310854_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: t_ PLT7j Region: lit%
Farm Name: xel�e > l,LQ W-I Owner Email:
Owner Name: ej-Q "s (J rr CQ Phone:
Mailing Address:
R
Physical Address:
Facility Contact: i:37e_ QS f1 Title:
.t
Onsite Representative:
Certified Operator: 4j
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: -5,4" + f-i'e lql
Certification Number: 2 D0 b2-
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current D Cow
Dr. P,ouI Ca aci P,o Non -Da'
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
s
Poults
#Othere
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 RNo ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes [:]No
[:]Yes [:]No
❑ Yes VNo
❑ Yes No
NA ❑ NE
NA ❑ NE
[4 NA
❑ NE
[DNA
❑ NE
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili 'Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[A 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): 3Z�
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
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes P 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
QWindow
�� f�❑ Evidence of Wind cDrift /10 ,Application Outside of Approved Area
12. Crop Type(s): coal�(e�.'r' '�Q�'A5 T�►��,c7r^' -*fin©
13. Soil Type(s): n — l l� )a,Tt<I
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes [!P No ❑ NA ❑ NE
❑ Yes �N No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ]o 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 D Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
0 Yes No
❑ NA
ONE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall 0 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 Continued

Facili ' "Number: jDate of inspection: rjp
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [P 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes;No
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [R No ❑ NA ❑ NE
and report mortality rates that were higher than normal? TT
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[] No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[!P No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�jNo
❑ 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).
I _4wA-e5nL-
10- qql-gB"91
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: _ Date: �ZO
Page 3 of 3 21412015

Type of Visit: 557ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: ge
_/IN Region: Lf/,t4,
Farm Name: p/e< <y Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title: Phone:
Integrator: 0& ,(fig
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design C►urgent
Swine C►apacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Design Current
D . P,oul Ca ac6 Po
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
jBeef Feeder
Boars
Pullets
lBeef Brood Cow
Other
Other
Turke s
Turkey Poults
Mer
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?
❑ Yes 'L�'No ❑ NA ❑ NE
❑ Yes J�no ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
KNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of inspection: L
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PTNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes L ❑ 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.) 9
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑Vo ❑ NA ❑ NE
waste management or closure plan? /
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 12'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) P
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE
maintenance or improvement? T
l I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et .)
❑ 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 ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ 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 P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes PrNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes KNo
❑ 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 P 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! 1I�
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes ZNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes dNo ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes _P No ❑ NA ❑ NE
❑ Yes ;;tNo ❑ NA ❑ NE
❑ Yes J?fNo ❑ NA ❑ NE
❑ Yes E!fNo ❑ NA ❑ NE
❑ Yesf o ❑ NA ❑ NE
❑ Yes ��o ❑ NA ❑ NE
❑ Yes -dNo
❑ Yes 5�No
YesNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question_#}: Eaplain�gny YES answers and/or any,additional recommendations or;,any-other,comments.
w
Use drawings of facility to better explain situations (use additional pages as necessary)..
%kt/ Aa C.o,wes av, /CA
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: kV22rM2
Date:
2/4)1201 S

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: - IAQ eAL2Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: (I r I te1
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator: Z�' .1�5
Certification Number:
Certification Number:
Longitude:
Region:
Design Current Design Current
Swine Capacity Pop. Wet Poultry C►apacity Pop. Cattle
Wean to Finish La er Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I jNon-Layer I Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current Dry Cow
De, P,oultr, C►_a acit P,o , Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
101
Turke s
Turkey Poults
10ther
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at:. ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes I/_ I No ❑ NA ❑ NE
❑ Yes '9No
❑ Yes C2No
❑ Yes No
❑ Yes No
❑ Yes [ZNo
❑ NA ❑ NE
DNA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[ISNo
❑ 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
P No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[�fNo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
17No
❑ 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
[�fNo.
❑ 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
[7No
❑ 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
[7 No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWIVIP?
❑ Yes
ZNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
C�Ro
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
0 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).
'
Sot(
,/ 5 NCa)
716
71Zj
01 "Tn c",7 IOU rn (M ,
' y\V.C-•_ta S
J
Reviewer/Inspector Name: t Phone: /•V-��
Reviewer/Inspector Signature: Date: 6P
(J
Page 3 of 3 21412014

Facility Number: Date of Inspection:
Waste Collection & Treatment
4.,Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA
❑ NE
Structure 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
Pr No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Na
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
o
VN
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
Z"No
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
6 No
❑ NA
❑ NE
maintenance or improvement?
ow.
11. Is there evidence of incorrect land application? If yes, check the appropriatPal
❑ Yes
FfNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Groundeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑o 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
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
0 NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VI 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. dyes go No
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield V120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Type of Visit: "U Com liance Inspection V Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Q Arrival Time: Departure Time: County: ��//�� Region:,
Farm Name: / Owner Email: T'
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator: /.�!/l � y7 (58
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design C►urrent
Wean Swine Capacity Pop.
Wean to Finish
I
Design Current
We# Poultry Capacity Pop.
ILayer
Cattle
Dairy Cow
Design
Capacity
it
Pap.
Wean to Feeder
I
INon-Layer I EFEE
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P.oul Ca aci P,o
Lavers
Dairy Heifer
Cow
Non -Daily
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Uther
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
PNo
TT
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
[:]No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 121412014 Continued

FacilityNumber. - Date of In ection: a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[] No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ 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 > lk. 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
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [::]Yes [—]No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection:
24. bid the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional.pages as necessary)., ;
�a � b ru; � ron� ✓
IL
S � c�.cl�-e su, r� ✓
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
L,s 4-
t,. 7,
aVy
Phone:
Date: 3
12141264

Reason for Visit: Q outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: a eparture Time: County: �� Region:
Farm Name:4-19 f Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Operator:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
INon-Layer
Ell
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
Di. P,ouI Ca aci P,o
I Layers
D Caw
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Turkey Poults
Other
i
i
0
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes "No ❑ NA ❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
/�No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �o
❑ Yes _E No
❑ Yes _La l4o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

i
Facifi Number:.... - Date of Ins ection:
Waite Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Vr'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [;;] o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): the
5. Are there any immediate threats to integrity of any of the structures observed? [:]Yes g] 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 JZCNo ❑ 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 C]�Ro ❑ 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 �' o ❑ 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 [2"NO ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 12 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 ❑"No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [:�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [2�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. 0Ycs ❑ No
❑ Waste Application ❑ Weekly Freeboard OWaste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [(No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

oS
Facili Number: 21 - Date of Inspection:
24.bid the facility fail to calibrate waste application equipment as required by the permi ? ❑Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �f o ❑ NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 4 No
❑ Yes Ff"�o
❑ Yes ZNo
❑ Yes Z No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
❑ Yes jffNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes V
fNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. .
Use drawings of facility to better explain situations (use additional pages as necessary).
64J 1 LJ fir+
0103 11 z7 lc�se� �� i� fiL wA)
l�j�f�ry j• �'� �
cJ
Reviewer/Inspector Name:
ReviewerAnspector Signature: '/ C_
Page 3 of 3
Phone:
Date: � Z�a" ..
Zi412o r

