670007_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: ® Co pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other `0 Denied Access
Date of Visit: Arrival Time: Departure Time:LLB County: O V.�L41v/Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: _H O&IJ �
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 0,9 3 6 6 f
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Curren#
Wet Poultry Capacity Pop.
La er
Design Current
Cattle C•apacih Pop.
D airyCow
Wean to Feeder
Nan -La er
D airyCalf
Feeder to Finish
Farrow to Wean
Design Current
Dg. P,oultr,, Ca aci P,o .
I Layers
D airyHeifer
D Cow
Farrow to Feeder
Farrow to Finish
Nan -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes VNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: J*
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 196 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes WNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [] NA ❑ NE
V
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes V 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 2fNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps [:]Lease Agreements
❑ Yes o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes m No ❑ NA ❑ NE
❑ Yes WNo D. NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [,� ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Othe :
21. Does record keeping need improvement? If yes, check the appropriate box belo . O7 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes m ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �rNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Ins ection:
24: Did the facility fail to calibrate waste application equipment as required by the permi 7
❑ Yes
❑ NA ❑ NE
201s 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
6 ❑ NA ❑ NE
g�No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
o ❑ 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
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
7N�
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ 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
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[/ No ❑ NA ❑ NE
[, o ❑ NA ❑ NE
[ No ❑ NA ❑ NE
Comments (refer_to.question #):_Eaplam 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).
ti Sa L'�' 5A11AF(e �JE x0 9A Js.
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phon jQ) 37
'-
Date: 7 luo
21412015

type of Visit: Z57dompliance Inspection• 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Zeason for Visit: O-K'outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I J / `°L /I) I Arrival Time: Q® Departure Time: County: On 5 f0t-' Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: Integrator:
Certified Operator: ✓ Certification Number: N'
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
W-e n to Feeder
Non -La er
Dairy Calf
Feeder to Finish
000 0
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,ouI Ca aci P,o ,
Layers
Dry Cow
Non -Dairy
113eef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ff�'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
G31<o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[�o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - p Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0/Yes
a. If yes, is waste level into the structural freeboard? R�Ycs
Structure 1 Structure 2 Structure 3 Structure 4 Structure
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
V
❑NA ❑NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Z]-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 Q No [DNA ❑ 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 [D]No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [I] <0 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes E/No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3 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): (� G 5 & C)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CTNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
U34o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[JNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
i�. 1
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA'
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
dNo
❑ NA
❑ NE
20. Does the facility fail to have al] components of the CAWMP readily available? If yes, check
❑ Yes
[?'Fo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[—]Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
E30'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facili Number: - Q Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the penult? [—]Yes B'Ivo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes To ❑ 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:
i
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [:]No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
[:]Yes
No
❑ NA
❑ NE
❑ Yes
�To
❑ NA
❑ NE
❑ Yes
[1'4o
❑ NA
❑ NE
❑ Yes
B<0
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
[]g--I�o
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
E]/No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [DKo ❑ NA ❑ NE
Comments (refer to question #f): Explain any YES answers and/or any additional recommendations or any°other comments.,
Use drawings of facility to better explain situations (use additional pages as necessary).
�CA��e.
n r
Reviewer/Inspector Name: i/ u l p Phone: 3 f l
Reviewer/Inspector Signature: �� �+ Date:
Page 3 of 3 21412014

-. N
Type of Visit: 0 Co ptiance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: N [f &- ?AP_14C4
Certified Operator:
Phone:
Phone:
Integrator: G
Certification Number: �� I
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry C►apacity Pop.
Layer
Design
Cattle Capacity
Dai Cow
Current
Pop.
Wean to Feeder
Feeder to Finish
Non -Layer
Dai Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , Poult . Ca aci P,o ,
Layers I
Dry Cow
Non -Dairy
113eef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ N
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

[Facility Number: - Date of Inspection: 1 �-
'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
Identifier: [,,A&v-6-J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): —VIZ.,,-
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? [:]Yes �VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes LLl o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Uf`No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
YNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�`No
❑ NA
❑ NE
Required Records & Documents
�
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
WN
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other: 1-1
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes LJ jN9❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: ( Z
O"24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ENo [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes Rio ❑ 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 [!] N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes dNoo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes to
[:]Yes ❑ N
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ZrNo ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
[] Yes
E],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
ff 1''
DNA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L_I °
❑ 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. I
Use drawings of facility to better exulain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: L L
- / 3 00
y-di
Date:
21412011

(Type of Visit: QrCo�pipliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint p Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: � County: ONE (,a
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: W t 1 r'44 1 P 1< R Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Region:
Certification Number: � 2 3 6 6 ?
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design C►urgent
VVet Poultry Capacity Pop.
La er
Design Current
C►attle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
q060
Design
Dr, P,oult Ca aci P,o ,
Layers
Dat Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Won -Lavers
Beef Feeder
Boars
jPullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 M/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑N
❑ Yes LZNo
❑ Yes yl o
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Ds ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure l
Identifier: W"
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
/No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes &No❑ NA ❑ NE
[:]Yes [Z/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesEIN/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 Q No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ❑ 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
F]
❑ 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
ENo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ej' o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:].Yes
�
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
to
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. �es ❑ No ❑ NA ❑ NE
["Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? El Yes [ o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [INNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: I r
2f. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes �WNo
o ❑ NA [:]NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes EfI140
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes [ENo
❑ NA
❑ NE
Other Issues
ZNo
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes MNo
❑ 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
[EJ/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
[�J/No 0 NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
V ❑ NA
5No
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ 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).
171_� 06CD rd IRK W;.-#4 -rVE Co0,P_E Cr AL2EA6--E,, CAC l.i(4k
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
voHA)
Phone: (Q16) 38X
Date: _q F10
214 011

Type of Visit: 0 C pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t Arrival Time: Departure Time: ® County: 0A) j j o l / Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: Hjr,14 261mcil
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: 973669
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry C►apacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
Dr, P,oultry Ca aE P,a
Layers
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
IT
Other
keys
ey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[—]Yes [�/No ❑ NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes Vl;
❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

[FaciQ Number: 69- Date of Inspection: 3 1 12.,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2No ❑ 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: (AGva hJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes EfNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes YNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes 0 IN3) ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ElYes E l"o 0 NA ❑ NE
ReQuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes WN,❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yesg/No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �10 (�4
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: rt
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(cs) below.
❑ Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 21 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 LfJ l" ❑ 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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes E�No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
V❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pales as necessary).:
�._
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone:
Date: 1Z/
2✓412011

Type of Visit !!j ;7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: O YS County: tWY 6 :J — Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: /�� J�� Title:
Onsite Representative: �tjrUra mc—k
Certified Operator:
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ 0 0 i ❑ Longitude: ❑ o ❑
Non -Laver
Dairy Calf
Feeder to Finish I 4 O d
2xY60
10 Dairy Heifer
110 Farrow to Wean
I
I nrNiiiii. ry
❑ D ry Cow
Farrow to Feeder U Non -Dairy
Farrow to Finish ❑ N ers El Beef Stocker
Gilts ❑on -La
❑ Pullets ❑Beef Feeder
Boars ❑ Beef Brood (
Poults
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?
❑ Yes ['f No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ZO/O
❑ NA ❑ NE
ElYes NA ❑ NE
Page Lof3_
12128104 Continued

