,w...................... �ef-tJf........ ....... ........................................................ .....................................................................
16. Do the receiving crop-, differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
�j No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
rMNo
18. Does the receiving crop need improvement?
❑ Yes
1:0 No
19. Is there a lack of available waste application equipment?
❑ Yes
X No
20. Does facility require a follow-up visit by same agency?
❑ Yes
1P No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
%No
22. Does record keeping need improvement?
JV 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
P No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
99 No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
M No
0 No -violations or deficiencies were noted during this.visit.-.Voum'ill receive no ftirther
correspondence about this. visit'.
Contments:(refer to question #): Explain any YES answers and/or any recommendations or any othencomments
'situations: '
Use:drawings of facility to better explain (use additional pages as necessary): u
'& VtOta be- t Vu t
l
tMjer C v�-
u k t °i� fir` �3t,rh�UB I
a w +
` v Y-e.."ve_ ke.scve. N- K4�hte, bit*, c}a.
7/25197
r
Reviewer/Inspector NamePwirzft-
Reviewer/Inspector Signature: Date:

fmT_ Withers & Ravenel
:AA Engineering and Surveying. Inc.
Nc T I I MacKenon drive, Cary NC 2751 1 Phone: [phone] Fax: 919-467-
CROSS SECTION A ----A
,Revisions
No. Description Date B
JANET JENKINS 2600 NURSERY
DUPLIN COUNTY, NORTH CAROLINA
OVERHANGING LIMBS, POWER LINES, ETC.
y 20' MIN OVERHEAD CLEARANCE
FROM HIGH POINT OF ROADBED
w0005 OVERHANGING LIMBS
TRIMMED TO IV MIN WOODS
FROM k EACH SIDE
22' MIN DITCH TO DITCH
14' MIN
ALL WEATHER TRA'4L 1MIDTH
—�1
4
COAtPACTEQ WELL -DRAINED RUAQBEU L DITCH
TYPICAL SUITABLE FOR ALL WEATHER CONDITIpNS TYPICSLOPEA
SHOULDER DITCHES
PROVIDE ADEOUATE OUTLET
FOR MOULDER DITCHES
(MINIMUM REQUIRED FARM ROAD
N. T.S.
STATE MAINTAINED ROAD - F-AvfD OR SOIL
ROADSIDE DITCH
ICULWRT
40' ATCULVERT
50' hmN LENGTH15" MIN DIAMETERb0` MWCLEARING
-
GENERAL DETAILS
`SC01%Y
Dtt to
[II�
E
5 16 97
By
Jot? No.
MW
3 0, 3

I1.
ROAD FLEv. - E-)STING
I
1 6 CLAY LINER
180 00' PAD LENGTH -
HHr,,i FNO CRADE
REFERENCE PO►JT
162,00' SUILDING LENGTH
f
1/�oPE
CONCRETE PAD
:F7E:E:ID:TANK PAD I I �--
LOW 04) GRADE
RLI'T ff (:E POINT
-I 4 1-1€1--
BUILDING PAD SECTION _(LENGTH
N. T. S.
— — — 80-00' PAD WIDTH
-- `-- _-- . 55.00' BLDG YAOTH
a
1=1
r
1.6' CLAY LINER
CONCRETE PAD
° a
3'
' F�
i t-1 11I I f- =1 1 Imo_ 3
cr=
1
III -�il—
N. T.
INSIDE TOP OF DIKE
STAKING POINT
i
ONTAL OFFSET FORSTRIP 70PIlOiL BEFORE FILLWr DJFE
LINER • 5.46'
OF DIKE
r
SOILS REQUIRING
CLAY LINER
UNER/DIKE CROS'S SECTIUfJ
��.2
N.
T.
Withers & Ravenel
Engineering and Surveying, Inc.