.r, ri
. ;.
s r
sion of Water Quality
Facility Number - ® Division of Soil and Water Conservation
� Other Agency
Type of visit: 0 Compliance Inspection n Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: // Arrival Time: .4 Q c eparture Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: tt,— Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer Da' Cow
Wean to Feeder
Nan -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design C►urrent D Cow
Farrow to Feeder
D , P,oultr, Ca acity P,o Non -Dairy
Farrow to Finish
La ers Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 j2TNo ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes ZNT
❑ Yes
❑ Yes ] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412011 Continued

facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EfNo ❑ 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: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J" No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ,E!j No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes X] No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes J'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 KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J�J_No . ❑ NA 'D:
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑Yes 'O'No ❑ NA':.Q'
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
PAN PAN > 10% or 10 lbs. Total Phosphorus Failure to Incorporate Manure/Sludge a into Bare, S61- ;
❑ ❑ ❑ P ❑ IP g t .;
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area: +'
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
IS. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA ' ❑ hTE
�❑TNo
❑ Yes,,,Z No
❑ NA
❑ NEB r
❑ Yes J2 No
❑ NA
❑ NE,
❑ Yes E�j7No
❑ NA
❑ NE
❑ Yes 'Eno
❑ 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 )ErNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, cVWtaste
e appropriate box below. � Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes /ffNo
,23. If selected, did the facility fail to install and maintainrainbreakers on irrigation equipment? ❑ Yes -Efl No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
' "F Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pe it?
❑ Yes
❑ No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments. -�
Use drawings of facility to better explain situations (use additional pages as necessary).
5ui e- 4
�I r
ih/�Fi[ y��J • OL4 �� wO�
f
VL✓�
s �s
��/'� / Y WLr�eCUC.J � � �l Ci � St/1'`�
O�
v"� V1 lC G'���+�]•
' Reviewer/lnspector Name:
,Reviewer/Inspector Signature:
,Page 3 of 3
Phone: 710 � — z
Date:
214,12011

Division of Water Quality
Fac l�ry Number Q Dtvvimomof Sou and Water Conservation
��, O -
Other Agency,
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 11112 Arrival Time: Departure Time: County: ��- Region: �fl
Farm Name: lco, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: //�� Title: Phone No:
OnsiteRepresentative:y�/f Z�20"rr, Integrator: rn
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: c = 4 = I{ Longitude: = e a
44 g -< Design Current. Des>gn Current" `
Design Current
Swine "�Capactty Population "Wet Poultry �Capaci�pulahan
Cattle
Capacity Population
❑ Wean to Finish ❑ Layer
❑ Dairy Cow
❑ Wean to Feeder ? ❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish_
� * �
❑
Dai Heifer
❑Farrow to Wean Dr"y Poultry
x
❑
D Cow
,tw
❑ Farrow to Feeder'"" �" "'° "
"'t "`'`�
-Dairy
wv ElFarrow to Finish t Layers
❑
Beef Stocker
❑Gilts ❑ Non-Layers
El
Beef Feeder
❑Pullets
❑ Boars
❑
Beef Brood Co wl
; ❑ Turkeys
O#berms 0 Turkey Points
Oth
-er El Other
>..�
um tier❑ o K tructures:
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes P,<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
Fe -No
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of inspection ll
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: f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Zvl>
❑ Yes J'No ❑ 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 P*Igo
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [ Ko
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ONo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P'1Qo
❑ 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 P-'No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ Xo
[I NA El NE
maintenance/improvement? //
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �fo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes )A 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 acre determination ?
'P'No
❑ Yes 0 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 recommendat►ons or any other�comments
Use, drawings of facility to better explain situations: (use additional pages as+itecessary)": s 4
a ,.a
i
T
Reviewerlinspector Name
; Phone: Z f�
4 ,
Reviewer/Inspector Signature:
Date: Cl Z Ca
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 ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;�,No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '[�'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes �2`No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes jallo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes Elqqb
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 'tKo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes J'No
.❑ NA
[:1 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 J:I-No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes J'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 ONo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
_1:;
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ONo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes 2 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
q
Page 3 of 3 12a8104

t
Type of Visit Q-Ceirpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit _(DAKroutine O Complaint O Follow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arri al Time: F: QZ Departure Time: County:
Farm Name: ,- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone /No:
gg
Integrator•
Operator Certification Number:
Back-up Certification Number:
Region: 61�_
Latitude: = o = I ❑ds Longitude: = e = 6 = H
Design Current
Design
Current
Design Current
Swine Capacity Population
Wet Poultry
Capacity
Population
Cattle
Capacity Population
❑ Wean to Finish
❑ La er
I
I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ D Cow
El Farrow to Feeder
El La ers
❑ Non -Dairy
El Farrow to Finish
ElNon-La Non -Layers
❑ Beef Stocker
El Beef Feeder
❑ Gilts
❑ Boars El Pullets
❑ Beef Brood Co
❑ Turkeys
Other P-Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharues & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZI.No ❑ NA ❑ NE
❑Yes
El No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
Oyes
o
El NA
El NE
❑ Yes
WNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 3/ — Date of Inspection a 8'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes C3No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
,ONo
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �o 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 P�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes J�'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 eNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance/improvement?
L Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes ;al
❑ NA ElNE
❑ Excessive Ponding ❑ Hydraulic Overload ElFrozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes,/ 'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [INo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes �' o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ,B'5o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes _P o
❑ NA
❑ NE
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: eV 17
rugsi uJ -V...... -

w Facility Number: 7zDate of Inspection L O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [;No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 9kNo
❑ NA
❑ NE
❑ Yes RNo
❑ NA
❑ NE
❑ Yes 4 No
❑ NA
❑ NE
❑ Yes ONo
❑ NA
❑ NE
❑ Yes ,Ll No
❑ NA
❑ NE
❑ Yes 0No
❑ NA
❑ NE
❑ Yes �?No ❑ NA ❑ NE
❑ Yes )2!rNo ❑ NA ❑ NE
Cl Yes JRNo ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes VNo ❑ NA ❑ NE
AdditionalComments
A.
W N NC) a.� a��S�s CrGv e
I 2 - 3 : YNK
� Js
a ► r1� e� n a- S2 e u
QC(eci- VVNvS
r
e c +to r G - � -So � c� CIL(20L�
Cf 60
b "i.Li-
Page 3 of 3 12128104