Facility Number:0 =
Date of Inspection
.Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ll4 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
`1
Identifier: LA&Crwy
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement?
ElYes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
C? o
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
l(J No
❑ NA
❑ NE
maintenance or improvement?
Waste Application /
10. Are there any required buffers, setbacks, or compliance alternatives that need , ❑ Yes ran No ❑ NA ❑ NE
maintenance/improvement?
1 L Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 6/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
U(No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�To
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
;No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
L,d No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Comments {refer to. ques tii on ) p m ie:r
#': Explain aYES'ans�ers andlor an recommendatiobs or anv other comments
Use dr;awm s of facili to_better ex lain situations; use additional ages as necessary}.
g_ facility p
.2L) UP,DRI-6 �tn_47_72- FM45, -Dc Try ZNE IL! EW WLJ p aN D A
0 -n TE ,
C'>N +T' NUS
Reviewer/Inspector Name ofCN��i � �� Phone:
Reviewer/Inspector Signature: Date:
b•7 11
Page 2 of 3 f 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [;XlNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Doe record keeping need improvement? If yes, check the appropriate box below.
EKes
El No
El NA
❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
PNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
v o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ o
El
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Zo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
WN
❑ NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M/No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(2 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
LJ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ICJ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
zlif
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
Zo
❑ NA
❑ NE
Additional_ Comments and/or. Drawings:
Page 3 of 3 12128104

Type of Visit Co pliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: eXAU.6ti.) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 40& H 10ER
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o [= 6 [=46 Longitude: = ° a 1
Elm
Design Current �esjgnCurrent Design Current
ineC•apac'sty Popion Wet Poultry C*apacity Population Cattle C*apacity PopulatiWean
to Finish
p
❑ La er
❑ Dai Cow
Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑Beef Feeder
EBoars
Pullets
❑ Turkeys
❑ Beef Brood Co
other
❑ Other
❑ Turkey Poults
I ❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes L/I No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑1No
El Yes
El NA
El NE
El Yes
VNo
❑ NA
❑ NE
12128104 Continued

l
Lk ility Number: �01 - `� Date of Inspection
f
µ`aste Collection & Treatment ,�
Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes lJ✓ 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: U464aaN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 34
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
WNo ❑ 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 enviiron ental 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
U�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
[3/No ❑ NA ❑ NE
maintenance/improvement?
IL is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
[/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o [INA
[INE
15, Does the receiving crop and/or land application site need improvement?
ElYes
to ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
6 o ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
FNo
❑ NE
18. Is there a lack of properly operating waste application equipment?
[I Yes
❑ 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):._.
d.
7) e.4onr,1V6_ WoR(g_ o.-J DZVk WWU—, i
r �
Reviewer/inspector Name Phone: / � -00
Reviewer/Inspector Signature: Date: r, 0'
'ape 2 of 3 12128104 Continued

k% ^. a
'acility Number: �', — Date of Inspection
i
ieauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes jNo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
dNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspection�No
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
El Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
xo
El NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
YN
[INA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[/NNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETNo
❑ 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
E�/No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
dN
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Zo
❑ NA
❑ NE
Ad>iihonal Comments and/orDrawings��°
a
12128104

Division of Water Quality
iFaciiity NuEnber (OCT Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit 07ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit tO Routine O Complaint O Follow up O Referral O Emergency O Other [I Denied Access
Date of Visit: I a °* v"t Arrival Time: Departure Time: County: UNS" a Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: mom►% ?AAXU
Certified Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: [—] o =]' = Longitude: 1-1 o = ` =
Design Current
Swine Capacity Population
Design Current Design Current
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
® Feeder to Finish
y
L4000
DrY Poultry
❑ Layers
Non -Layers
❑ Pullets
❑ Turke s
❑ Turkex Poults
❑ Other
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
❑ Boars
Other
❑ 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)
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 0No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ o
❑ Yes
No
❑ NA
❑ NE
❑ Yes C3No ❑ NA ❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment ,. (
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes 0 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: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
dNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
ENo
❑ 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
ENo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
(YNo
❑ 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
2No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Q'No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
2/No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R[No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ErNo
❑ NA
❑ NE
M. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes
[jNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ENo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z"No
❑ NA
❑ NE
'Explain a©y,,YES"answers
qJc?tA►rc WUP Wtill Oets. 0K)JEc<. UPDAtC. WXT14 Acp_ Ay a*.3D Gws.
as,) fk -- cAPY o f os.(-.
Reviewer/Inspector Name I jb{ 2 LL I Phone•• �gjpj%g ` —73V
Reviewer/Inspector Signature: Date: 314Io9
I UXC L Ul J l4/LU/VY l.Ur{!!/ll r

r
Facility Number: " r7 — Date of Inspection �► ojOt
Required Records & Documents �(
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes E No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
[]'Yes
❑ No
❑ NA
❑ NE
the appropirate box. dWUP ❑ Checklists ❑ Design
g ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ONo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�fNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El"No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[TNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ENo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
2/yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
D No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
E�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,�/
Id No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�
D No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Z�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
H
Page 3 of 3 12128104

Type of Visit 7R'Dutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit - 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied,Access
Date of Visit: % io li Arrival Time: 9Da Departure Time: C] County: ws'L6­1 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: -DOIJ JC_"►JLX�'33 Integrator:
Certified Operator:
Phone No:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = 0 0' 0 f4 Longitude: [= O [= , ❑
Design Current
Swine Capacity Population Wet Poultrttj_y
❑ Wean to Finish IEJ Layer I
Design Current Design Current
Capacity Population Cattle Capacity Population
I ❑ Dairy Cow
1 ❑ Dairy Calf
❑ Dairy Heifer
❑ Wean to Feeder
IEJ Non -Layer I
KI Feeder to Finish
CtDOO
k?
❑ Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ D Cow
ElNon-Dairy
❑ La ers
Non -Layers
❑ Pullets
ElBeef Stocker
❑Beef Feeder
❑ Beef Brood Co
❑ Turke s
❑Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
6 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
EN
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: 6—
Date of Inspection to 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: U4 6<)c1_)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 39
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes OrNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes ,9"No El NA El NE
8. Do any of the stuctures tack adequate markers as required by the permit? El Yes El"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 ElE Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes d No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑, Yes No El NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 0Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes C2No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes VNo
❑ NA [I NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE
jonm7emtments{refer toqSations ar any other comments.
e drawgs�.of�facility�to$bette��ainzsttu,�ahons: (use�addihonal pagesvasRnecessary,):_
15) 12V'. p6cos (t 1 ZtjW
7
Reviewer/Inspector Name - `jd jjt;/ �)agAXt - - Phone:
Reviewer/Inspector Signature: Date: t a o8
Page 2 of 3 7 12128104 Continued

-Facility Number: — 1 Date of Inspection G is
Required Records & Documents
19. Did the facility fait to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E]'�No ❑ NA ❑ NE
the approprrate box. ❑ ArUp ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ca/No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZNo
� o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
ZNQ
❑ NA
❑ NE
El Yes
❑ NA
ElNE
ElYes
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?
Additional Comments and/or -Drawings: r ,
❑ Yes
0 o El NA
❑ NE
El Yes
No ❑ NA
❑ NE
❑ Yes
dNo ❑ NA
❑ NE
❑Yes
0No El NA
❑NE
❑ Yes
I❑ NA
❑ NE
El Yes
7No❑NA
❑NE
Page 3 of 3 12128104