111 MaeKenan Drive, Cary NC 27511 Phone: [phone] Fax: [phone]
EXISTING GRADE
16' t FROM INSIDE TOP OF DIKE
SET TOP OF PVC CAP AT
TOP OF DIKE TOP OF DIKE ELEVATION
3/4" PVC PIPE DRILLED AND
C;LUfd INTO. J" PIPE
PAINT RED
3" PVC PIPE -
START PUMP
' { I. 111111=III-11 E= 6" (TYR)
�_ I I za'
1= I P=111=111=1 � 1-
STOP PUMP
BACKfILL AROUND STAFF GAUGE
WITH BENTONITE AND COMPACT
- 1-III-III-III-
ill—1 I I �I I III a�
_I I-1 I —I 1 li 18" BURY DEPTH MIN
—
III -
�` Ali^,FF_ GAUGE
1
PROFILE VIEW
JANET JENKINS 2600 NURSERY
DUPLIN COUNTY, NORTH CAROLINA
N. T.S.
YL ON
Df S
-OA TE
OSTS
2' TO 3' SECTION OF FLEXIBLE
REINFORCED CONNECTOR HOSE
PLACE FLExJBLE CONNECTORZC
SEWRELY FASTENED TO PVC"
12" TO 18 FROM PIPE WITH STAINLESS STEEL BAND
SUPPORT TO MINIMIZE LAMPS.
STRESS ON DISCHARGE 20 LF PVC DISCHARGE 'FLOATER" PIPE
PIPE, WATERTIGHT PLASTIC BARREL OR
SIMILAR FL07ATION DEVICE TO
SUSPEND END OF PIPE JUST BELOW
WATER SURFACE -- LASH PIPE TO
FI FLOAT WITH NYLON ROPE
ISTART PUMP LEVEL
STOP PUMP LEVEL
MIN�WATER LEVEL AT
DOUBLE 8 X 4 TART UP
A��
PIPE SUPPORT
�Ll
n 4' MIN WATER DEPTH SHOWN IS WITHOUT SCOUR
PROTECTION ON LAGOON BOTTOM. IF SCOUR
PROTECTION IS PROVIDED, WATER DEPTH MAY BE
PIPE SUPPORT SHALL BE DECREASED TO 1/2 TREATMENT ZONE DEPTH.
BACKFILLED WITH CLAY
AND COMPACTED
DISCHARGE PIPE
N.T.SS-
SPECIFICATIONS FOR CONSTRUCTION OF WASTE TREATMENT LAGOON
FOUNDATION PREPARATION:
THE FOUNDATION AREA OF THE LAGOON, LAGOON EMBANKMENT AND BUILDING
PAD SHALL BE CLEARED OF TREES, LOGS, STUMPS, ROOTS, BRUSH, BOULDERS,
SOl3, TOPSOIL AND RUBBISH. SATISFACTORY DISPOSITION WILL BE MADE OF ALL
DEORIS. UPON COMPLETION OF THE CLEARING OPERATION, THE EXPOSED
SU8GRADE IN AREA TO RECEIVE FILL SHOULD BE PROOFROLLED WITH A LOADED
DUMP TRUCK OR SIMILAR PNEUMATIC -TIRED VEHICLE (MINIMUM LOADED WEIGHT
OF 25 TONS) UNDER THE DIRECTION AND OBSERVATION OF A GEOTECHNICAL
ENMNEER OR HIS REPRESENTATIVE. AFTER SITE EXCAVATION HAS BEEN
COMPLETED, THE EXOSED SUBGRADE IN CUT AREAS SHOULD ALSO BE
PROOFROLLED THE PROOF"ROLLING PROCEDURE SHOULD CONSIST OF ONE OR
MORE COMPLETE PASSES OF THE EXPOSED AREAS AS DIRECTED BY THE
GEOTECHNICAL ENGINEER. ANY AREAS WHICH DEFLECT. RUT, OR PUMP
EXCESSIVELY DURING THE PROOFROLLING, AND FAIL TO STABILIZE WITH
SUCCESSIVE PASSES, SHOULD BE EXCAVATED (UNDERCUT) TO SUITABLE SOILS
AND REPLACED WITH COMPACTED FILL. IF PREPARED SUBGRADES ARE LEFT
EXPOSED TO INCLEMENT WEATHER OR DISTURED FROM CONSTRUCTION TRAFFIC,
ADDITIONAL SOIL REMOVAL AND REPLACEMENT MAY BE NECESSARY. THE
LAGOON AND BUILDING PAD AREAS SHALL BE THOROUGHLY LOOSENED PRIOR TO
PLACING THE FIRST LIFT OF FILL MATERIAL TO GET A GOOD BOND.