Facility Number 1 31
la Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency v
Type of Visit Qf Co Hance 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: 6 3 p Arrival Time: ® Departure Time: County: ImutiLL Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
On site Representative: E D0 i(_- Q AZ_A:�e
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
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
Latitude: 0 0= a" Longitude: [�° [� i [�"
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_1.❑ Layer
ri ❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current_ .,
Cattle Capacity Population r.
❑ Dairy Cow
❑ Daja Calf
❑ Da'x Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 2(N ❑ NA ❑ NE
El�No Yes ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of inspection /6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
,StructurelI
Identifier: L,/f!tzsb N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
,Lfi,/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
environ ntal 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
Z 1V El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ENo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CNo ❑ 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)
i
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
I
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
I eo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2b
❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
' No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
1,) (,(_C4J 02AU5 w ALA-S,
I&
jJ60 WL/P w.tjg:r0
3-b 9Ag5 -tb ID062•
OnA 12cC0,0 O_f 13 Y
,oE c.� r S, zoe-1 56tiID
�}{) CA&UAAtr6nl &sVNTh)
36 09YJ
Reviewer/Inspector Name
(i Phone: 1,' (—d
Reviewer/[nspector Signature:
Date: 1013A
12128104 1 Continued

• Facility Number: S — Date of Inspection d S
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ es M No [I NA ❑ NE
20. Does the facility fail to have 1 components of the CAWMP readily available? If yes, check Yes El No El NA El NE
the appropiate box.
WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does ecord keeping need improvement? If yes, the the appropriate box elow. Yes ❑ No ❑ NA ❑ NE
ld Waste Application [We ly FreeboardZO
aste Analysis LJ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall Stocking �J Crop Yield inute Inspections onthly and 1" 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?
Comments and/or Drawings:
❑ Yes
El NA
[I NE
❑ Yes
7No
❑ NA
❑ NE
[Yes
❑
El NA
❑ NE
El Yes
o
❑ NA
❑ NE
[I Yes
WNo
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
ZN o
❑ NA
❑ NE
❑ Yes
n No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
fTNo
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
12128104

.. .
,WDivision of Water Quality
I M_ Facility Number O Division of Soil and Water Conservation
M_M_� O Other Agency
Type of Visit 7 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑/ Denied Access',
Date of Visit: �� �� O Arriva ime: ' / ,/ /
eparture Time: nty: ��LZN Region: wfA0
Farm Name: 7 �= r, Owner Email:
Owner Name: 6200— k.'a U,Q Wc"'r- Phone:
Mailing Address:
Physical Address:
Facility Contact: ,, Title: Phone No:
Onsite Representative: /i��y� I_= AQ7 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude: ❑
Operator Certification Number:
Back-up Certification Number:
Longitude: = ° ❑ ' ❑
Design Current'. Design Current Design Current
„Siv�ne. Capacity. Population We# Poultry. Capacity.;, Population Cattle' . Capacity_ Population.
] Wean to Finish ❑ Layer_
] Wean to Feeder 1 ❑ Non -Layer
Feeder to Finish
Farrow to Wean Dry Poultry
J d
Farrow to Fee er
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other:
❑ Other
Non-L;
Pullets
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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes xNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes /No ❑ NA ElNE
❑ Yes /No ❑ NA ❑ NE
12128104 Continued

Facility Number:,5 — 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 I Structure 2
Identifier: W
Spillway?: AIQ
Designed Freeboard (in): &5
Observed Freeboard (in): to
Structure 3 Structure 4
❑ Yes �/ j No
El Yes /❑ No
Structure 5
❑ NA ❑ NE
El NA El NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA [I NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes o ❑ 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 XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No [-INA [-INE
(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 YNo []NA ❑ NE
ElExcessive Ponding ElHydraulic Overload ElFrozen Ground ElHeavy 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 ElApplication Outside of Area
12. Crop type(s) Se"f l laaa ",4- S:::� it.
i
13. Soil type(s) _L AA0 ^
i
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?
❑ YesNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes 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):
. <
ERe
wer/Inspector Name �' Q Phone: D '� - Z'�
werlInspector Signature: Date: I Q ro
Page 2 of 3 1717 /p4 Continued

Facility Number: 'rj —j Date of Inspection I/
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? IZYes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IV
El NA El NE
the appropriate box.
❑ WUP ❑Checklists [I Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. F(Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
El Rainfall El Stocking El Crop Yield 2�mute Inspections ❑ Monthly and 1" Rain Inspections Weathe 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 PNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ONo ❑ 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? 9Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes 'No ❑ NA ❑ NE
El Yes No El NA ❑NE N
❑ Yes X
No ❑ NA ❑ NEC
❑ Yes o ❑ NA ❑ N
❑ Yes No ❑ NA ❑ NE
lAdditional Comments and/or Drawings: / I
Ck
�OGL
AlAfP
116 g�4gc IZ14'5r.a_ 40V4e_�15e_5 O/V 4W-2 (4 3AII,
OA-
1X69 cc..) �
Page 3 of 3 12128104

IType of Visit Qf Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visiitt A Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access iI
Date of Visit: %� Arrival Time: 1.19Departure Time: ; ounty:
Farm Name: Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
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
t
Region:
Phone No: )
Integrator:../�(p/� cJN
Operator Certification Number:
Back-up Certification Number:
Latitude: = ' = ' = Longitude: = ° = ' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turk e s
❑ Turkey Pouits
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: EP
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 vNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

r, f
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes to No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Stwc ure 1 Structure 2 Structure 3 Structure 4
Identifier: 4
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesNo
[INA ElNE
(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) )Z
9. Does any part of the waste management system other than the waste structures require ❑ Yes ;ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes X
No El NA El 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 Dji(i ❑ Application Outside of Area `
12. Crop type(s)
13. Soil type(s) )15'k !V,
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
No
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�K
XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
No
X
ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
X No
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer.to question Exp;dn,any YES;,answers:andlor any recommendations or any otheir`�commeats '
Use drawings of facthtyto better explain situations (use additional page as�n ce♦ sary) a 5 <" ; �';
.Y..
w) 06�rjb2 /vim �o s r 5N G1i U� �zca ; r�iX
/t%
��/hE�>A-7z��„�• lU��p�� &'9�0
�,22zG-�4T-7On� ;G;,IScaE�7�v� /�n/A
Reviewer/Inspector Name Phone: 0
Reviewer/Inspector Signature: ftg�_' Date: 0
12128104 1Continued

a M
Facility Number: — Date of Inspection
ReQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? /yes ElNo ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes /No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 9Ycs ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard OlWaste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking 0 Crop Yield 0120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections Xweather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes joNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
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
9Yes
❑ No
❑ NA
❑ NE
❑ No
❑ NA
❑ NE
,VYes
❑ Yes
'd No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
7(NE
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 FfNo
❑ Yes /0 No
❑ Yes /yl No
❑ Yes A. No
El Yes A.
No
El Yes �No
❑NA El NE
El NA El NE
El NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Ad�dttiogal Commerit`s an'dlor Drawin s . ,`
2q) / %(� D 2,0 �4',02 Vi /4nl.O A Z6&T7o�o1 �iG�324>
/v6? a Fcu�cJ,
Q
12/2&04