P
F-acitity. Number (�'f
Qf Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit (yCorrtpliance 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: 1W Arrival Time: f Z.rib Departure Time: County: _W. M.4t1- Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �a tJ 14 LA)]e Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
�O
Latitude:
Operator Certification Number:
Back-up Certification Number:
Longitude:
Design Current Desigis Current -Design Xurrent�
Swore ,Capacity Populatton Wet Poultry t Capacity Eopulation Cattle x Capacity Populate °_
] Wean to Finish
❑ Layer
] Wean to Feeder
; ❑ Non -La er
] Feeder to Finish
190OU
1 oz
T _
Dry'Poultry
] Farrow to Wean
] Farrow to Feeder
Layers
] Farrow to Finish
Ll Boars
Other
❑ Other
❑
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
. 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
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes '(No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ N ❑ NA
❑ NE
❑ Yes
❑ Yes
YJ No ❑ NA
❑ NE
❑ Yes
� 0 ❑ NA
❑ NE
12128104 Continued

Facility Number: 4-1 =1 Date of Inspection,
Waste Collection & Treatment
4" Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
o ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): %p
Observed Freeboard (in): Z�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ONo ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Ef 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
,Q No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
/No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑yes
�,�
L/J No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
ClYes
[ffNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below,
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ 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
❑ZNNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ON.
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ YesrNo
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
L/J No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
21"No
❑ NA
❑ NE
Comments (refer to question #}c Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary:)::
Reviewer/Inspector Name I �Nini (-_l_ I Phone: C��l 74C — 73 K7
Reviewer/Inspector Signature: Date: -SZ I ZL
rare z uJ -1 IL/-/51U4 Lonttnuea

Facility Number: 7 — Date of Inspection 3 I o
,_kuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP El Checklists ❑Design El Mans El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes MJO ❑ 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
❑ Yes 2Nr. ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZN
El NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[;Ko
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Q NQo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
B<o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes /O No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EfNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C to
❑ 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
13 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ETNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
9 o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

46Division of Water Quality
Facility Number ] ` Q Division of Soil and Water Conservation
Q Other Agency
Type of VisitC pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: G L o Arrival Time: Qf' Departure Time: County: 1)A)SL4kJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative: D'QIJAL. b
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude: El
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Longitude: = o =
Design Current Des�gm Current` Designl r` Current
Swine Ca aci Po ulation Wet Poultry, "� " '-
p ty. p ti Y Capacity Population" Cattle CapacityE Population
❑ Wean to Finish
❑ Layer
❑ Wean to Feeder
❑ Non -Layer
Feeder to Finish
Li*oo
Dry Poultry'
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
ffNon-La era
❑ Boars
Other .
❑ Other _
❑ Daky Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
J i Wn a
] Turkey Poults R }
] Other Numberof Structures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes / [I NA El NE
El Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: ') — Date of Inspection G dL
Waste Collection & Treatment
4. I�orage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LAGCDIJ
Spillway?:
Designed Freeboard (in): 1.10
Observed Freeboard (in): 37
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes L/J No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ElNA ElNE
❑Yes OCNo ❑NA ❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t ental eat, 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 [fl/No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ yes [�Ao ❑ NA ❑ NE
maintenance or improvement?
Waste Application ��//
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes [3 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift ❑ Application Outside of Area
�1
12. Crop type(s) 13 C C,+ i S!6 O '
13. Soil type(s) 5-tgt mom- s tj.*j&euj& A crow
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes fNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
rONo El NA ❑ NE
,C__,I //No ❑ NA El NE
;93 o El NA El NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or,any'other,comments ;
Use drawings of facility to better explain situations. (use additional.pages as:necessary)
�.� ya,,R1� NE�m �%on- toJta. Gl�ASS OF SSE WAI.I.. AL
Reviewer/Inspector Name Ja'A AgW Gam.. Phone: 9 _ ?
Reviewer/Inspector Signature:
Date:
rugc c vj j 1y.i'1011v'r uunnnuea

Facility Number: &J — Date of Inspection
Required Records & Documents , ,{
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes E! No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes O No ❑ NA ❑ NE
the appropriate box. ❑ VrUp ❑ Checklists ❑ Design El Maps ❑Other �
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes M No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L"J N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes L�J Njp ElNA ElNE
24. Did the facility fait 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
ElYes
❑ NA
❑ NE
❑ Yes
L o
❑ NA
❑ NE
❑ Yes
Ld No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ 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
Id No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
FAdditional Comments and/or Drawings: . . I
Page 3 of 3 12128104

�� '
Type of Visit 0 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �1�0 Departure Time: County: 0AJ5LJt4 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: j)Q0&j> L�f0 W_-D33 Integrator:
Certified Operator:
Back-up Opera�_r:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o [= Longitude: [� o =1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
�i ❑ Nan -La et
Other
❑ Other - - -- - - - - '
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 21No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ No ❑ NA
❑ NE
❑ Yes
❑ Yes
� ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspections
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: CN44
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ No ElNA El NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ElYes E 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 th
yeat, 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 7No
❑ 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 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LI N [I NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Q E&M jcx, CG a� �) c-s cu L ST, 0 _
13. Soil type(s) &rAL.t..Ss.l ,. IJM F,Lk PA (To L US ja►JTRq VIA- C / --
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
to question:##)Exolailn-any YES'answer!
a'4.) �e� �o o� �`� Cgc�rcLATio,� 3a 4�►� swETr
fAru,- !j3 Goob S UPC.
[] No ❑ NA ❑ NE
dNo ❑ NA ❑ NE
LG Ito ❑ NA ❑ NE
VNo
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Name „ . „ —�F� fs�� rLL�• Phone 9l� 3�5 - p
Reviewer/Inspector Signature: Date: 44 1 o "
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
N. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ko ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other
21 _ Does record keeping need improvement? If es, check the appropriate box below. LI Yes ❑ No ❑ NA ❑ NE
P g P Y
❑ Waste Application ❑ kly Freeboard ❑ Waste Analysis ElSoil Analysis ElWaste Transfers ❑ Annual Certification
❑ Rainfall ElStocking Zrop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain InspectionsEl Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes YNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Y s VNo El NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? [ Yes ❑ o ❑ NA ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes k� �D ❑ NA ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ' ZN o ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ZNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes qY/No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? El Yes No El 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 _,Q No El NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes y
El ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings: .
12178104

Type of Visit .0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit JORoutine O Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: --7 . Time:
O Not Operational O Below Threshold
© Permitted [3 Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: ....._._._ .� .
Farm Name: ...... .r/.. e ��..�....... t... t"! 1............ ... .... .......... _... ...... Coeuity:..... /.%.�.,..�..................................................
OwnerName:..__ .... .........._. :............ .... ..................... _ ...... Phone No:..................
Mailing Address: — .. ...._...........................__.... ......... ..... ...
Facility Contact: ........ _........._....._.. Title: ................_...._.......... _...� .... Phone No: ........... .......
OnsiteYRepresentative: .,. 5 Integrator:
Z.0j.)w....... �� J 1�.........._....................... � _.l`�................................... .......... ..._. ..
Certified Operator: ....... ............._......_......_.._._............................. ............ ..... Operator Certification Number:
Location of Farm:
jo Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude + 1 " Longitude • ' "
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 40 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 ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes V&o
Structure ! Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _.... - - ---- ------
Freeboard (inches): 2 1
12112103 Continued

acilityNumber: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
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? If yes, check the appropriate box below.
❑ Excessive Pond,}ng ❑ PAN ❑Hydraulic Overload , ❑ Frozen Ground ,❑ Copper
12. Crop type t46 flAq
13. Do the receiving crops differ with those designated in a 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?
I5. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Zinc
Animal Waste Management Flan (CAWMP)?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during Iand application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes Z No
❑ Yes )2fNo
❑ Yes 0 No
❑ Yes ONo
❑ Yes 00 No
❑ Yes XNo
❑ Yes RrNo
❑ Yes IoNo
❑ Yes ?'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 9No
❑ Yes ,f No
❑ Yes 00
❑ Yes 'XNo
❑ Yes 0No
❑ Yes XNo
w.�tiiiu'�w�6nn�n�siiwls4�nwcnr,anv:nl�ar weir�menlr ".':. ' -
;use arawtngso� racrury so Wetter expia�n s�wauons. tuse.aaailronal pages as necessaryl: 1 ❑ Field Copy ❑ Final Notes
'aw
Reviewer/Inspector Name L
Reviewer/Inspector Signature:
Date:
12112103 Continued