EXCAVATION AND EARTHFILL PLACEMENT
THE COMPLETED EXCAVATION AND EARTHFILL SHALL CONFORM TO THE LINES,
GRADES, AND ELEVATIONS SHOWN ON THE PLANS. EARTHFILL MATERIAL SHALL
BE FREE OF MATERIAL SUCH AS SOD, ROOTS, FROZEN SOIL, STONES OVER 6 INCHES
IN DIAMETER, AND OTHER OBJECTIONABLE MATERIAL. TO THE EXTENT THE ARE
SUITABLE, EXCAVATED MATERIAL MAY BE USED AS FILL. THE FILL SHALL BE
BROUGHT UP IN APPROXIMATELY HORIZONTAL LAYERS NOT TO EXCEED 9 INCHES
IN THICKNESS WHEN LOOSE AND PRIOR TO COMPACTION.. EACH LAYER WILL BE
COMPACTED BY COMPLETE COVERAGE WITH PROPER COMPACTION EQUIPMENT.
NOTE THE SPECIAL REQUIREMENTS FOR PLACEMENT OF LINERS IN THE LINER
SECTION OF THIS SPECIFICATION.
THE EMBANKMENT OF THE LAGOON SHALL BE INSTALLED USING THE MORE
IMPERVIOUS MATERIALS FROM THE REQUIRED EXCAVATIONS. CONSTRUCTION OF
FILL HEIGHTS SHALL INCLUDE 5 PERCENT FOR SETTLEMENT. DIKES OVER 15 FEET
IN HEIGHT WITH AN IMPOUNDMENT CAPACITY OF 10 ACRE-FEET OR MORE FALL
UNDER THE JURISDICTION OF THE NC DAM SAFETY LAW AND REQUIRE PERMITTING
BY THE NC DEPT. OF ENVIRONMENT, HEALTH AND NATURAL RESOURCES, LAND
QUALITY SECTION. THE HEIGHT IS DEFINED AS THE DIFFERENCE IN ELEVATION
FROM THE CONSTRUCTED HEIGHT TO THE DOWNSTREAM TOE OF THE DIKE
PRECAUTIONS SHALL BE TAKEN DURING CONSTRUCTION TO PREVENT EXCESSIVE
EROSION AND SEDIMENTATION.
LINER:
THE MINIMUM REQUIRED CLAY LINER THICKNESS SHALL BE 1.6 FT,
NOTF� LINERS (PARTIAL OR FULL) ARE REQUIRED WHEN INDICATED ON THE
DRAWINGS OR WHEN MATERIAL IS ENCOUNTERED DURING CONSTRUCTION THAT
WILL NOT PROVIDE THE PERMEABILITY LIMITS AS STATED LATER IN THIS SECTION.
A TYPICAL CROSS SECTION OF THE LINER IS INCLUDED IN THE DRAWINGS WHEN
LINERS ARE REQUIRED.
WHEN AREAS OF UNSUITABLE MATERIAL ARE ENCOUNTERED, THEY WILL BE CNER
EXCAVATED BELOW FINISH GRADE 1'0 THE SPECIFIED DEPTH AS MEASURED
PERPENDICULAR TO THE FINISH GRADE AS DIRECTED BY A QUALIFIED
GEOTECHNICAL ENGINEER OR HIS REPRESENTATIVE. THE FOUNDATION SHALL BE
BACKFILLED AS SPECIFIED TO GRADE WITH A MATERIAL APPROVED BY THE
GEOTECHNICAL ENGINEER OR HIS REPRESENTATIVE.
REFER TO THE DRAWINGS FOR SPECIAL CONSIDERATIONS,
SOIL LINER MATERIAL SHALL COME FROM AN APPROVED BORROW AREA- THE
MINIMUM MOISTURE CONTENT CIF THE LINER MATERIAL SHALL BE AT OR WET OF
OPTIMUM MOISTURE CONTENT AS DETERMINED BY A STANDARD PROCTOR TEST
(ASTM D698). WATER SHALL BF ADDED TO BORROW AS NECESSARY TO INSURE
FpOPER MOISTURE CONTENT DURING PLACEMENT OF THE LINER. THE MOISTURE
CONTENT OF THE LINER MATERIAL SHALL NOT BE LESS THAN OPTIMUM MOISTURE
CONTENT DURING PLACEMENT. THE MAXIMUM MOISTURE CONTENT RELATES TO
THE SOIL MATERIAL BEING TOO WET FOR EFFICIENT USE OF HAULING EQUIPMENT
AD PROPER COMPACTION. PROPER COMPACTION OF THE LINER INCLUDES
P C'EMENT IN 9 INCH LIFTS AND COMPACTED TO AT LEA',T 95 PERCENT OF THE
S ANDARD PROCTOR MAXIMUM DRY DENSITY (ASTM D698) OF THE LINER
MATERIAL. WHEN SMOOTH OR HARD, THE PREVIOUS LIFT SHALL BE SCARIFIED
AWO MOISTENED AS NEEDED BEFORE PLACEMENT OF THE NEXT LIFT.