(Type of Visit gVCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: d Time: ; 6 O
.„ Not Operational Q Below Threshold
0 Permitted 13 Certified © Conditionally Certified 13 Registered Date Last Ope or Above Threshold:
Farm Name: ... _ _ . . _ . _ . County: »�._�.... .
Owner Name: _ - _ __- _ _....__ . _ ._ _ ....... 'Phone No:.
?Mauling Address:------
Faciliity Contact: . !_.. _............_......_.. Title: _J_M,Phone No:
Onsite Representative: � I r (_�14 O»7P�f j �ylUS �Int�toi =Am�69&
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • " Longitude & 1 64
Discbaees 8 StE+eam Iin acts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
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 EffNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XrNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Strur 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): oc
12112103 Continued

Facility Number: ' — gJ Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes yErNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes .EM
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes -2vo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes J;wo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance./improvement?
❑ Yes .-2T4o
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes .2-No
❑ Excessive Ponding ❑ PAN PHydraulic Overload ❑ Frozen Ground ❑ Co er and/or Zinc
12. Crap type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWW)?
❑ Yes P-No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes [?No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes ;2,No
I6. Is there a lack of adequate waste application equipment?
[--]Yes � ff No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ,0'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
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ZfT40
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 ;314o
Air Quality representative immediately.
Co ats {scfer to�q on) Eacpigzn smy XES ifor r+evammenda ons orrA o
iUsedawin�s oftytbetteei+atglatn siwations. (ase=scckl I pagesas ryj: ❑ Wield Copy ❑Final Notes'
Fo im i s i VL 00d. S
W „
Reviewer/Inspector Name e �
Reviewer/Inspector Signature: Date: o
12112103 Confinued

Facility Number; Date of Inspection % C�
Required Records & 17ocnments
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
-,eNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
,�o
23. Does record keeping need improvement? If yes, check the appropriate box below.
2tes
❑ 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
EfNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
ZNo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
J'1Vo
28. Does facility require a follow-up visit by same agency?
❑ Yes
$'No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
)2 No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
gYes
❑ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RlNo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
2to
33. Did the facility fail to conduct an annual sludge survey?
,Qf Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
JffYes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
ZrYes
❑ No
Stocking Form , 6 Crop Yield Form ❑ Rainfall Inspection After I " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
a Lo, i i to
d G� 4 .�
I_s©U c u ,,L o0
re CIO Fa
3 sr) P1ec�se,^ ��� �- Crop y e .S
S e C�/o ;'1 r
l
12/I2M3

Type of Visit compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine Itr6omplaint O Follow up O Emergency Notification O Other
Facility Number 3! Date of Visit:
Q Permitted 0 Certified © Conditional) ertifted 13Registered
Farm Name:
�ae, gr'i Ce-V �
J
Owner Name: G— /.! la ✓ ` Ce
Mailing Address:
Facility Contact: f Title:
Onsite Representative: �v5-�' `'-_lIS �l rJ e
Certified Operator:
Location of Farm:
Time:
❑ Denied Access
Date Last Operated or Above Threshold:
1
County: !1`
Phone No:
Phone No:
Integrator: �r�� E
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 0 u Longitude ' 4 u
D sign Cuurrent
Desigo Current Design Current
Swine Ga act P,o utatfon
Poultry
Ca aci P,o elation Cattle Ca ac' P,o ulation
❑ Wean to Feeder
JE1 Layer
I ID Dairy
❑ Feeder to Finish I t
110 Nor --Layer
1. 1 ILI Non-Dai
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Tiotal Design C*apacity
[:]Gilts
[] Boars
Total S .
Number of Lagoons
Holding Ponds I Solid Traps
❑ Subsurface
❑ No
Drains Present ❑ La een Area I0 Spray Field Area
Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
eyes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Wastg Collection & Treatment ,�,
4. Is storage capacity (freeboard plus storm storage) less than adequate? El<
Spillway 4 es ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 _
Freeboard (inches): 15.5
05103101 Continued

c
J
Facility Number: Date of Inspection 4 2 03
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, El Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6was answered yes, and the situation poses an _
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? Xycs ❑ No
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
'Waste Application
10. Are there any buffers that need maintenanceiimprovement? ❑ Yes ❑ No
11. Is there evidence of over application? Oxcessive Ponding ❑ PAN ' Hydraulic Overload Yes El 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? El Yes ❑ No
16. Is there a lack of adequate waste application equipment?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design. maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively terrified operator in charge?
27. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie' discharge, freeboard problems, over application)
23. Did Reviewer'Tnspector fail to discuss review inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
'ZYes ❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about tliis visit.
�-.-cam. _,� ....,p
Comments{refer tan gneWdi O). =Eilam.any YES answers fsndlorguy-re�t►m mReadatrons ur snv oxher commeAts: � -
Use drawtngs of #aciitty to better esitlaen situatu�ns,' {use additional pages as necess ❑ F �.
_� Field Copy ❑Final Notes ,
bin._'"1..:..�`:�;xe�..'�...��m-'-s'a.=•"1'z, _._.. �. .�.. 8:.e ��^i^...s"�'-�✓hts,:i^m"rS'e'%,ar-��'��.:.xr�+�...— ��ka75�-��'
RespondeA 74e q Co Pr4:n� ��o R�cic Z)e"P who se,7� p;c4,1-e5
ae s 4L"4 AI --e WA-j
diktu5
and .'/I� a44 ,vela �' Wa34e -fie . vie . E��e'ds Sq y-) 41-xre
WAS ✓10 rvvl l9-q Lt h e 1.7 P Was 1►^r t cl ct i't','1 .Slt plc S ,4 p ,!t,4v rCS t; e re
'
�nke4- 5,d�� i t s oCGur:" � +'� ate►e` C644 -aryy 40 Ae ; I-rV' 'q4;0 1
�°
ale-(i 7) dcs,' yt1 needs �O belly t...�d. Elsa; -/<'c bites: 4eP/ O- G
Reviewer/Inspector Name�a
Reviewer/Inspector Signature: Date:
05103101 Continued

•
Facility Number: -?I Date of Inspection 43
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional Comments and/or Drawings:
Ire,- 44 5 24a r" iS l ,04 t�er�Q✓r1i•-� 4C
OZGl P7/. IJ.s 4e r, sa � s he e ►'.r 6e . r �o reki-I e[-F a �
.�1 l)rG . q [o o pdr O�"C /7 eed s �6 (� tiles ,' Jc n rtegr q n
0-F Ae DEG . Also, 1 V,-i [e ,'-3 f0nd;111)
Up neap P � � � t'+1y spa a �'�� �� ss % �� y tva-S�i: •�g , �40 d "46
rvleed to I,,ke Go�rl Cll �t ✓� GtG�r'oM -�b �4I CsV/e�-� �� SJ Pvbl � c
n 04 111, GGt +I G s'' k"T A y be %9 v ",e d )ernd ''^�} scc'"'Llo�� -es v 14,E J.
Uslzc✓ W► l be ten4atdad 44b, 4n41sej D�Sgr�xr� /VV; ewfa)�
05103101