Facilify Number: — Date of Inspection /r B
Required Records & Document_s
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes XNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WiJP, checklists, design, maps, etc.) ❑
Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes uj 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 A No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes A No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes to No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 26 No
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 Z No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes j[� No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes RNo
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes O'No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes XNo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes JzNo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit, You will receive no further correspondence about this visit.
l2/l2103

Type of Visit Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine O Complaint 0 Follow up Q Emergency Notification of 0ther ❑ Denied Access
Date of Visit:
Facility Number
Q Permitted O C rtified ©Conditionally Certified 0 Registered
Farm Name: 7 A,.
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: 4
Certified Operator:
Location of Farm:
G Time:
rO Not Operational 0 Below Threshold
Date Last Operated or Above Threshold:
County:
Phone No:
Phone No:
Integrator•
Operator Certification Number:
❑ Swine ❑ Poultry [:]Cattle ❑ Florse Latitude 0 of u Longitude ' 1
Design Current
$wine aci P,o uHidon
Wean to Feeder
Design , Current Design Current
Poultry: City Po ulat'on Cattle Ca aci P,o ulation
❑ La er ❑ Dai
Feeder to Finish
FEI
❑Non -La er ❑Non-Dai
❑Other
Total Design Capacity
Total SSLW
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
Holding Ponds 1 Solid Traps IM No Liquid Waste Management S stem
Diseharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillwav
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number: -- Date of Inspection 0
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 maintenancelimprovement? ❑ Yes ❑ No
8. Does any pan of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ❑ No
9. Do anv 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 ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA'ArMP)? ❑ 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?
Reouired 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?
Oe.l discharge, freeboard problems. over application)
23. Did ReviewerAnspector fail to discuss reviewhnspection 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
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer tii gaestmn) Espiaom any I'ES answers and/arany recommeniiat:oios ar atrv_ather comments.
Use drawing of fa�cliity to better explain sitnatiam (use adrlrtinhal-pages as necessary) -`❑ Field Copv ❑ Final Notes
-
x ,
+�-.: .a��=,a..rc���.�[—sFi�.:r _S..$,T'm.1:S-wi,,'d3."I ci:>..'°ic.. i:^'e.5k'1.�".Sk�:.J...� �• t_{+^w''."we.3''ic.-x�. ��.a�+-saY-�+s--Y' f:. ...�L
Kip �4"L �tVeA , St-1c, LU ►�. � -ads
Reviewer/Inspector Name �` '"': r hs _ w--- q
Reviewer/Inspector Signature: Date: U"G
0510101 Continued

_ -
�..._ w
Dwisinn-af Water Quality
r r _
�. �.-
O Dtviston-.af Soiland Water Conservation
µ O'Other Agency
(Type of Visit © 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 67 7 Date of Visit: 9/t7/2002 Time: 14:45
Q Not Operational Q Below Threshold
® Permitted ® Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold_ _ __ __ __ __ __ __
Farm Name: 4..k#suYat'x%1nc................................................................... County: QU51.Q>r........................... -------- W. ......
Owner Name: Dsloald_&-Cathy------.- eAki�S Phone No: ---------------
MailingAddress: a.4U.I5a...1raf.0........................................................................................ .I8s*SQ.AVA9..NC................................................... Z8,54.9 ..............
Facility Contact:........................................................... Title: .............. Phone No:
OnsiteRepresentative:Ssl c9mmtnlIntegrator:$rrQll'14psiiQ�.---------------------•
Certified Operator:L9AAe.jD.plppjd...................... J'Clakjo............................................. Operator Certification Number: 2.Q.21$ ............................
Location of Farm:
West of Richlands. On East side of SR 1301 approx. 0.9 miles North of SR 1300.
®Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 • 56 G 05 Li Longitude 77 • 33 t 52 66
Design Current
Swine Capacity Population
❑ Wean to Feeder
® Feeder to Finish
4000
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current. Design Current
Poultry Ca aci . ' Po ulation Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 4,000
Total SSLW 540,000
Number of Lagoons 1 ❑ Subsurface Drains Present D Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ❑ Na
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 t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -----•--•-----------•--•--• -----
Freeboard (inches):
05103101 Continued

Facility Number: 67-7 Date of Inspection 1 9/17/2002
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? El Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste 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
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit 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/ )YUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ 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.
Commen#s refer to ueshon # -E lain an YES�ans ( q,) xp y wens and/or any recommendations or any other comments V
Use drawings,of facility Eo better explain situations (use additiiiiial pages as necessary) : ❑Field Copy El Final Notes
�
This inspection was done in the Wilmington Regional Office. It was an inspection of information that Mr. Jenkins submitted in response
+
o the finding in the July 9, 2002 inspection that there was about one pound of overapplication on pull I I on the 2001-2002 small grain
rop. In his correspondence that was received by me on August 19, 2002, Mr. Jenkins says that he contacted Bill Norris of the Onslow
County Soil and Water Conservation District on July 12, 2002, and Mr. Norris advised him that he was using the wrong map and acreage
figures. Furthermore, Mr. Jenkins says that the application record that I viewed for pull 11 with 0.67 acres should actually be what is no
labeled as pull 12 of 1.78 acres as provided by Mr. Norris. This being the case, it appears that overapplication of PAN on the 2001-2002
mall grain crop did not occur as previously noted. I am sending a copy of this report to Mr. Jenkins along with a letter.
w
er/Inspector Name ,Sf6newall Matins --
ERevielwer/Inspector
Signature: Date:
05103101 Continued

Type of Visit JZf Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ffRoutine O Complaint O Foilow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number ''j Date of Visit:
0 Permitted 0 Certified [3 Conditionally Certified [3 Registered
Farm Name: G e 5 rq . oon, _'yet
�
Owner Name: ana 1d e-all, I J m -1,1 5
Mailing Address:
Facility Contact: 1 Tittle:
Onsite Representative:
Certified Operator -
Location of Farm:
Time -
Date Cast Operated or Above Threshold: _
County: 49kj S1 04./
Phone No:
Phone No:
Integrator: Gam, Mall `s
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 " Longitude • 4
Resign
Swine -Ca acity
Current Design Current Design Current
P,o utation Poultry Ca aci P,o ulation Cattle Ca aci P,o ulation
❑ Wean to Feeder
❑ La er
❑ Dairy
Feeder to Finish
I qV 00
I
on -Laver
❑ Non-Dai
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
❑ Gilts
❑ Boars
Total Design Capacity
Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑ La oon Area ❑ Spray Field Area
-- - -
Holding Ponds 1 Solid Traps �E�jjjj]❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure i Structure 2 Structure 3 Structure 4 Structure 5
Identifier: i
Freeboard (inches): Y 3
05103101
❑ Yes ;�rNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ,�No
Structure 6
Continued

Facility Number: G'7 — r7 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures 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 ? 42 - rZ V 4 CA I]a r a l l G " G er't 72,c
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
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 )ETNo
Cl Yes ZrNo
gYes ❑ No
❑ Yes )DNo
❑ Yes ❑ No
Yes ❑ No
❑ Yes ( qO
❑ Yes [--]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes O'No
❑ Yes �No
[--]Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 2 No
❑ Yes ❑ No
❑ Yes JZ'No
❑ Yes ❑ No
Oyes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #j: Explarn any YES answers -,an recommendiitions or,snyother comments,
ilse'drawrn&. of facility to betteir explain situations. (use add.itibnal:pages asdnecessary) ❑ Field Copy ❑Final Notes
�g ache wtis+{ I Table - , however �irr 44;a
ra10 `('s .r�leW P�,�r �Z. Ei+��r O(Flefe PL/11 1z T�b.�ri
vt4he
We,C4e. V>Ighrt gvto( key i!1/',')4j4) jr% ►'Acy al 7} po ese►JI Is d.r'
!
qo(O( Pull !Z �� hp if+"r�Ot^�i o� �cSiFh i'vlXe4md ke�to [ � t
✓Wi-j
+Ile I-.��t s q vt . Mr . 7en ; •15 Sa,71 /ut ,,I d ; vl '41j e >C;V tpe D�
ls 1I�IZ— is 1cwee Ictnd. Rs f,gr' of �1ii�►ti441;r s1'4 rOt�T it/i � �
J
Reviewer/Inspector Name I J C li�/1 jt�j,$ T
Reviewer/Inspector Signature: Date: 6 Z
05103101 Continued

Facility Number: — Date of Inspection �? t. 3
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 ZNo
❑ Yes ONo
❑ Yes EfrNo
[:]Yes OrNo
❑ Yes ONo
❑ Yes ❑ No
Additional, Comments and/or Drawings:
18.Ca) Con4:,►ved) PVl1 wrq 4'-eo( -fo Cons:-alev, q Sk1O,1C-- PVll 1-
i� QrdE- 4a kec PV!( 0r4-I� X �14e lot -,Wes elreAS or �'►"e-ld .
Pvll Ae wos4e, pjan -no b l e -- As O. 6'2
�r' o :ten -#"r�t � ; r� r ; c� ol.� i d � �q.,01 W h�' �'L G'D�r�l +' ,,•� q �v � � 1 1 �'O �G ✓'
Ji4
Pulls ,Shown gYrd -�421'' respecq;ve CtCYCruS,
Pv11 1 ( M-1 be ,--.ere 4L.Vot-1 D, 6? q@.es . /Need 46 hea,
assessed Gorreca oo-eA)e- o,nd 7"mclaote 4,k,'3s in 4hn,
Waage, pToe Pvll I 1 is D.61? acres ) 4L e►, rey-,c ov 1°�. wee no4ebeln
CC� 7j1�' C✓as{� pro,"1 ��, ys qha4 4�e srv►a� �1'ri1i� OVerseed !s
19l1ewed 100` lbs PAA /atcM o,,ta Gate be �r�Zl?d W 1x
no re4VC4;a-. ,-, yI rol'�C'-1 "ga C Tkcorrec-4.
The -plan rl eeX 5 4e b e l evr red fo st o,.✓ -4+ *&t 4140c•11ence
ne r75- 4s PA�u/a_cre ©-n -Ike sr ll g���h 1+ 1,4 ; f 9 r r zed _
'g-e"we 40 vse cr +vas -le q»al ys,s da4cd w1f4k;-1 60 dnls
TLI� Orl�%iGLt9�o..� /'PGOrp{S.
-f Ltre h 51-.o u U G h e Za61
l0n_(�� Goy-fKJed� y► ---Tevt4;-s ;,d,'crt-�eC� fka�- he Pulls Pvl� li
25 �; 'Fe lekt4I ;4 iS sL�dw� o,�,�en�eQl �n -eke mno, nieed 1e
f4t,.,
t?-f
n_ftere 44AG t-,e wla.p r QC►�@rn�e wrs.�e- p1,i+11 o�•1d
alF are i#q "rt9ree,-te14Ql1�"V1/s.
14, Need -la have wef]able gyres do�v�e�t�ar-�;cY► �IE�9�.��,.,,;G(-�ks�e-�C�
enelx Full 44e gereg9,2 -Fe,- e,,tek pall.
05103101
ZS. 4 Oterea { r AC14 44e n ppl;,c4d,er f,;eld Ar puil j #1�r w;A", 200 lee4 Pi`q dwell;Aj n�
e7wlie,d bi YV-,- c7enR-S- T4e Iwell;m� helen�S - e -1he prev►ou.s Ow+Ne✓' e,04ke;epr,,.
also, Pulls 2 163 apPeA,- 4Q be 7-04-1e4 a/ 7wk;�,' -,--

Facility Number: -- r]
Date of Inspection LfZ
Pa ,e Y
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond
liquid level of lagoon or storage p with no agitation?
27. Are there any dead animals not dispose properly within 24 hours?
fail to discharge atlor below
28. Is there any evidence of wind drift during Ian plication? (i.e. sidue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located the liquid surface of the lagoon?
30. Were any major maintenance problems with the vent* tion 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 hav propriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary co ?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional Comments and/or Drawings: 4`
2-5. da v9h-r��rs 1�o e�. 1jr . Ten k:n s says e owrrs the l4n o�
-IAA hi'S �daV9i-1r,rs
q •� eq � re4 a�' t
8 enippe-1rs 41�)q4 When Tn �� �er1��.tis G��'sc6yi✓]eG�S aliP
hose -rieerrr 44e h yld.'arit 4of P,v11s 14z �ktel hiti-4e tJ'AvPl-f
-00r'OW1 411 o/' ?ate /74� Ad 1 fl C17 %ueed �O
e,hSv.re weale 140e> nn4 �rscLl„.9� ;hid Aed,'lck.
T d'4 n64 see qn, wgsge i l 44a -,64c4 0- Ae -/:,ne Of
�hrs 1 hsrC4;6:I .
z z. ' e o v,e.r 7 eed s -Io n
L
05103101

r.;
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit �1,(Fioutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number I"ate or visit: Time: dC30
Not O erational 0 Below Threshold
Permitted 13 Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
FarmName: .......�....kQ-.......................................................................................... County:....14�-'.............................................
Owner Name:
Phone No:
Facility Contact:...............................................................................Title: Phone No:
MailingAddress: ...................................................................................................................... .................................................................
Onsite Representative. .,.O -! Integrator:.... 'r'-�11`S
....................
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 1 46 Longitude ��0 6 «
Design . Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish 00 Q ❑ Non -Layer [] Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design;Capadty
❑ Gilts =
Boars
Total' SSLW
- Number of Lagoons ;: l �_ '_ ❑Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
F _..-. .. Holding Ponds /:Sold Traps - ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance 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 NNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes NNo
01/01/01 Continued

Facility Number: 67)
Date of Inspection 0 G
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes kNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ........... 1
......................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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?
i I. Is there evidence of over application? ❑ Excessive Ponding [I PAN ❑ Hydraulic Overload
12. Crop type bE' `''�``-t—�s�` i � `\ °I_�-' Gti.P✓re
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
17. Are rock outcrops present?
❑ Yes )9No
❑ Yes ,13�40
❑ Yes 'No
❑ Yes XNo
[:]Yes kNo
❑ Yes Wo
❑ Yes Z' No
❑ Yes )RfNo
❑ Yes Wo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 14No
❑ Yes �f No
❑ Yes ❑ No
18.
Is there a water supply well within 250 feet of the sprayfield boundary? ❑ Unknown
❑ Yes
❑ No
❑ On -site ❑ Off -site
Required Records & Documents
19.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
4Yes
❑ No
20.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
XNo
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
21.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
N(No
22.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
tqNo
23.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
D4 No
24. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes XNo
25. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes kNo
26. Does facility require a follow-up visit by same agency? ❑ Yes gNo
27. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
Odor Issues
28. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes kNo
liquid level of lagoon or storage pond with no agitation?
29. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes % No
01/01/01 Continued

Facility Number: — Bate of Inspection ! G
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon?
32. 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.)
33. Do the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Printed on: 1/4/2001
❑ Yes
No
❑ Yes
® No
❑ Yes
No
❑ Yes`
No
❑ Yes
ZNo
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Field Coov ❑ Final Notes
`7
N
Reviewer/Inspector Name , (�.` may= 111-1 ar �` p; = -i5n �
JiG, .ae3izb 4.w-o-- i.'.a�-- .i. .-.i...i.. iaa6 x-+�na,
Reviewer/Inspector Signature: Date:
01/01/01

Revised Apri120, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 6,-1 - q Operation is flagged for a wettable
Farm Name: es s acre determination due to failure of
On -Site Representative: Part 11 eligibility item(s) F1 F2 F3 F4
Inspector/Reviewer's Name: ALI�4 . e
Date of site visit: �—(1— 0d._.
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Date of most recent WUP: j`�-19_1 b Operation pended for wettable acre
r determination based on P1 P2 P3
Annual farm PAN deficit: bGa pounds
Irrigation Systems} - circle #-hard-hose traveler, 2. center. -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system wlportable pipe;
6. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part Ill. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part 11 - F1 F2 F3, before completing computational .table in Part 111).
PART 11. 75% Rule Eligibility Checklist and -Documentation of WA Determination
Requirements. WA Determination required .because.operation .fails -one of the -eligibility
requirements fisted -below:
_ F1 Lack of :acreage -which Tesulted in:over m-pplicatiomof-waste-water, (PAN) on:spray-
field(s) according-tofarm'sdast two years:ofJmgatian-xecords:
F2 Unclear, -illegible.- or lack of information/map.
F3 Obvious 7ieldiimitations-(numerous3j itches ;failuredo:deductTequired_.__
buffer/setbackmcreage; Dr25%-.ofiotaImcreageadentmediri-CAWMR Includes -
small ;-irreaulady-shapedfields fields -less than��cresfortravelers-or.less-than
2 acres for. stationarysprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in Part III.

Revised ADril 20, 1999
Facility Number -
Part 111. Field
by Field Determination
of 75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBER'-2
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS3
f
f
f f
I
f
f
f
f
f
f
FIELD NUMBER'- hydrant, pull,zone, or:point numbers may be used in place of field numbers depending on CAWMP
and type of irrigation -system." If pulls, etc. cross -more -than one field, inspectorlreviewer will have to combine fields to
calculate 75% field by field determination zor exemption; -otherwise operation will be subject to WA determination.
FIELD NUMBER2 - must be clearly delineated on -map.
COMMENTS3 - back-up fields with CAWMP acFeage_exceeding-75% of its total.acres and havingzeceived less .than 50%
of its annual PAS! as documented in the farm's previousfwo years' (1 n97 & 1998) of irrigation- records -cannot serve-as"tne
sole basisfor requiring a WA Determination.-LBack-up fields -must -be -noted in the-commentzecton and must be accessible
by inrigabon system.
Part IV. Pending WA Determinations
P1 Plan Jacks :follov inginformation__
P2 Plan -revision may_satisry-7.5% rule based on adequate overall PAN deficit and by
adjusting -all field _acreageio below 75% use rate
i �l�. I,
P3 Q},'�2r (ie n prUce s f installtting new ira fgafion syste ): l"�eni �c v��

aint O Follow-un of
I Facility Number I
of DSWC review O Other
Date of Inspection 1.51 f l 1 W l
Time of Inspection © M hr. (hh:mm)
© Permitted © Certified [3 Conditionally Certified [3 Registered 113 Not Operational Date Last Operated:
Farm Name: County:...........\-! ................................
Owner Name:
Facility Contact:
Title:
............ Phone No:.......................................................................................
Phone No:
MailingAddress: ....................................�.........................................................................................................................................
Onsite Representative: Integrator: ���t'G��
g F.................................. ...... .
Certified Operator: ..................................:
Location of Farm:
Operator Certification Number:
Latitude ' 4 46 Longitude ' 4 "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance 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)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): ............ ��
❑ Yes ❑ No
❑ Yes �rNo
[-]Yes EYNo
❑ Yes KNo
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes WNo
seepage, etc.)
3/23/99 Continued on back

aeility Number: l — T Date of inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
J�OCNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
1% No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
t'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
0Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
ONo
11. Is there evidence) of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
8fNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes XNo
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?
'AYes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
KNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
j4No
Required Records & Documents
I7.• 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?
Yes
(ie/ WUP, checklists, design, maps, etc.)
❑
,(No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
N�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
gNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes allo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ,[No
.. yi.... r........... were noted clitr... #his.visit.... will deceive �. further;
• Corres oridence'.a'botii this visit. - - • - -
Comments {refer to qua on #) Explain any YES answers and/or any_ recommendations orany other coi�imenta � � '
C�) sex" L4
iTse drawings of fac>ilrty to better explain situations {use=additional pages asonecessary) . � � ��.�,��, �,�:. -��.-� a
5OL�
1►-� ►'� Ce 3-s �1��� �� 1� i��� ���-.� s��--tee �� � �
Name Reviewer/Inspector
p - Cis. `�_� -� � e - � - _'� . �,. �•_- .� • - : `:. '� .-�:.-'� '
Reviewer/Inspector Signature: s �_ Date: M

E'acil ty Number: Pz— Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 9No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 1� No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RNo
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 I `No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or II
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 0 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 rr;K,N, o
tiona :Comments an or rawu�gs•
t
Cle r►— -J tc� h�2w '1 yYiy�` �Uti i�� CAS

Lagoon Dike Inspection Report
Name ofFarm/Facility _ f CJ/')
r-
Location of Farm/Facility S/L°
Owner's Name, Address
and Telephone Number
Date of Inspection (126
Names of Inspectors _
Structural Height, Feet f!!d X- a d Freeboard, Feet l
Lagoon Surface Area, Acres �� Top Width, Feet l
Upstream Slope,xH:IV {Z7 / Downstream Slope, xH:IV
Embankment Sliding? Yes No
(Check One, Describe if Yes)
Seepage? Yes_ No
(Check One, Describe if Yes)
Erosion? Yes No
(Check One, Describe if Yes)
Condition of /`
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes _Z�-- No
Engineering Study Needed? Yes No T
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments

= ` Q Division of Soil and Water Conservation -'Operation -Review
•C1 Division of Soil and:Water Conservation - Compliance Inspection
® Division of Water Quality - Compliance Inspection
- .13 Other Agency -.Operation Review'.
0 Routine IQ Complaint Q Folhiw-up of DWQ inspection Q Follow-up of DSWC review 0 Other
Facility Number Date of inspection I r
Time of Inspection DO 24 hr. (hh:mm)
® Permitted ® Certified [3 Conditionally Certified 0 Registered JE3 Not O eraEional Date Last Operated:
Farm Name: 4- A.-5....r.A.M 1C............................................... County:.......NSC�D1rI Wt20.....
Owner Name: _..Q.NA�.Q... C R.1'H... ,1..l4.Kl:"! 5.............................. .
Phone No:....9.(a...31- .. .372..... Arent
Facility Contact:-...J)PNA�r ................Title:.. .... Phone No: ...................................................
Mailing Mailing Address: ...... 1 4..... .................................................... .....TACKson►V tt_LE...t....................... .. 4D....
Onsite Representative: $70N �►TN �-/ ��1�CrNS Integrator: CA'��G L!
P.................................................sl...................................................--........-........................................................... I.............
Certified Operator: ......p; A'0 9A........... . ....�.[Y1 ....................................Ks Operator Certification Number:.... �Za.3{ ................
Location of Farm:
—R►CHLAADS
------................................. 11.N...A...!...i�r...-EQ.�{?+!�?..pt�iixtk...21--f....F.....�A......................,�....... �
Latitude • ©OS Longitude
• ✓3
Design Current _ _ Design Current Design Current
Swine Capacity Population
'.Poultry °
Capacity Population ' Cattle
Ca acity Po ulation
❑ Wean to Feeder
.
❑ Layer
❑ Dairy
® Feeder to Finish
Op
❑Non -Layer
❑Non -Dairy
❑ Farrow to Wean
=
_
"
❑ Farrow to Feeder
❑Other
-.-[]Farrow
to Finish
_ Total Design Capaaty
900
❑ Gilts
=
-
Total SSLW
d0 D
'=
❑ Boars
Number of Lagoons, ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
y:
L :J
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
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 YNo
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 NNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: z
r
Freeboard (inches): ................................ ................. -.-....................... .
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage,_etc.)
3/23/99 Continued on back

) acility Number: a j — ©q Daty of Inspection
�J
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 maintenarice/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?
1 l . Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type Q,#S --
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Rio •yi4ati6ris or• deficiencies •mere noted• during �b s:visit: Y6t* WH1-r' eceive iW further
correspondence: al)nut_ this visit.. * . . ..
. . . . .
❑ Yes I No
❑ Yes XNo
❑ Yes ❑ No
❑ Yes VNo
❑ Yes JXNo
❑ Yes XNo
❑ Yes O<No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [] No
El Yes �To
❑ Yes XNa
❑ Yes No
❑ Yes o
❑ Yes VNO
❑ Yes XNo
❑ Yes No
1_
❑ Yes KNo
❑ Yes No
❑ Yes No
Comments (refer to=questEon #) 'Explain any YES a svc ers axidi r any recommetrdations or�any other comments
Use drawings of facility to better explain situations (use additional pages as necessary,) -
A ti' k,— . 5 *zq - •Y+ �
Reviewer/Inspector Name
Reviewer/Inspector Signature. st Date: 117:? h'G;
3/23/99

Facility Number: (pl
Date of inspection j 3Q r
M
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
❑ Yes
R110
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
JNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
19(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
rq�`No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
KNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
XNo
Additional omments.an or rarnngs.
3/23/99

r.j
Q Division of Soil and Water Conservation 0 Other Agency .
°�{ ,division of Water Quality
outine O Cunt' faint Q Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection /to
Facility Number 7
Time of Inspection UVZ!2__j 24 hr. (hh:mm)
Megistered rCertifsed AAplied for Permit akrmitted JE3 Not Operational . Date Last Operated:
Farm Name:..'1R4.....`....HThk!�..Sji,lo^!.'.�r�.�' ounty:......C�NSw.....................................................
Owner Name:.3�0Ng. DD.. ...0 ... i l". L S.............................Phone No:........Y-��.... .ga%�� //...................................
Facility Contact: ...................................... Title :....... a1 .......................... Phone No:...7�
MailingAddress:..... ..T... .... 4-..— ......f. `!..........:..... A.C,t i -........................................................... .......................
Onsite Representative:....4.1 ... 1 'i.� 111.1`............................................... Integrator:......(... .................... ........................
Certified Operator:...... 5...... p a�
Operator Certification Number: .......................•-....---.....
Location of Farm:
1
............ .................
..
..............
......................................... `...
�.��ci�:...�.... `..�.w�.....k-�ar�..(.,�.- _... i`....oa..^ .8iv
Latitude • - d h5 I66 Longitude j 7 7, 9 3 L I, L5-__1_J"
Design Current Design Current ` „ Design Current
vme `capacity :Population' Poultry. -Capacity ',Populatio Cattle Capacity ,Poptalation
❑ Wean to Feeder
®.Feeder to Finish
QLO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Subsurface Drains Present j❑ Lagoon Area J❑ Spray Field Area
......... .. ........ .
x ❑ No Liquid Waste Management System
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
KNo
2.
Is any discharge observed from any part of the operation?
❑ Yes
)No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
KNo
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
or
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
b 10
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
IR,10
maintenance/improvement?
5.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7..Did
the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97
Continued on back

Facility Number: r7 —
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have}acertified operator in responsible charge?
8. Are there lagoons or storage p\bnds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure ? Structure 3
a.4......................................................................................
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify D"A'Q)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type COA&"'�,. "_`£ o` t— Q }�t..................I.............................
❑ Yes IN No
❑ Yes A-FrNo
IV Yes ❑ No
❑ Yes No
Structure 5 Structure 6
❑ Yes *No
❑ Yes 4No
❑ Yes *No
❑ Yes 11�_No
❑ Yes kNo
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes O�Ro
❑ Yes �(No
❑ Yes [fNo
❑ Yes 6'o
❑ Yes kNo
❑ Yes �No
❑ Yes �(No
❑ Yes k No
(es 04o
Z.4 40 w., �. 5 c.� c.u.,-. b vn d�c a., Ao
Reviewer/Inspector Name ` U
"
Reviewer/InspectorSignature:
Date: rO�rs q�
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

® Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number
Date of Inspection . ; 1 Z �
7
Time of inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status* (M Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review Z.
❑ Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: .._ .... _._..... _.._. _ ......
FarmName: _..1� G ........................ __.. ....... County: e cs ;._ ....- .. _ .. _ .....
Land Owner Name:.. !!t.-_..... _ .... _ ss V- !F..SQLN.5....... _............ _....... Phone No: _.._. JrS .... Y.z ` _.._. _........... ....._...
Facility Conctaet:._!,!a� 44�!... ... _ Title: Phone No:
Mailing Address:
Onsite Representative: ti�.�'`.. Yr-V-- ._.....
... U,4rz7�xvn
Certified Operator: ..� ✓� ...�'^' 4z �e s _.... .....�.... _ .... _..._._...
Location of Farm:
Integrator: 2 ��C? i .... .....E ?a .....---
Operator Certification Number:
Latitude ' ° u Longitude
Type of Operation and Design Capacity
��D sign
Current.Desrgn Currentg� Design Current
Swine k
�3,Poultry� r ».Ca aei ' .Po ulatian, n Cattle Ca k uc' Pa' suia eo
ulatid,. ,.
❑ Wean to Feeder
10 Kim ik, ID Dairy I
3 Sv J ❑ Nan -La er LELNqn-Dair
IN
Feeder to Finish
c�,,3p
Farrow to Wean
Total Design► Capacly z
Farrow to Feeder
Farrow to Finish
_ »
x j
❑ Other
Number o�ons}I Haldtng Ponds ❑ Subsurface Drains Present
h a t ❑ Lagoon Area Spray Field Area
QgDeral
1. Are there any buffers that need maintenance/improvement?
2. 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 Surface Water? (If yes, notify DWQ)
e. If discharge is observed, what is the estimated flow in gaVinin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes evo
❑ Yes B No
❑ Yes O' o
❑ Yes E"NO
❑ Yes
B-No
❑ Yes
B-No
❑ Yes
M-115
❑ Yes
GI-wo
Continued
on back

"-,- `Facility Number:.... ... .._..-.3...._
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes [9-1lo
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Ijagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) Iess than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
2 d
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes ❑-No
❑ Yes U-NO
❑ Yes EMO
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste ,A Uglication
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .,_CO:gs±!.1:L......_..__..... _ .... ............. ....... _
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For -Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes
U-ITS
❑ Yes
R No
❑ Yes
BNo
Lrl Yes
❑ No
❑ Yes
❑ No
❑ Yes
Bi-Na
❑, YYees
U-No
1 Y es
❑ No
❑ Yes
❑► ddo
❑ Yes
❑-No
❑ Yes
ER -go
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Comrrients{refer, to;queshon #} Explain any YESvanswers'and/or. any recommendations ar any other comments' z
Use drawings of facility to better explain situations.,,(us_e addihonaI pages as necessarn,
. :.
r4 Lroo tJ w.�i � �c t �2 N a-r i ..� P I � c � �► 'r T Li ; s d rT � ►,.. � , r 4
Ca A-54 -AL HA9 Of;F AJ
S�r.�q Liz . tic l pS Ga.r S2 4-rIr" is ori.;L. d;_
LAO 3 S?f-4.t �w� —ram G✓ k S .
Reviewer/Inspector Name 2"�4M�,
-WreeQY3 k Nax �..k C �� £ �,tt � � w�
' "�
,��
f€, __
_
Reviewer/Inspector Signature:
S „tJ( �
_ Date: Z'
Of
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL NL%NAGEIN ENT
ANT AL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: _ -ZO , 19
Time: 1: 3012
Farm Name/ Owner:
MailinsEAd&ess: C4Z,
r 4 OI S 6p-Q.!-ee
County: d n 5 l o w Zsr37G/
Intem-ator: .0 -4- 'A r.> i [ `s _ _ Phone:
On Site Representative: r Phone:
Physical Address/Locadon: _ Ste' r4 orb f• S
A1or14 „ x
Type of Operation: Swine X Poultry Cattle
Design Capacity: Number of Anima?s on Site: ©do
DELI Certification Number. ACE DENS Cerdficaidon Number: ACNEW
Latitude: Longitude: �7 ° Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot _ 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) r No Actual Freeboard: ' Ft. Inches
Was any seepaaa observed from the lagoon(s)? Yes o Was any erosion observedza or No
Is adequate land available for spray? or No Is the cover crop adequate? Yes or(a
Crop(s) being utilized: Ca�S�� I-o nc � P . - 30 Cz� s
Does the facility meet SCS minimum setback criteria? 200 Feet frogs Dwellings? lRor No
100 Feet from Welis?(D or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Sire :m? Yes orq6
Is animal waste land applied or spray irrigated within 25 Feet of a USGS 'Map Blue Line? Yes i ro
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o r o
Additional Comments: c 51- Z-e . %ter
nw_- , p ram. d=
Inspector Name
la_ wl, 1V-r [Aug/l_. C1�c' +�.6U�vdi �i /c_ A/"L,!9
d � 5 C�crc
S i _na.ture
cc: Facility Assessment Unit L•se Auachments if Needzd.

UNLkH I TUNS BR NLH - WU � ax :919-r15-b(=
Mar 8 '`fib 1U:19 F'_ Uj/Lr2
County: niw.6'Ln o
Information Taken by: 40Y
.,. N.C. Division Of Environmental Management
Complaint Report Form
Datrfl"zmc• glq ham/6--
Report Rec'd From: 4AA; '' i 2 Complainant:
Agency: Address: i 8c,' , , �►- ,�,
Phone #: Phone #: 3 z4 4 5
Complaint: P a 6 "'',4 Qc.tfh cL
0
Type: S. Water G. Water Air S/Haz. Other (Specify): .
Location: A 15 SoA me
Surface/G.W. Involved (Name):
Regional Office: ARO URO WSRO RRO FRO, WARD WIR:
{
Regional Contact: nAPhone #• S
Other Agencies Contacted:
EPA Region IV - [phone] - 24 hours
Emergency Management 733-3867
Solid and Hazardous Waste 733-2179
Pesticides 733-3556
Wildlife Res. Comm. 733-7191 or 1-800-662-7231
Marine Fisheries [phone]

It k
ESwine LJPoultry FICattle I[IShaen ONorses E
.
.... .......
des
WWI -LCI. ..7.,
J,
M1,52
MERM
i
INext I Previous I

Site Requires Immediate Attention: - Nd
Facility No. _ �2 -7-
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 8 I3 . , 1995
Time: /
Farm Name/Owner: j fM �• Q x T�'2 M J4MCS Cox
Mailing Address: _ _ Y3 A2bEe RD . 1 GE4 LA t ! 0 S . M C z35 -74
County: D i.l 5 Loy4 l
Integrator. CA 2e o Phone:
On Site Representative: osko. _ Phone: 9 L O 3 2 -53 r
Physical Address/Location: ,,q ✓H,r',s x1earo_4,1, (ICA�136) (e!c1'c�4NQS NC.
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 4000 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3`-f 5(' ' as, Longitude: '77 -�3 'i27•7}" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 6�or No Actual Freeboard: S Ft. Inches
iWas any seepage observed from the lag(jon(s)? Yes orf i�_Was any erosion observed? Yes order
Is adequate land available for spray? (f )br No Is the cover crop adequate? Yes or(T9
Crop(s) being utilized: C_04v�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?(es or No
100 Feet from Wells?� or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or Do
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes org)If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or90
Additional Comments: � BZ,<� �/�-
%w ryl Y�i i� _ Q �is,.. i• dys _ '� /J h �.. _ . f . ./a
DuP_eEiT
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

OPERATIONS BRANCH - WQ Fax:[phone] Jul 24 '95 18:06, P.09/18
so
U]
•
Site Requires Immediate Attention ti 0
Facility Number: &;7- 7—
SITE VISITATION RECORD
DATE. 1995 1995
L %, � l�f- —wr-,
li
Owner: rrt e k•, Farm Name: m�
County:
Agent Visiting Site: C S -Phone- 9/0 5,!5, 7Z.
Operator:' _ )riles Cox phone: ply 27-S4 -5--Xt8
On Site Representative: Phone:
Physical Address:
Mailing Address:
Type of Operatior
Design Capacity: , Number of Animals. on Site: G Z?
Latitude: 0 Longitude: U "
Type of Inspection: Ground Aerial
Circle Yes or No
Does the Animal Waste Lagoon have Sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot +$ inches) or No Actual Freeboard:. _ gg Feet Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes o&Was there erosion of the dam?: Yes oro
Is adequate land available for land application? Yev or O Is the cover crop adequate? Y, o _•
Additional Comments:
Fax [ , i iQ I Q'i 715-.3,; 9
Si--ndrure of A
,so