THE SINGLE MOST IMPORTANT FACTOR AFFECTING THE OVERALL COMPACTED
PERMEABILITY OF A CLAY LINER, OTHER THAN THE TYPE OF CLAY USED FOR THE
INER, 15 THE EFFICIENT CONSTRUCTION PROCESS OF THE COMPACTED LINER. THE
EQUENCE OF EQUIPMENT IN AN ESTABLISHED PATTERN HELPS ASSURE
=NIFORMITY IN THE ENTIRE PLACEMENT AND COMPACTION PROCESS. FOR MOST
LAY SOILS, A TAMPING OR SHEEPSF00T ROLLER IS THE PREFERRED TYPE OF
OMPACTION EQUIPMENT
IN ACCORDANCE WITH NRCS SOUTH NATIONAL TECHNICAL CENTER (SNTC)
TECHNICAL NOTE 716 (RE1I SED SEPTEMBER 1993) THE MAXIMUM ALLOWABLE
`'.SPECIFIC DISCHARGE OF THE LINER IS 1.0 X 10-5 CM/SEC. THIS SPECIFIC DISCHARGt
IS DEPENDANT ON THE PERMEABILITY' OF THE LINER MATERIAL, THE LINER
THICKNESS, AND THE HYDROSTATIC PRESSURE ON THE LINER. WITH THE
MINIMUM REQUIRED LINER THICKNESS STATED EARLIER AND THE MAXIMUM
LIWUIid VLr 111 W4 I! IL ♦rf1VV JIY, 1I1L Irl n. n.{{y I1,J iVl I" LI♦{vlL An Lie i 31 T; IY, `.vlvla r. f. re.0
LINER IS 1,25 X 10-6 CM/SEC. UPON COMPLETION OF THE LINER. UNDISTURBED
SAMPLES WILL BE TAKEN AND TESTED FOR ACTUAL PERMEABILITY. ANY
PERMEABILITY TESTS INDICATING A HIGHER PERMEABILITY THAN STATED ABOVE
WILL BE CONSIDERED AS FAILING, FAILING TESTS WILL REQUIRE RECOMPACTION
OF THE LINER MATERIAL AND RETESTING. THE SOIL LINER SHALL BE PROTECTED
FROM SCOUR PRODUCED BY THE DISCHARGE FROM WASTE OUTLET PIPES.. THIS
CAN BE DONE BY USING SOME TYPE OF ENERGY DISSIPATOR. CONCRETE FLUMES,
CONCRETE BLOCKS LAID TIGHTLY TOGETHER, OR USING FLEXIBLE PIPE OUTLETS
ON WASTE PIPES.
VEGETATION:
ALL EXPOSED EMBANKMENT AND OTHER BARE CONSTRUCTED AREAS SHALL BE
SEEDED TO THE PLANNED TYPE OF VEGETATION AS SOON AS POSSIBLE AFTER
CONSTRUCTION ACCORDING TO THE SEEDING SPECIFICATIONS. TOPSOIL, IF g�„ewr
AVAILABLE ON SITE SHOULD BE PLACED ON AREAS OF THE DIKE AND PALL TO BE CA r,".0
SEEDED. TEMPORARY SEEDING OR MULCH SHALL BE USED If RECOMMENDED S?��j �«•.. '.
PERMANENT VEGETATION IS OUT OF SEASON DATES FOR SEEDING. PERMANENT
VEGETATION SHOULD BE ESTABLISHED AS SOON AS POSSIBLE DURING THE NEXT
PERIOD OF APPROVED SEEDING DATES. w IAL
REMOVAL OF EXISTING TILE DRAINS: 7
's�-Si•''ri��L�,•`•sC� �•
AN OBSERVATION TRENCH SHALL BE DUG ALONG THE PERIMETER OF THE LAGOON r,*i� `•••..•- <� :`
25 FEET OUTSIDE THE PROPOSED EMBANKMENT TOE TO VERIFY THAT NO
SUBSURFACE DRAIN TILE LINES ARE PRESENT IN THE LAGOON AREA. THE TRENCH
SHALL BE DUG TO A MINIMUM DEPTH OF FIVE FEET AND SHALL HAVE A WIDTH
ADEQUATE TO ACCOMMODATE EQUIPMENT USED FOR BAC'.KFILL AND
COMPACTION- TRENCH SIDE SLOPES SHALL BE 1: 1 OR FLATTER. TRENCH SACKFILL
SHALL BE COMPACTED AS STATED IN THE EXCAVATION AND EARTHFILL �n�rtievlrr+Inure,,
PLACEMENT SECTION OF THE SPECIFICATION. �a�+;;.:.'' ,
WHEN TILE DRAINS ARE ENCOUNTERED, THE TILE WILL BE REMOVED TO A•`�
MINIMUM OF 25 FEET BEYOND THE OUTSIDE TOE OF SLOPE OF THE DIKE. THE TILE
TRENCH SHALL BE BACKFILLED AND COMPACTED WITH MATERIAL APPROVED BY
THE GEOTECHNICAL ENGINEER OR HIS REPRESENTATIVE. TILE DRAINS THAT ARE +`
REMOVED $HALL BE EITHER CAPPED OFF OR REROUTED AROUND THE LAGOON, AS �r'!f�'G�ti�t�••Q�
OtPECTED BY THE GEOTECHNICAL ENGINEER OR HIS REPRESENTATIVE.
SAFETY AND HEALTH REQUIREMENTS:rsrulnllrri''"",��
ALL OPERATIONS SHALL BE CARRIED OUT IN A SAFE, SKILLFUL, AND C�
WOR, ,'MANLIKE MANNER. ALL APPLICABLE LOCAL, STATE, AND FEDERAL SAFETY
HEALTH REGULATIONS SHALL BE FOLLOWED AND APPRt IPRIATE PERSONAL
SAFETY AND HEALTH MEASURES USED AT ALL TIMES DURING CONSTRUCTION.
BUILDING & LAGOON DETAILS
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Designer
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Sleet No.
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T
CROSS SECTION A--- A
nilz,Tl gPRF-n APFA
2 FT MIN
COMPACTED SOIL
6` TYPICAL
TEMPORARY D1VERS-'1(--)'N
Withers & Ravenel
Engineering and Surveying, Inc.
111 MocKenan Drive, Cory NC 27511 Phone: [phone] F`ax: 919-467-604$
N.T.S.
a�{
1
i
JANET JENKINS 2600 NURSERY
DUPLIN COUNTY, NORTH CAROLINA
OVERHANGING LIMBS. POWER LINES ETC.
20' MIN OVERHEAD CLEARANCE
FROM HGh POINT OF ROADBED
S OVERHANCINC LIMBS
TRIMMED TO 11' MIN WOODS
FROM EACH SIDE
22' MIN DITCH TO DITCH —
YY
14' MIN I
ALL WEATHER TRAVEL WIDTH
1 1J2'/F1 }/2'/FT
�J 1
4
COMPACTED WELL -DRAINED ROA[ff,.D TYPICAL DITCH
SUITABLE FOR ALL HEATHER CONDITIONS SLOPES
SHOULDER DITCHES
PROVIDE ADEOVATE OUTLET
FOR SHOULDER DITCHES
MINIMUM REQUIRED FARM ROAD
N.T.S.
5TATE UAINTA*4ED ROAD - RAVED OR SOIL
TW,I /'-- ROADSIDE DITCH
50' MIN LENGTH I ,
15' MIN DIAMETER CULVERT 60.
MIN
CLEARING
SECURITY GATES
END OF TAPER/SECURITY
ENTRANCE MUST BE PLACED SO ` GATE LOCATION
THAT 1/4 MILE VISIBILITY IS I
PROVIDED IN BOTH OIRECT'1ONS
0
0
0 14' 'MIN ALL 'HEATHER TRAVEL WIDTH
22' MIN € DITCH TO q DITCH
MUMUM ENTRANCE REQUIREMENTS
N.T.S.
GENERAL DETAILS
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Sheet No.
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