I IQFacility Number ¢ Date of Visit: /3 03 Time: �0
Not Operational 0 Below Threshold
0 Permitted U Certified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: cddoc Ge -+'`r County:
Owner Name: Je vti[ S 6 /1 P, C e Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: -0--cf-E owt_± ---d s_-
Certified Operator:
Location of Farm:
Phone No:
Integrator: M Vr —45i_OWL.
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0a 06 0u Longitude 0• 4 L_J�
Design
Swine Ca aei
❑ Wean to Feeder
❑ Feeder to Finish
Current
I'o ulation I?o�it ,
ry s
❑ La er
❑ Non -Layer
:Deign Cur n Design Current
P ' ►attle
Ca aci P,o ulation > C Ca acity P.o ulation
❑ Dairy
❑ Non-Dai
❑ Farrow to Wean
❑ Farrow to Feeder
Other
❑ Farrow to Finish
Total Design Capacity
Total SSLW
-A
❑ Gilts
❑ Boars
❑ Subsurface Drains Present ❑ La oon Area
Number of AEFpD5=:�
Ponds 1 Solid T❑ No Li uid Waste Management System
❑ S ra Field AreaHolding
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? `Yes [I No
Discharge originated at: ❑ Lagoon 0spray Field El 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) jCJ yes ❑ No
c. If discharge is observed, what is the estimated Flow in gal/nun?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection , & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard (inches): 33
05103101 Continued

• Facility Number: 31 — 54 Date of Inspection 3 13 a
5_ Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA WMP)?
❑ Yes
❑ No
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑ No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
E(No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.:,`
Caminents`(refer to.questian #) Explain any ES°answers,and/or anyrrecommendatioii or any:other comments. �A
J
facity
Lise`drawings of to better explain situations: {use addshonal:pagessas,necessary) ❑Field Copy ❑ Final Notes,
�c s�va,, a(e d �� Ct CD+-►�1 a�'nT �r+ct✓'.� -E i c L _7 a ve eve-,- yref N i n5 Q-r 1nJq_J4C
Il..��
W Ctj 0 6C t/ ✓or 1 r. A►oaf ,r es � 14 ; �� ; n �-r V rt u�'F i n l e A d � 4 c1l .
QcGUr►-eof D ct /'OAdtAln- d► 4Gk G1nd a}no-}hfr d;4el, eUpin �hrp�j�-
�►yles 4 do e� 4akeJkl �f
-)te_ lore ex-4 7, tvc4-#er Cjval;q y sI,,i
4e4,n) dis'eka e ;s- of /easy- 2 a0 0 jM11 vets
w
Reviewer/Inspector Name $1Jil- EL./ Ali' �. - r "'�
1ta 3 �._
Reviewer/Inspector Signature: Date: -90/ 3 3
05103101 Continued

Type of Visit i Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine C) Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number
Date or Visit: Time:
IQ ,3/ 5
Not Operational Q Below Threshold
Permitted U Certified
U Conditionally Certified U Registered Date Last Operatedd or Above Threshold:
Farm Name: �&RrliC_ a"(4 County:
Owner Name: I Ae� 5rCTz- _ _ _ Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: �����n% S//F Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0 0 K Longitude
;Deli n Current
Syr a -,a acitti.. �Po ulatmn Poultry .Ca ac tv Po ulati t _ Cattle � apacm ...:pops rent
an lation i.. .
❑ Wean to Feeder
Feeder to Finish
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer ❑ D
I; ❑N r a ❑Non -La er
w ❑Other -
Total
Number of Lagotrns 4 iL1 Subsurface Drains Present IILJ Lagoon Area 1LJ Spras Field Area J
Holdu3gFPonds / %Hd Traps ❑ No Liquid Waste Management System
Discharges & Stream impacts
1. is any discharge observed from any part of the operation?
El 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 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 XNo
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ElYes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes x No
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: 31 — Date of Inspection 0 2 4
/
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
Ellf� Yes
,_ f
No
seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
XNO
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
Yes❑
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
IV
//❑ Yes
XNO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
VNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
WfNo
IL Is there evidence of over applicatio ❑ Excessive Pondin9 ❑ PAN ❑ Hydr ulic 4verlo
❑ Yes
)ZNo
12. Crop type !JlJP (lf}451�,F�
13. Do the receiving crops differ with ose designated in the Certifie Animal Waste Management Plan ( AWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
X No
b) Does the facility need a wettable acre determination?
❑ Yes
o
c) This facility is pended for a wettable acre determination?
El yes
No
15. Does the receiving crop need improvement?
VYes
❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes
PNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
VNo
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)
es
o
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
X/ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
0140
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNO
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments. refer to uesteQit # Ex la3n:as YES answers:sttd/ttr atty recommendations oranv. ercomu�ents: r
Else drawings of farihry-to`beiter explain_"situations. tuse'addifid"Upages°as necessary) -:5 Fi_eid Gonv ❑ Final'"
Notes
Ae- C-.o,J�,?o� ,D, ���PF ��P�AS %✓�`,E,� �i� ,�S7�c5CzsN
�}-s�, Gl����A55 �it/T.�DG �fF�� �Tl�cxrr►t+0 �.��C..-s���
r
Reviewer/Inspector Name - 0
Reviewer/Inspector Signature: Date: O
05103101 .�, 1 Continued

Facility lumber: —� Date of Inspection D2
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? El Yes �Q No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, 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? (Le, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 9No
31 _ Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawings:.%J1= -
`,CJ44' 'Cz-5 ��.Q� �Dl} S� S� i✓
1V4'qQ04J f;lEe Q �Fz�o 0 `W SFr / s teloa
fAq/y).
/tlfe-Qe o 2,2 /� �F Lzm ,E XA14)
Goc�7eO-
/Q
�oOZ �f��C/f /��GzCi¢�2�i�S �F�� �o��•��,ED L`t✓5�i✓G-
L'C)4 s v; 4mq cases
S /lQF� !O ��E �h jAPi2D Pe;zA
,8F7cv
1�dLc.s / �Ff GA�BEG A �1 /�� F/J�L y /s Fy;t% in AP XA13 —6v
44��a 5 /✓F �f`o 067 Dr�o/�102
O5103101

`.Divrsioti of -Water Quality-
0
Q Division of Soil and Water Conservation.
QA.
Other Agency
Type of Visit ,Komptiance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit _0 Routine O Complaint O Follow up 0 Emergency Notification O Other © Denied Access
Facility Number Date of Visit: 1 l7 Time: 3 '• S Printed on: 7/21/2000
O Not Operational O Below- Threshold
© Permitted D.Cerrtified [3 Conditionally Certified [] Registered
Farm Name: Z � r C %?r't:.. � [.. ............. ..................................................................
Owner Name: t�Q! �`~e S .................r G.C
..............................................................................
Facility Contact:.............................................................................. Title:
Mailing Address:
Date Last Operated or Above Threshold: ..
County:.... ,11� 1 - ..........................
Phone No:
Phone No:
Onsite Representative:.,.U_L' '_ ^ l.' .f 1"C f f ' �J.r ,
............................................................................. Integrator:.............
Certified Operator:,, .......................... .................... . ................................ ....... Operator Certification Niimber:...................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �« Longitude �• �� ���
Design Current Design Current Design Current
n Poultry Cattle Ca cPo elatio,raton
Wean to Feeder ❑Layer 1 10 Dairy
Feeder to Finish ❑ Non -Layer 10 Non -Dairy
Farrow to Wean
- ❑ Farrow to Feeder Other
rt y= Farrow to Finish Total Design Capacity
Gilts
Boars Total $SLW
n
❑ Subsurface Drains Present ❑ Lagoon Area F1 Spray Field Area
Holding Ponds I Soiid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [ILagoon [ISpray Field ElOther
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (Freeboard plus storm storage) less than adequate? ❑ Spillway
Stru�ture I Structure 2 Structure 3 Structure 4
Identifier : ....................r ..............
Freeboard (inches): q5
5100
Structure 5
❑ Yes.,ZNo
❑ Yes )?I -No
❑ Yes I�N0
❑ Yes �^o
❑ Yes No
❑ Yes j] No
❑ Yes ZNo
Structure 6
Continued on back

Facility Number: ,� — s Date of Inspection ! f Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes XNo
seepage, etc.)
6-. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify UWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes zNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ;2rRo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN Hydraulic Overload Xyes ❑ No
12. Crop type gera C_6 int4 r,a_1.6'-&Z_t) Js U Grit/\,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes XFNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ZNo
b) Does the facility need a wettable acre determination? ❑ Yes XfNo
c) This facility is pended for a wettable acre determination? ❑ Yes ' No
15. Does the receiving crop need improvement? ❑ Yes P No
16. Is there a lack of adequate waste application equipment? ❑ Yes IRNo
Required Records & Documents 1
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 ONO
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes 12'No
20_ Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONO
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ,ONO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ONO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ONO
24. Does facility require a follow-up visit by same agency? ❑ Yes ,0'No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes _EfNo
i'�o violafioris;oT defcier�c es were not;e� diming this'Asit; You will•Te 6*6 iio uMhelr : .
coirespo deik e. ahaut this .visit. .. . ..... . . . ... ' . ... . ' ... ' ...... ..... .
f 1 � 014,re.'Ol f ovavl ocly� Lis ocGV>n�a( oil f UI.tZ; do � AL
o ve'rq I I, 4he
Reviewer/Inspector NameEn
Reviewer/Inspector Signature:,�ry�, Q�+✓►.. Date: 111h1171 5100

Facility Number: Date of Inspection Q
Oddr Issuefi
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below A 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 P'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 21NO
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 'PNo
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.) a ❑ Yes ONo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes JPNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Cl Yes ❑ No
AdditionaUComments an or. ravings
J
7

Type of Visit , O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 $54 Date of Visit: 9/4/2001 Time: 11:25 Printed on: 9/6/2001
Q Not Operational Q Below Threshold
® Permitted 0 Certified ® Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: Eddig.kire#4.................•--................................................... County: RV.RIIa.................................... }'.YIM)......
Owner Name: ,Ittm> sue)price Phone No: 89:�37.9Z3.or_4JlZ-�2$=?.54.(QLC�----
Mailing Address: 2X13.11� ixt. �rlrst................................................................................. Newhary.5C ........................................................ 29J.QR ..............
FacilityContact:........................................................... Title: ............................................... Phone No:...................... .........
Onsite Representative:,J1D_iLET_--------------------------------------- Integrator:�py��mjJvy�----------_-------•
Certified 0perator:Char.11c.................................. U.alker....................... ........ Operator Certification Number:2Q Q,2.........................
.................. ....
Location of Farm:
:ast of Beulaville. On West side of SR 1715 approx. 0.7 mile North of SR 1804. A
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 ' S3 6 57 " Longitude 77 • 43 & 0$
.Design:,
7. Swine - Ca aci
❑ Wean to Feeder
® Feeder to Finish 4896
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number, of Lagoons
v Holding Ponds/ Solid Traps
Current Design Current 71
_
onulation Poultry Capacity Poqulat,:; Cattle
t
Subsurface Drains Present
No Liquid Waste Managen
Area J❑ Spray Field Area
Discharges & Stream Imuacts
1. Is any discharge observed from any part of the operation?
❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes []No
.
b. If discharge is observed, did it reach 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 ❑ 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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier1............. ........................... .......................... -•--•--•----......-•--•-.............................. ...........................
Freeboard (inches): 43

V9/VJ/V1 uuminueu
Facility Number: 31-854 Date of Inspection 9/4/2001 Printed on: 9/6/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
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?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
[} No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
w.
Comments (refer to rques#ion #) Explain any YESganswers and/or any m recomendaiuns or any other comments
sedrawings of facility to better explain situations {use add�ttonal page`s as necessary) P
ield Co ❑ Final Notes
y
This inspection was conducted in response to a report from Mr. Bryan Spell of the Division of Soil and Water Conservation that animal
ante was discharging out of one of the hog houses and this appeared to have been occurring for awhile. I observed that animal waste
had discharged from the hog house and had entered a ditch. It does appear that the waste had been discharging for awhile. Water quality
samples and pictures were taken.
Reviewer/Inspector Name 'Stonewall.Mathis -
Reviewer/Inspector Signature: Date: la D i

0510310I
Facility Number: 31-854
Date of Inspection 9/4/2001
Continued
Printed on: 9/6/2001
Odor issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
❑ No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
❑ No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
❑ No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No

O Division of Water Quality_.
Division of Soil and Water Conservation
O Other Agency .
Type of Visit O Compliance Inspection e Operation Review O Lagoon Evaluation
Reason for Visit 40 Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
bate or Visit: 9 0 % "Time:
Facility 1Tuntbcr ,�
O Not Operational Q Below Threshold
© Permitted © Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: pp �........ppp .......C�J.`'........................................................
ounty•....
Owner Name:....... ............................... Phone No:..
MailingAddress: .....................................................................................
FacilityContact:..............................................................................Title. Phone. No. .............................................
Onsite Representative:....1/.LIDS.�fl.!L........�5.,��. .................................................... Integrator: .....�Gi!....�`..%��cr j1 ................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
A
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 0` ��° Longitude �- • �� �«
Design Current Design Current T Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder I ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Ll Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons C� ❑ Subsurface Drains Present 110 Lagoon :area ❑ spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Dischart.pes & Stream .Irn�cts
1. Is any discharge observed from any part of the operation?
Discharge Originated at: ❑ Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
h- If discharge is ohscrvcd. did it reach Water ofthe Stai ? (Ifyes, notify DWQ)
c. If discharg is Observed. what i; the estima[ed flow in Lyulhi in?
d. Does discharge hvpass a lagoon «'stem? (If ycs, notify D`1'Q)
2. Is there evidence of past discharge from an}' 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?
1jaste Collection k Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Struc:turc ' Structure 3 Structure 4 Structure 5
KYes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
Structure 6
Identifier'.................................................................................................................................................................................
Frc:choard (inches): 'Z
05103101
Continued

Facility Number: 3 —$S Date of Inspection `7" 7'"'�'
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/'trees, severe erosion, El Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes � No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require main tenancefimprovement? wYes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑Yes ❑ No
12. Crop type
.+.3v1'R •'cam . _..� Yimp-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑'Yes E] No
14. a) Does the facility lack adequate acreage for land application? El Yes El No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
10 No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists. design, maps, etc.)
XYes
ElNo
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
yyj 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 Reviewerlinspector fail to discuss review/inspection with on -site representative?
❑ Yes
j No
24. Does facility require a follow-up visit by same agency?
Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
[] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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): ❑ Field Copy ❑ Final Notes
15
�C"eGr-Sl�tj�Ua E�1 ,'!aI]`hlr
w/0J,JQ whj 4.7r{,ii,.Cj /Car Xirt ) 6 �/���✓/C t�/.y� .I �J�f� �1ory{� ��+►�t tkC
�otl-
le4fi"
'S P'�P-e ��t �- a �, s/
Reviewer/Inspector Name f e p y
Reviewer/Inspector Signature: Date: -f14 6
05103101 T T a Y Continued

Facility Number: — Date of Inspection !Tinted on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or 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 { dNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, {] Yes P No
roads, building structure, and/or public property)
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 j No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments and/orDrawings:
_
151-Y s -4--,t`S lc9 &4 +1
�. .4.
rf � e- i ! Ov t� L.i
re Ll' lC d
te7 �/e7 41 k�
v� �a S c'
T
5100

o(Divisron of Water Quality, z
Q ivis�on of Soil`and Water Conservation
_..
Other,Agency ,
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: �7' D3 Time: 1�1 �� _ Printed on: 10/26/2000
Not Operational Q Below Threshold
Xpermitted [,] Certified 13 Conditionally Certified © Registered Date Last Operat:�ST-
Owner
.......... Phone No: ............................................
Facility Contact: .Title: .............. Phone No:..................................................
jj
Mailing Address: .l..�. .......... ..........S-6.!.......... ........� .......:..... 1 .�.�
Onsitc Representative:... ramIntegrator:.........
Certified Operator:
Location of Farm:
............................................................. Operator Certification Number:
w
I Imo:
&(Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 �' �•� Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
eeder to Finish ❑ Non -Layer ❑ 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 110 Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 9 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
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 XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment
)1�4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes JkNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..........:......... ...................................... ................................... ....................................
Freeboard (inches):
5100 Continued on back

Facility Number: Date of Inspection 0 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obse d? ie/ trees, severe erosion,
❑ Yes
ANo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
rV 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?
kyes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
O'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
KNo
IL Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
<No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
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?
A -Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
Al KYes
❑ 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)
XYes
❑ 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
XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑KYes
�No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Yes
❑ No
24. Does facility require a follow-up visit by same agency?
DkYes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
V,Yes
❑ No
Cio•yiQlati00S;ar- dgfic ncies were itQf 4 during phis;visit: You will i eeeive Rio fucthe�
correspontienre: about this :visit. . . .. .
Comrrien er to questions#) Explain any- YES answers andlar p recommendnartiy'jn� or any other comments = a;
Use dra ' of facility to better ex loRsituations use additional. a es as neces
�r��� o�a� t s �'1nR� y on ywu,+.s,�- w-�-etc•t,-- a�i-- a. �s 1 b
ll1n�,� a T,w jet . TV%A-V WV- ov- D4 �my - ' .rw..-�
Gtiv �, �°i" a.wc_ ,rt4j- ,,mod -4D 1c 1.�,p a- ?-� f " �rcG�v +� a'f a �/
- '1 trV+�L's • trw1� (.VA V Yt K4 — V71Fj \-LV ii t i S d`i U ( 7— V
l
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 5100

Facility Number: Date of inspection Y 5 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor helow V-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 WNNo
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 OdNo
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 peimanent/temporary cover? 9Xes ❑ No
ments an or.. Prawings.
L 1 S rLt �-rO C-w 'W t ti— t' 11
tOW S
a 1 Cy'.
���
Me
WtA
t Vl oL
ry Y �fil�rvl�C'� t3'� ��/1�� . II� �, D►/1 Sl riC, r
IL't+ 0LL"Vv
K7� Y �-t-. 51�� OvY`t- VIV 4
! !�-
w•1 Ll
d s fit ss _s w Y 'L ,`uya�Vw 6A 6 ho�-,.I �[ Avvv
5100 �,�.�,� �.t,� . 11�,t,�,`� �. 0�. ► f� °�' �u�''r {'�`� la � `�-t�: ,�e�Y� m -

�f
Y
In
7
od
A
n
0

0 Division of Soil and Water Conservation - Operation Review
E3 Division of Soil and Water Conservation - Compliance Inspection
100 Division of Water Quality - Compliance Inspection
Other Agency - Operation Review {
LT Routine O Complaint O Follow-up of DWQ inspection O Follow-up ref DSW C review O Other
Facility Number `+ g Date of Inspection (, (�
Time of Inspection L�lL..J 24 hr. (hh:mm)
Permitted E] Certified 0 Conditionally Certified 0 Registered Not O erational Date List Operated:
0 ` • P ...............
Farm Name: ........... .�l tL..... �1>;Gt?........ lh i`T........ County:.......bLJr.1k .....................................
0-wner Name: .................. �:..�r. _ . Ll I ....:... Phone No:.....���,. �.�-'.�SL3................
Facility Contact: ........... y...... 41............................Title:..............................---- .................................... Phone No: _816 4La.-zga7..........
MailingAddress:...... Z A. 13 .......i ; .....5 ................................................................. .............. 44,t 3c, ............................ .Z110..........
�..
Onsite Representative: ...... 9,y,.......$.'mom................... Integrator
...................................... � .............................................
I..............
Certified Operator : ................................................... ............................................................. Operator Certification Number:................ ..........................
Location of Farm:
.......5..x..l�.( O.: 1-L ..P.K.ilts--.--. 4.................................... A.
..........................................................................................................................................................................................................................................................................•
Latitude �' �° Longitude
Design Current
5wtne Capacity Population
❑ Wean to Feeder
Feeder to Finish cl
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
- - Total Design Capacity
Total SSLW
t;
6 6c), 94 o
Numberof Lagoons ❑ Subsurface Drains Present ❑ Lagon A orea ❑ spray Field Area
Holding Ponds/ Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gallmin'?
d. Dices 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
Identifier:
❑ Yes 10 No
❑ Yes EANo
❑ Yes Q No
❑ Yes ® No
❑ Yes [h No
❑ Yes 5d No
❑ Yes MNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Freeboard (inches): .......-.Z2.................. ..........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3123/99
Cl Yes 'W No
Continued on back

Facility Number: 1 — SS Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Write KN_p lication
10. Are there'any buffers that need maintenance/improvement?
11. Is there evidence of over application? [*Excessive Ponding ❑ PAN
12. Crop type
Ij
13. Do the receiving crops differ with t ose designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
L Q
❑ Yes
12 No
Yes
❑ No
Yes
❑ No
❑ Yes
0? No
❑ Yes
[VNo
WYes
❑ No
Animal Waste Management Plan (CAWMP)?
RMWred Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
r
El: �ib -A.6. A.t.i6ii.s'od.ffld.encies were noted• OiWihsg •this:visjC • Y:oij Will•feceiye d futthi r
comes otidence. Aaut this .visit. ....... • .. .. • •
Comments ((refer to-questidn #) :Explain any YES answers and%r aj recommendations or"any other cc
Use drawings _of facilityto better explain"situations (Ei4Fadditio pages as necessary) _X_ -' :
I. Cn lr, 0, d l mil S60(d be -sbf". 1,0,w dt%jcvS far` 0, 1A""—fo I
Lo-��r 51�ov1 � �e, �-aj►raJ�� .
❑ Yes PWNo
❑ Yes KNo
❑ Yes No
❑ Yes No
Yes ❑ No
❑ Yes PONo
YN
Yes ❑ No
❑ Yes r No
Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes ED No
❑ Yes 0 No
PO Yes ❑ No
Yes `a No
IUW
I$- it, SpVD1 (;_(O swuli
11, F—XV55�vt- DOLL t h s00,d �4
666, UMa 1) o
F [> o U)-\7
Reviewer/Inspector Name
Reviewer/Inspector Signature:
t �-ifIUS-
die 1-�Ei�t�� 9 eJ o�wci "SUM 6 orWev� ?Ovtdo�
b� Y'B . / -&j r e� fir. &q r; ►titoa,L �p � Jls�'j µ a.%4.
.
VVA of tXm- cb,,v� k PHO J,'4. AJv(grrJ
Date:
LA
3/23/99

Facility Nurnber: — Date of Inspection j JGj�
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
[]Yes
No
28,
is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
[V 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
4 No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
No
Addition omments.anor. rawings.��=rt �
l5, P tAw Co - en p 'SjleA1 � i gv-avfU
1-7- co o F ge a l Q I�r�i {- w� �� ar` Covenie : 6t`(3 b{ av S i k . 1
1�1, +Yu arvCa�e in U.4, 00 5kO'4
!�� - b v� j� i 1 r►�jA or` Q Avzwrw 5 S i�alJl �} b Z 1 y' c y-r' 401\ do ; q" . DP_snh s 60 s
��►a sf-� �Ouf i �Uri Pf d.[�--
aMn�Q4`y a,� (�rtis}t a,na[ �i5 5y,ov�a by 6'vt n a,, cc evt" 3 Y►�oh is. `i
�-
D-Crt 60
I
R1Z - Z 6'0"S . U r e. 4'L 4 c Vt ('VS "r'- 4-.-
i-rrlSc or des�5n. Spy e44'[,7 V, SkOL)IJ be-- Ve'13�)d O- 0-
STOL� Z tVfV, �Or 5P-'A %M;k-\ Gyq� al 5p 1bs1r-c .
i r druv�lG q0; EC'kJrn rak of 1%Lt� 1�t� act; S9o'J1J be absei(ved
an pail �.
IFS
3/23/99

13 Division of Soil and Water Conservation [j Other Agency
Division of Water Quality ='
-r
101 Routine 0 Complaint O Follow-ue of Minspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Ins'
ectiou ll
Time of Inspection 24 hr. (hh:mm)
E3 Registered r Certified 0 Applied for Permit 1A Permitted 113 Not Operational Date Last Operated:
Farm Name: 01.c...... ' Cic&... ��...�.�lY�¢� l�+'�5�.... Jr�. County:.....�u��irry....................
OwnerName: ......... ............. ......... .[SAL,t................................................. Phone No:..... r3.......................................
Facility Contact: ............ 9.y.......&Vx'i,P-A&U.......................... Title:.....Lr ................................... .. Phone No: ..��i4�.1,�.:..&8�.�.............
Mailing Address: .......1113.....
� !i. a►rxs . ....................................
Onsite Representative: ........... V-1 Fx1x3riXMXW ...................
Certified Operator. .....................................
Location of Farm:
.................... I ... SL .................................. .. X1 10.3 ..........
........ Integrator: ......... A. 1h {1...........................
Operator Certification Number: .........................................
.................. '---- 6y sf .....51 L.....A.........!S.X.... C..1r...,
...... Q:.?.... W1.t. .'s...... Kr ... ........f1. ...... ...1. ... a ..........................................
....... .... ....................................................................... .....................
Latitude ' 6 « Longitude -{ l ' Lk 9 © [L
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes 0 No
2. Is any discharge observed from any part of the operation? ❑ Yes g No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes �9 No
b. If discharge is obsen-ed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min? tj
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes [p No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes [ No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5_ Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ® No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 1P No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes [� No
7/25/97

Facility Number: 3 (-
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
[ No
Structures (LagoomMolding Ponds Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6'
Identifier:................................................................................................................................................................................
............ I..............
.---.--
i~reeboard (ft): ........... ���`.................................................................................
10. is seepage observed from any of the structures?
❑ 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 maintenance/improvement?
[ Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
§a No
Waste A lication
14. Is there physical evidence of over application?
❑ Yes
[9 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type....�h�. .........................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
R No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement?
❑ Yes
No
19. Is there a lack of available waste application equipment?
❑ Yes
No
20. Does facility require a follow-up visit by same agency?
❑ Yes
No
21. Did Reviewer/Inspector fail to discuss reviewrnspection with on -site representative?
❑ Yes
No
22. Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
JO No
0� No.violatio'nsor dericiencies were-noted-dur,ing this:visit.- You'W'iff receive•no-furttier• :
corrO061 deice d oiet this'. Visit.
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7/25/97
Reviewer/Inspector Namer 2 F �v
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Reviewer/Inspector Signature: Date: