310017_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual
II

\\q5
1vision of Water Resources
.Facility Number � - � 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: autine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L� Arrival Time: =00 Departure Time: , ' d County: Region: G(�
Farm Name: '0 t� 2. 1, y _ Owner Email:
Owner Name: Ar "de- rt uc 4 f A,l — hone:
Mailing Address:
Physical Address:
Facility Contact: J�) 0&1 5 %�-5 Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
�l
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharges and Stream Impacts
Latitude:
Phone:
Integrator: S",Y' 4'_ W
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
]Non -Layer
Design Current
Dry Poultry Canaeity Pod.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
[�o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
2-MA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
E2r1qA_
❑ 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
Q NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E:a no
❑ NA
❑ NE
I Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes rl"No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Ak
Facili Number: - Date of Inspection: rt
Waste Collection & Treatment
4:�1s storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes � ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 2 ` A ❑ NE
Structuredr Structure 2 Structure773 Structure 4
Structure 5
Structure 6
Identifier: �' 1 Z 2�J 2,' J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6 S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[,2<o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Rio
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
["No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[:rNo
❑ NA
❑ NE
maintenance or improvement?
I 1 _ Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): }C�vN..� �pS V C erg
13. Soil Type(s): f.L _p ,r► �� 1� --
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [eNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Eff<o ❑ NA ❑ NE
❑ Yes [3 o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes !o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [305o ❑ 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 E4No ❑ 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 [?fNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C!!�No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facilily Number: - Date of Inspection: u�^
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3-T1To__ ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [!INo ❑ 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 RTNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ld""'o
❑ NA
❑ NE
❑ Yes
E? No
❑ NA
❑ NE
[]Yes
RENo
[DNA
❑ NE
❑ Yes
F Noo
❑ NA
❑ NE
❑ Yes Q No
❑ Yes E3<o
❑ Yes 2"No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Calc6V4 f&�-_ k
—�, -- r G7
N C)
�C 5-c 1.11
cf,1( 2— r
s a-
Z
2. j6
7,co
3, 3.
s
6'
,ram -5
3-
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: d tu" �IIJr, 5
Date: N
2/4/201 S

f °% ivision of Water Resources
Facility Number - 17 O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Co nce 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 O Denied Access
Date of Visit: L t Arrival Time: ® Departure Time: /{ County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: -7 4 ^49— Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
w2m to Finish
can to Feeder
Feeder to Finish '31k f9
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -La er
Non-L
Pullets
Other
Poults
Design Current
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[:]NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
VN0o
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 21412015 Continued

Fa sill Number: - Date of Inspection: Z 4L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes M4o ❑ 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: Z t Z^ L Z-`(
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 �' $
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes do ❑ 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 environmen l threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes FNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are buffers,
Yes No
NA
NE
there any required setbacks, or compliance alternatives that need
❑
❑
❑
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
l2. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
o
❑ YesWNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No
❑ NA
aNE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
E!f� E
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ N
❑ NA
r:f"NE
Required Records & Documents
FIR
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
E]rNE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA di"
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ No ❑ NA rNE
Page 2 of 3 21412015 Continued

�. Fatili Number: - Date of Inspection:S'-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA E 'lq—E
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ['es ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA Q'NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No l315ri 0 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 [7"No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ]�No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWNVIP? ❑ Yes 6o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes R�N
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to.question # Exjilain any 'YES answers and/or: any=additional recommendationsgo . an ;other`comrnents �-'
Use drawings of facilityto. better asPlainsituations (use additional pages asnecessarY),
a
� c. c..-c- � Itr-- o ?�� (•,,� S�� c � � o r\ "� l' �} +�—S P fin,,, `�
r2+�r
L-, 2_ j �' -3 S/ k �,
Q c.,_f'rt^ tr C �a n
t t., t 6e e
-- � i•_ � q ��/..cr � r r .� 7�, v�J' r 2 S " FyM.��y.,., c
p. 0 u 2-A
_. aS bKr 1f car-q�-,i s 1 r 9r1 5 ffe Cie cc�- f'4
.� [ptr�cr-u 1CorJr r� Q �ti„of � /
9C2
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Ito 7 ? & 7-3 py
Date: 1'
21412015

` .VDivision of Water Resources
-Facility Number ©- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Q.e�me Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outing 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 71 /1 ri/ (b Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: L / Title:
or
Onsite Representative:
■
Certified Operator:
Bach -up Operator:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wep to Feeder
Feeder to Finish
Tf TS707-
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Integrator:
Certification Number:
Certification Number:
Design
Current
Wet Poultry
Capacity
Pop.
Layer
Non -La er
Design
Current
nry Paultry
C".anacity
Pan -
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No [D NA ❑ NE
❑ Yes E] No ❑ NA ❑ NE
❑ Yes rNo❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: `3 17 Date of Inspection:
Wiisfe Collection & Treatment
N
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Cn ❑ 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: �_ 2y Z l 3 2 —
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5T 5_7`
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
E] 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, potify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ]jNNo ❑ NA ❑ NE
maintenance or improvement?
Waste Aavlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ 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
E3�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
aNio
❑ 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
fNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
eN
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility umber: (-7 Date of Ins ection: �q
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes Qlo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? []Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ENA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No [DNA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes jj No
❑ Yes ONo
❑ Yes ❑,Mo"
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer.,to question ft"Explain;any�YES answersand/or any additional°recommendations or any, other comments -'= °
Use drawings of facility to better ex l.airrsituations use additional'. a es.as neces
�- I✓ S 3 l o 017 31 00
Reviewer/Inspector Name: ct `r I O `-^'� { I Phone: r 9 7 7 G 7�ov
Reviewer/Inspector Signature: .--C Date: ZK�17Z IX
Page 3 of 3 21412014

("ivision of Water Resources
Facility Number ( - U 0 Division of Soil and Water Conservation
Other Agency
Type of Visit: Com nce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: �(T Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
�'41ATP/I
=0-
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Wean to Finish
can to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
ury rounry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
01
NA
❑NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412015 Continued

w�
Facility Number: 3 f 7 jDate of Inspection:
Waste Collection & Treatment
4. Is;storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Z- Z -2-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): SS T 7 If y
�
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
ONo ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�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
❑ 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
Ej"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?
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
l9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes Y'blo
❑ Yes
❑ Yes [No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes
ff No
❑ NA
❑ NE
❑ Yes
K] No
❑ NA
D NE
❑ Yes fNoo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EKNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
Zn
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - /7 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check zYes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ ilure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
J Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Z No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
I!I N.
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other-.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o
❑ NA
❑ NE
N
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
&
❑ NA
❑ NE
Comments (refer.to°question ft Explain any YES'answers and/or any additional recommendations or any other comments.
Use drawiugs of facility to better expiain situations (use additional pages as necessary).
��P4r� r ��s rowsAqg&0310017 pe�,�,•�al�.
SJ
L ig 2 2
Lµ-
Z—z Loj'(
n LPL, J n n e r1+-� ✓i '� y 5/CAc'7 • 1 A S 0
/
low Stu C:! G AA —0'I�1 d-N' ` �. Ca i++ry-&*--'ta
M C L% 8 1 f At f L. & &--C sry I R *0 7 6 3 s- v) .
Reviewer/Inspector Name: �1 Q ✓t ` (r .9 `-Z V
Reviewer/Inspector Signature- � t
Page 3 of 3
Phone: 1 O 796 y
Date:
r 9 11A
21412015

ivision of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of visit: Q'Com nce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
leason for visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of visit: R Arrival Time: Departure Time: / 3 D County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: ,l !.-,� `�e� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Certification Number: I j s 7 3 e
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Yo
Non-L.
Pullets
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Daia Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ev'6
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
C No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection: / Q
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: Z` C Z `Z z- 5 z- 4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): s CP �F' S G
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 [jE No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 'o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F]--N-/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 CYN/o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes © No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ' No 0 NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[—]Yes gy�o
❑ Yes o
❑ NA ❑ NE
❑ NA ❑ NE
Required Records_ & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Ef'No ❑ NA ❑ NE
20. Does the facility fail to have ail components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes rfNo
o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

. Facility Number: 3( - j % 1 IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
D Yes
�No
❑ NA
❑ NE
. 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Z�-Ws
❑ No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Ion -compliant sludge levels in any lagoon 44 pp/-
List structure(s) and date of first survey indicating non-compliance: 2 -Z01f--1iP13
iy O*A- . j Pa
, �'I 7—t3 l p i JP1`9-1// vl6
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
�No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
[DNA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ffj 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 dNo
0 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 E 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 >TNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes +[�] No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes dNo ❑ NA ❑ NE
omment& (refer to question ft Ex any,YES; answers and/or ;any additioosl recommendations or, any other comments..
Use drawings of facilli y to be#ter.explain situations;.(use,additional.pages as necessary). w
g w.s F�^`'`� u.. t,.4 t ( G( o See-r., iSpe4iY;o r�,
1. u S S � c1_4 rC-
Zs,sl<��e. �rl��i c
VAJ'�
-fig t' era T I q 9 k j,,, I'l-k C �. Ake,
L� L_ 5011 4r 0a yr t.c l rv/ 5
G rr 4`tL 4-- 5 0--\ ? ro 7 3 S
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone: (o 7 73D1�
Date: /
21412015

Fact y Number ��Drvisn of>So�land WaterConsenahon� f, Y
„, r Q�Other. Agency.
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:l J County: PUf Lid Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Do Integrator:
Certified Operator: Certification Number: q�7.57317
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
01 -'.., -'� ""�ai�.,.
`e Wes. x ,
::.`De§jgn Cerrrent o - w�RDCS1�Qa('nT1 ent. c a DCSIp4" CUrrCtlts
, r `�, >- ,Q"„ -ws,-.»�=, ^.'i4b" sS.
Sr ine � Capacity x Pop Wet Poultry Cap caty Top,, : Cattle C ty Pop.
�-�
Wean to Finish La er DairyCaw
Wean to Feeder Non La er '_ Da' Calf
Feeder to Finish -. Dairy Heifer
h
Farrow to Wean , ;,.Design}Current29 Cow
Farrow to Feeder "`D Poul Cs ci 'Po , Non -Da'
„�,K�«,,.,,
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers " ` Beef Feeder
4 Boars Pullets Beef Brood Cow
Turkeys ..� ��- ; • 4wr v, - r ,�k
- � �
er Turke Puults a .
�.. Qth,F" .
f Other Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes El"No ❑ NA ❑ NE
❑ Yes 2"No ❑ NA ❑ NE
Page I of 3
21412014 Continued

Facility Number: - Date of Ins ection:
go
„Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes PNo ❑ 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: pi ' Z/ 2 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �� � 2 33
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 M/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
fNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
d 1 o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
2rNo
❑ 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 Lj No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Ko ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
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 ETNo
❑ Yes 01<0
❑NA ❑NE
❑ NA ❑ NE
❑ Yes Z rNgo ❑ NA ❑ NE
❑ Yes ErlRio ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �o —❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspectio;NoOIE]
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 6],V ° ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

FacilityDate of In Number: - inspection: ! I
;4. Did the facility fail to calibrate waste application equipment as required by the pemut. ❑ Yes n1mo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Zyes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes EKO ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E 1VO ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Q "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 No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes a<o ❑ NA ❑ NE
❑ Yes ❑<o ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
[✓� ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments re er toa uest,on;#): Explaifi4jiy ,answers an or any a rhona recommen ahons or an of er comments ',- .
Use drawings of,facrlity, to4better°expla�u situations•(use additional pages as necessary):_ �.
Reviewer/Inspector Name: V o d h m)(-( �_ Phone:
-13 �V
Reviewer/Inspector Signature: ! Date:
Page 3 of 3

L'.""'Fici*
aDivision of_Water Quality
Number - 0 Division of. Soil and Water Conservation
0 Other Agency
Type of Visit: 7Routine
pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Gj l Arrival Time: i7s Departure Time: 6 O County: �t� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: _i�20cC - Tk'TKINS Integrator:
Certified Operator: Certification Number: 577j�
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Svwine' Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish 0466
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -Layer
Design Current .
Dry Poultry Capacity POD.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design , Current,
Capacity Pop.,
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharsies and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
VNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ 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
�No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: jDate of Ins ection: I
Waste Collection & Treatment
Is storage capacity (stntctural plus storm storage plus heavy rainfall) less than adequate? [—]Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
❑NA ❑NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
2- 1 2- Z 2-3 2- "T
Observed Freeboard (in): , 2 S D _51 L?_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E� 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 Ca/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment I threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [ Vo ❑ 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 LJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑YesZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorr;rd
application? If yes, check the appropriate box below. Yes 6 o ❑ NA ❑ NE
❑ Excessive Ponding raulic 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 CAW -MP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0"No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [;�`No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [:2r/No ❑ NA ❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Y11 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EKN ❑ 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 E;Xo" ❑ 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 a ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes W-No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - 'j Date of Inspection: C
4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes &To
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑NA ❑NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes F;KNo n NA n NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
PfNo
❑ NA
❑ NE
❑ Yes
C�/No
❑ NA
0 NE
No
❑ Yes
U
❑ NA
❑ NE
❑ Yes
I?! No
❑ NA
❑ NE
❑ Yes No
❑ Yes �i�'
❑ Yes No
❑NA ONE
❑NA ONE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
�uLu
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phonc: of 10 '/7b ?3VD
Date: 9 h, 43
2/4/20

QI Division of Water Quality
Facility Number - i '] O Division of Soil and Water Conservation
iv O Other Agency
Type of Visit: Compliance Inspection 0 Op ration Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine O Complaint Op
0 Referral O Emergency O Other O Denied Access
Date of Visit: k 1 Arrival Time: j I D Departure Time: 1 Z'%r County: lL UPI Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: J LTm0d Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.
Wean to finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Design
Current.
Wet Poultry
Capacity
Pop.
La er
Non -Layer
Design
Current
Dry Poultry
Capacity
Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gaIlons)?
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?
Longitude:
Design Current
Cattle Capacity. Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes E2/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA NE
❑ Yes E/1 o ❑ NA ❑ NE
❑ Yes [o ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: Date of Ins ection: 1111
Waste Collection & Treatment
4. Iritorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes E5 No ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E 0 DNA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes WNo ❑ 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 EYes [:]No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [2 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes R 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 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2/1No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 6"No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [;I/No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? [—]Yes YNo ❑ NA ❑ NE
Required Records & Documents
I9. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes rNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [:]No ❑ NA dNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stacking ❑ 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 [ o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes yNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: loate of Ins ection: t /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA [�NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [—]No ❑ NA E(NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �j(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 [/NNo
❑ Yes La No
❑ Yes ZNo
[—]Yes W-No
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
dliNo
[ No
❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
SF 31- i5 -U SPE CTZ60 o�j ll� ti3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: / Vt113
21412011

© Division of Water Quality
Facility Number © 0 Division of Soil and Water Conservation
O Other Agency ...
Type of Visit: Q Co
Hance Inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Denied Access
Date of Visit: l Arrival Time: 'l/p S Departure Time: l p County: 0 tJ LTd Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Phone:
Onsite Representative: 7\)6V(r A 1 �LJ)LJ S Integrator:
Certified Operator: Certification Number: cis 5rj 319
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish OOJ)
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design,,
Current
Wet Poultry
Capacity
Pop.
Layer
Design
'Current
.-Dry Poultry
Capacity.
Pon. ".
Layers
Non -Layers
Pullets
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?
Longitude:
Cattle
Design Current`
Capacity Pop..
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Da'
Beef Stocker
Beef Feeder
]Beef Brood Cow
❑ Yes VfNo ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes [ [DNA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facill Number: - jDate of Inspection.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes dNo [] NA ❑ NE
t
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: Z _ } -2 - Z 1-3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �;(_ j'1 5 Z_ yU
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 2�No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 2No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [Z(/No ❑ 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 ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ENo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
fNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�j<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
Ej_'No
❑ NA
❑ NE
[:]Yes
2llo
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2'go ❑ 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 E:rNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ello❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: 17
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes�zo ❑ NA ❑ NE
&e appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes 911�o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
CR/No
❑ NA
❑ NE
❑ Yes
E�No
❑ NA
❑ NE
No
❑ Yes
C,a
❑ NA
❑ NE
❑ Yes
C No
❑ NA
❑ NE
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes 0o ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
Reviewer/Inspector Signature: Date: L
Page 3 of 3 21412011

11 U Division of Water Quality
Facility Number - I`j 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 C�o�pleance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (2 Routine O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I1= Arrival Time: Departure Time: 1 p County: pUPL_'t / Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: L76()&- S Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
I E I I Layer
Non -La cr I JEA
Non-L
Pullets
Other
Points
Design Current
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
5ry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: 'x 1 - In I I Date of Inspection: f iA
1 5 111
Y � I
V�i ste 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:^ a _ o� -3 a — q
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 40 66
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 property addressed and/or managed through a [:]Yes CJ'No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes �No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes QXo
❑ 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 [�3/No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [2
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [2/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[;VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
Yl o
❑ NA
❑ .NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes
E(No
❑ NA
❑ NE
acres determination?
/
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P11<0
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Zo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes LCJ
❑ 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 [3"No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ' o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: - Date of Ins ection: 24911,
14 Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check dyes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
dNon-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: 11 1A
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [�(No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �fNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ENo ❑ 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
EJ'No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
] No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ENo ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dN o ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ _ 0 NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑Yes
EP<o___E3NA
❑ 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):
Z5) l-�q StooG.( rFaA C-ok wq&-6-,,nJ 1-3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: L
2.1412011

FacilityNumber I']
Division of Water Quality'
Q Division of Soil and, Water Conservation
.0 OtherAgency.
Type of Visit t3Co Hance Inspection 0 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: Arrival Time: ® Departure Time: County:
Farm Name: E Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone No:
Onsite Representative: D ou&- AT &6 Integrator:
Certified Operator:.
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
$. ❑ Farrow to Wean
❑ Farrow to Feedei
". ❑ Farrow to Finish
❑ Gilts
❑ Boars
J❑ Other
o
Latitude: =
Operator Certification Number:
Back-up Certification Number:
Region:
0" Longitude: =° =,
_Design Current, Design Current' Design
Capacity Population Wet Poultry'' CapacityPopulation Cathe Cap
acity )f
_ ❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Col
i
EllNumber
of Structures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
s-.
❑ Yes n No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑NA
El NE
❑Yes ❑ o
❑ Yes
❑ NA
❑ NE
❑ Yes f2 Zo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2' 7__3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EI No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes ZN . 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/f No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ NA ElNE
maintenance/ improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2No ❑ 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 gNo
o [INA El NE
18. Is there a lack of properly operating waste application equipment? El Yes ❑ NA ❑ NE
Comments (refer" fo gnestion',#) Explain any YES -answers and/or any recommendations or any otlter4c6mments�,
Use drawings. of facility, to better explain situations: (use addtttotial pages as necessary).
,�:�„ -�� •:;g =ram. ��` �r_����~ �,,�„,:
Reviewer/Inspector Name °
�. _°.� Phone: U —
,3ff
Reviewer/Inspector Signature:
Date: Who
Page 2 of 3 1 12128104 1 Continued

Facility Number: %4 L — Date of Inspection i
TT
,Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes .❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design g ❑ Maps ❑ Other p �
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes EXo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ®No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CNo ❑ NA ❑ NE
W
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
20
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ywo
❑ NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
U No
[DNA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
El"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
E
El NA
El NE
If yes, contact a regional Air Quality representative immediately
fNo
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 ReviewerAnspector fail to discuss review/inspection with an on -site representative?
El Yes
,�
[J N
[I NA
❑ NE
33. Does facility require a fallow -up visit by same agency?
El Yes
L"J No
❑ NA
❑ NE
Additional Coinmeuts'andlor Drawings:
Page 3 of 3 12128104

FacrIrtyNumber'
Type of Visit 2SZoutine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: f 1 2 0 Arrival Time: Departure Time: County: L Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: pal/ 191m 3 Integrator:
Certified Operator:
Phone No:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede:
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: = c = 6 = « Longitude: = ° ='
=
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
urkey Poults
❑ Other
Discharges & Stream Impacts
I . 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 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 2No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ N
El Yes
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104
Continued

Facility Number: I I — I j I Date of Inspection !� u
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes/No
El NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(/No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
dNo ❑ 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
environmental
t eat, notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q4o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
O/No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[/No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[UNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[;�`No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
�SI ) 5Ltf>Dfi(e_ ?I R 1A0 P
Reviewer/Inspector Name (J�`
Reviewer/Inspector Signature:
1"6 (Z, - 2-1 1 Z— Z.) Z -- 7
Phone: L2 L
Date: 11 -"
11/28/t74 Continued

Facility'Number: Date of Inspection t1 U 8
Required Records & Documents ,,��//
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes EdNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
Q&o
❑ 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 Ej
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
if No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E]�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes &No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ENo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ['lo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Id 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
[;a 10
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
�j
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
L/] No
❑ NA ❑ NE
General Permit? (iel discharge, freeboard problems, over application)
,�,/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E7 No
❑ NA ❑ NE
12128104

Dtvts1 WoUll ater Quahtyr
Fac1l�tyµNumber 3 1'� D Drvisi©n of Sail4andnWater�ConservahanZ.
D:Other-Agency k
[Reason
cype of Visit mpHance Inspection O Operation Review O Structure Evaluation O Technical Assistance
for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ( 66 Departure Time: County: U P�"� 1� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone No:
Onsite Representative: OUP �s
Certified Operator:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
L Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Latitude: = o ❑ 1 0 « Longitude: = ° [--] ` = 4
Design Current . Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Da Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Humber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o [I NA
❑ NE
❑ Yes
ElYes
N ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection �� t
Waste Collection & Treatment
4.cjs storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 9 L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) dNo
6. Are there structures on -site which are not properly addressed and/or managed ElYes ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaltreat, 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 [3No ❑ 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 CNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAW MP?
❑ Yes
0 o
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
L"f No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
[I NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VN'4o
❑ NA
❑ NE
Reviewer/Inspector Name I
Reviewer/Inspector Signature:
�nrZN L� I Phone: (SIV) 776 ` %S
Date: It
12128104
Page 2 of 3

Facility dumber: 3 1 — j? 1 Date of Inspection t t
Reauirefl Records & Documents
19:' Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3'�No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El 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 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
4!fNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Imo/No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
IJ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LJ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Vo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P 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
L 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
ZNo
❑ 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
N
❑ NA
[_3 NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
7No
❑ NA
❑ NE
Additional'Comments and/or Drawings:
Page 3 of 3. 12128104

Facility Number 7
0 Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (7 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: a Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Do U G _Os
Phone:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Region:
Latitude: =O = 1 �" Longitude: = ° 0' = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 3 1 676131 {oA o
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
I. 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
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
Number of Structures: F]
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 E No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes o
W
El YesFNo
❑ NA
El NE
El Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection ll d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes WNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _1M-2-- l 06A, 2-1 QM Z_-3 ✓h Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ �� 6 sq
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2 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 0 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 enviranm taI 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 0No ❑ 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 [2rNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes allo ❑ 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
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
0 No
[ I No
[� No
No
ffNo
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):
0M'1_-q N4E0S
6-F f 31-0E I P
jo u�� pdP41— Aj -31-- Iq. ?Ewt,,vc
'rjALAS, a" CA_ --94r4O '7010e..
El NA El NE
❑NA El NE
❑NA El NE
❑ NA ❑ NE
❑NA [I NE
LLD O A l-�-S -of //A jJ
Reviewer/Inspector Name L/o e L Phone: C9/6179I l
Reviewer/inspector Signature: Date: L a
12128104 Continued

R
Facility Number: — n Date of Inspection 11 0
Required
Records & Documents
/
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
El Yes
B o
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
40
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
,�
Lees
❑ No
❑ NA
❑ NE
❑ ste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall � ing 1erop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ffNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
'Li No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[3�'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ErNNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
es
[I No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
El?eo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M 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
[-b
❑ 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
044o
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,�--,,��
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
,L7No
13 No ❑ NA
❑ NE
Additional Comments and/or
12128104

k
Facility Number
0 Division of Water Quality -
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: : y Departure Time: f p� ounty:
Farm Name: rP S `��' 2 6' Tom_ � Owner Email:
Owner Name:49M Phone: _
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: Phone No:
xJDuG, l �
Onsite Representative: _ i�r1�nJ Or°F „ ��5 Integrator:
Certified Operator: _ Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ o = & = Longitude: = ° =' = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feedei to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other - -- - f
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Dischary-es & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
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?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
[I No
El NA
El NE
❑ Yes
JeNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes IQ No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

1
Facility Number: - / Date of inspection # O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes VNo
❑ Yes ❑ No
❑NA ❑NE
El NA El NE
Structure 1
Structure 2
Structure 3
Structure 4 Structure 5 Structure 6
Identifier: 2_1
2-0 _
2 - -:�
27_—
Spillway?: / /j o
/ IP
//O
A.,
Designed Freeboard (in): � Z _'5�
7, 11
1� JC
S
Observed Freeboard (in): "pAn
YU
*b
_ (V&
460
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes EfNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PrNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
l2. Crop type(s)
13. Soil type(s)
14, Do the receiving crops ditter trom those designated in the C;A W MYY
15. Does the receiving crop and/or land application site need improvement?
LI 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
V 1 No LJ NA U NE
VNo ❑ NA ❑ NE
VNo ❑ NA ❑ NE
1Z No El NA El NE
0 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):
%) Vf f r 4 6 ­5I �L L / (44oAei ,D 4v 2 _2
/JGI ifi '�✓� L �j�0/�i Z/1�G y������'[r �Qi�zi�/!�j/�itJ
;X45a/Yti /* 1
E-Reeviewer/tnspector
viewer/Inspector Name Phone:
Signature: Date:
Page 2 of 3 'y/ 12129104 Continued

1
Facility Number:� — Date of Inspection
Rea uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ElNA ElNE
the appropriate box. El WLp ElChecklists ElDesig
n El Maps ❑Other �0
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 1 ° Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes VNo El NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes ❑ No ❑ NA NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes F(No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No [3NA ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings: n
Rep., 547-.0 41'4� 11,5 &,f-,j
O,G 3Z/5-?T D,v )i5��46zo MCA
y 9�E
�O�iJ�—. �d' � vo � • �Tt� /.s�zs�
l
Page 3 of 3 12128104

9_..
.Division of`Water Quality.
'g
Facility. Nudiber f Division of Soil and Water Conservation.
0 Other Agency"
.. .._ ._. "_(.ar..
Type of Visit grCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit PrRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: i Q Departure Time: County: Zz/" Region: 70
Farm Name: �J%�% FL��i 7 1 Owner Email:
Owner Name: AA � Phone:
Mailing Address:
Physical Address: _
Facility Contact:
Onsite Representative:
Certified Operator: —
Back-up Operator: —
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Title: _ Phone No:
Integrator: & iu0rr'2!.4
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 ° Longitude: °
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I1, 10 Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pou Its
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 21 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
RrNo
❑ NA
❑ NE
12128104 Continued

:A
Facility Number:,5 —
Date of Inspection f !A OS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
ldentifer: ��- --_ 2-2— 2- 3 2 — V-
Spillway?: /!%11 w
Designed Freeboard (in): l�,Jr lq�
Observed Freeboard (in): M 3 T T✓ .36
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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 ZNo ❑ 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? 0 Yes ❑ No ❑ NA ❑ N E
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes PrNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes 0 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes PTNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes XNo
❑ 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 Wind Drifl ❑�Alpplication Outside of Area
jof
/1 C
12. Crop type(s)
13. Soil type(s) :Z44V"-O'.J, VA) erTllV�l �z (F_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ZNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes JZ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes ZNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ANo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes gNo
❑ NA ❑ NE
ommeuts (refer to question; #} Eaplatn any YES?answers and/orany,recommendatlons�,orany�ather comments..
.!� 4 S `•. .. ,-- .. a � Ai ..iiL� 1.1':.�,rF -
.�. . .YP_..e
�c-
�� "Ile
�f �LG �f.� L/}GG�i�15 G✓�-tc�.5 N,Ef� �rRASs Lo✓f�2 AG/� . `jt3.n � /��?OST.�i�I
�k-.ic� ©W Z9cml1 �-5F. �,�zccf_s A�,o �,4z�,Elz� J,PI��p D•�
i P ©F yhr 1.�,�C� �J-G oo,.? 2 -r/�,�,t -ec r s 41 gal �,es lI�EE/,
Reviewer/inspector Name ` rr _ Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number:. — f Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PdNo ❑ NA ❑ NE
the appropirate box. ❑ W-UP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
Cl Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes WNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes )ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes YNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes gNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
ANE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 19No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes VrNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes VNo
❑ 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 ONo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes zzNo
❑ NA
❑ NE
91) 4'lCrL' L/CG r l�mpG•4Goo„j 2-/
Xac'eo
viue�"'CoRo�
12128104

Type of Visit AQr6ompfiance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: C Timer
Facility Number
Q Not Operational Q Below Threshold
APermittedMCertified 13 Conditionally Certified 13 Registered Date -Last Operated or Abov Threshold:
Farm Name: I t_.�_a� �s 1.. i`' _ .....� -... County: » » .._ ._ . ..
Owner Name:
Mailing Address:
Facility Contact: Title:.__.__
OnsiteRepresentative:.._�I� , l Q�l*�.G OZIL
Certified Operator:
Location of Farm:
Phone No:.
_j.�/P�hxone No:
Integrator. .. L.:...1 W P —
-- Operator Certification Number: _
❑ Swine ❑ Poultry ❑ Cattle © Norse Latitude • 9 " Longitude • ` «
Mcham & StreamLmmcts
1. Is any discharge observed from any part of the operation? ❑ Yes fifNo
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 , J rNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �To
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes O No
Structure Structure2 Structur-e�3 Structure Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103 Continued

Facility Number:3 — Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
❑ yes
XNID
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ yes
No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
/No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
No
elevation markings?
/
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
ONo
❑ Excessive Ponding ❑/SPAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 1� I, g CPL�L�►/�RPrf .
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
X. No
X.
14. a) Does the facility lack adequate acreage for land application?
El Yes
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
PING
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
[:]yes
Rf No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
XNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
VNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
[:]Yes
ONO
Air Quality representative immediately.
;Comnp� (refer to�queshon��}- �► �' �: � �' .� w ..� �- °r-an p.�°.:; - r�.._cominentk
t[ise drawsags'al'ety to beer acplarn s�mataons. {use Rdditsasi pages nary) d C Final N tes
z z❑_
0�,.:..�+�..,:....;:......-
Fie[ opy o
t P�fe
001 joo�,-5�4CIY
!19
Reviewer/Inspector Name ' "' w _ � ,
_z _�=
ReviewerAnspector SipaWre: Daze: Q
12112103 1� Continued

Facility Number. — 7 Date of Inspection
R.equired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
❑ Yes
XNo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�'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
E'No
25. Did the facility fail to have a actively certified operator in charge?
[I Yes
(((((( PINo
25. Fail to notify regional DWQ of emergency situations as required, by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�No
/Xj
28. Does facility require a follow-up visit by same agency?
❑ Yes
No
29. Were any additional problems noted which cause nonccmpliance of the Certified AWMP?
❑ Yes
�No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
VYes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
F
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑'No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
710
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

.ram lc --i
E l D�r�sion of Water Quality W
(� Drvtsion of Soil and Water Conservation
OOther.Agency�.•
Type of Visit 76 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit %Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number �� Date of Visit: li Time: a7 in
10 Not O erational 0 Below Threshold
® Permitted R Certified O Conditionally Certified J D Registered Date Last Operated or Above Threshold:
Farm Name: itl fj�A6 Sew SI2 _ �'" �_ County Ah ek
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: 1¢�T 41' 11 0n _ _
Certified Operator:
Location of Farm:
Phone No:
�jPhone No:
Integrator•
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 �' �" Longitude ' ' 0"
Design Current
Design Current Design Current
Swine Capacity Population
Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder 1
10 Layer I I Dairy 4
19 Feeder to Finish
❑ Non -Layer I I ❑ Non -Dairy
❑ Farrow to Wean
- — — - — - �-
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
I
❑ Boars
Total SSLW
Number of Lagoons ®;
❑ Subsurface Drains Present 10 Lagoon Area ❑ SeraSeray Field Area
Holding Ponds 1 Solid Traps
JE1 No Liquid Waste Management S stem
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: _Z-�1- - - Z `Z z-3
Freeboard (inches):�j-
05103/01
❑ Yes 1KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
J�tNo
❑ Yes
C!�No
❑ Yes M No
Structure 6
Continued

�_ t :&
Facility Number: 31 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ft) 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 kNo
(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 R] No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes W] No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes C4 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Ej No
11. Is there evidence of over application?? ElExcessive Ponding ❑ PAN ❑ Hydraulic Overload ElYes ®No
12. Crop hype kh z*4A4
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes SNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [KNo
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? ayes ❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[S No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
PNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[KNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
KNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
(LNo
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
kNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
®.No
23.
Did ReviewerlInspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[1 No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[KNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer toiqueshon Explainany YES ansviers,andlor anyrecommendahons or<any o#herscomments. 5_
Used wings ofa�cdity to berexplain situations. {use addit� n i;paganecessary)„r s= ' El Field Copy El Final NoM­
le �rinr�� -t�ie��S 4re...h� GvC�! �Sf E���/� �►t r Vo- 4. plelv... Itwe o' l¢St
Yearn (Axy -i-m1y �o►J��� �sl ���s �rVWA ,
4n
e"IA o6e ,5
H,
Reviewer/Inspector Namea
Reviewer/Inspector Signature: Date:
05103101 6- Y Continued

­- w
Facility Number: 22 — 6 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover?
EM
Ak r (' stl Y,, fO*-hA Pt7
-- A1A-AW'-4'j Xs 'WP�
1kd -Ae /..Ka- ylli'aqe,
❑ Yes �&No
❑ Yes &�No
❑ Yes 44No
❑ Yes �jNo
❑ Yes EA No
❑ Yes RLNo
❑ Yes j�;LNo
6A1 r1 O! '90W -AZ-Al- .1 ve
05103101

❑ DSWC Animal Feedlot Operation Review '
® DWQ Animal Feedlot Operation Site Inspection
113LRoutine O Complaint O Follow-up of DAVO inspection U Folio.% -up of DSIVC review V Other 1
[::Facility Number
Farm Status: ❑ Registered ❑ Applied for Permit
❑ Certified [a Permitted
Date of Inspection
Time of inspection L=� � 24 hr. (hh:mm)
Total Time (in fraction ot'hours
[ex:t.25 for I hr 15 min)) Spent on Review
or Inspection (includes travel and processing)
0 Not O erational Date Last Operated: ..................................................................................
Farm Name- ..DM .... l=a.r.. .s...., .e.. ..-..... S.a.kc...... 1.....y.....................
Owner .. ......��.fi. Y : t. �.... ..... .!�. �^^,X.................................
Facility Contact: ..�.f...y..C.�... �.u.� y! C............................. ritle . ..........................
Mailing Address:..... g.2........L� b.n.�+-- ....... . d"�
nnsite Representative:.j.....C..,:�'..
Certified Operator: ... A.lr1LCx............................. ..C`^.'acari.........................................
Location of Farm:
County:...D v.. is.r.:a.................................. ... W.I.K.0
0
]'hone 'so: ............ ...........................'..D ...............
......� Z.q
.................. I................. Phone No: .`i1Ea .2.q.�... ...513
Lc.......... z.g...`�.�r. S(���
�........ .. ......
1 ntegrator:.1_t.t1..1r:R. �1
........................
............................
Operator Certification Number:,.._. ..+3 5............
1f1.....Yt.p.�r.. ..�.st 5.. ..... f A v! R.......Q........... ... .1.. t..l--•. f A� 11.. . .. i!► 4 f�.... .. ...... r+n.t..�....1r�.+G.x.tils...... C �..... I p
. t ..
.,�►.?-r.e.�.t�.a�^.........► t.:........P.1.1..k..K.....C.+ a......�.........� s............................................................................................................
Latitude ' 4 ®:4 Longitude ®' [�j "
Typeof Operation Design � Current% .' Design' ...t , g
yp P I)esi Current. ;.Dest n ;: Current
Swine .•Capacity Population Poultry =' "Capacity Population 'Cattle -Capacity Population
❑ Wean to Feeder
Feeder to Finish
31 V
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
W
Number of-Laeo' ons �.Ho' "'Q Ponds' I �-1 f' ❑ Sut�surface Drains P 10 Lagoon Area I0 Spray Field Area
General
1. Are there any buffers. that need maintenance/improvement? 2 Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon El 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 R1 No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑Yes No
3. Is there evidence of past discharge from any part of the operation? El Yes IS No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoons holding ponds) require ,LYes ❑ No
4/30/97 maintenance/improvement?
Continued on hack

.1 .- r
Facility Number: —
6. 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 0No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes f•No
Structures (Lagoons agoons and/or Holding fonds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes H-No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
...... ..... L,.... (0 ................................................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes ® No
11. Is erosion, or any other threats to the integrity of any of the structures observed? Ej Yes ❑ No
12. Do any of the structures need maintenance/improvement? J&Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes '® No
Waste Application
14. Is there physical evidence of over application? ❑ Yes JO No
(If in excess of WIMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...l7.e�cr-rs..r.. ......................... L........ ..................... X_......................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
EINo
IT
Does the facility have a lack of adequate acreage for land application?
❑ Yes
ElNo
18.
Does the receiving crop need improvement?
CRYes
❑ No
l9.
Is there a lack of available waste application equipment?
❑ Yes
E9 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
0 No
For Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No "
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? e Yes ❑ No
24. Does record keeping need improvement? aYes ❑ No
t. Y-tty w b t tt+-+r b u't*4-- a-K-d.. a.► t 1pv V-X_rX -4 - to &-�rw Stir
. C. 6 Tv t. C-t W 0.l �"-4 v � +�- O't-1`�nr P-'Y`C 0.-wE-4-.S v� 5 Q d-• r-.e/LY -+ tl C4 e
1 i. j 1 Z. G. v v e i i 1-a ... �.s a it-Y— c5 "'� ' �`q C p n Yw s ask 01 a l g 06 -. -# 3 L J�� -if q i- p �e.cr-x,� I C
/l1to� et. ie otl bars S�+fx o..l.d�>al[.[ a i Y_ In 'oc..��, F;,,0.ttyy wt vt�,e iaf�+K n�
.�J d o • 1 2—
`
o• �: i v 0 •� C O- -t, V 4 1N [ X_,J - S
ke.v a cir, la[� �L rpvJa Lp.�� c.Ja-S
y � �
llli; f � �I � g P 1
t c.r. i s w- � Ir, w K OP prop Lri� r amp l2
b L. iLw.V3 v_ vz`�o=+p W l� QT} W 0..S n. l.s D 1 •^'� \ a 14 w L� '-` ' w►
{ f h e �; �. 1 It 'U, o --s ~ �c.[ti e ,i VP w i � ► t'he Tv,_� o 'ale v-
,S I^-•D v UL a tea} Y. o.. —o f t "S 5 ^ .t a fj cc S o a aJ1Sa
{ s e,,. ,,t t� t•t� D w { ; t,� i w , ..ti ; �, P 7
q 4r-t c., r cam. -so, I c a. n t-e-S t s e X G g v re -w ► f Fc uw-df
h .� n $�' C v. 0.V r lk� { +i Q d P 1 y✓�'L a'1 �C t . $ �-C�- ' d "` `1 D J f r ✓ �� a Cr p n
VP_ co r-d--s . .r
• NCO-t-j va wat sr
Reviewer/Inspector Na
N
%vDS�p
t [4,
Reviewerfinspector Signature: f • _ _L .. ,_ \/-I t
rr- Divicion of Water Oiiality. Water nunlily .Cectinu Forility
Date:
4/3n/97

Type of Visit _OrCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0Routine O Complaint. O Fonow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 / Date of Visit:
© Permitted [3 Certified 0 Conditionally Certified © Registered
Farm Name: ..... .. l.'�!��....:�e rr.../L.....S_.�S....1.1.......................
Owner Name: �^�i - � S �f" K -r5 a H i i
......I......... t........ i+........................................
li D Time: =
Not Operational O Below
Date Last Operated or Above Threshold: W
County:.. I* .........................................................
PhoneNo: . ................................... .......... . ......... .. ...
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: ................ ....................................................................................................
OnsiteRepresentative:. ��.....---•'•'R�6W ._.. Integrator: .... .vr.
Certified Operator: ................................................... ......................................................... . .. Operator Certification Number: ............. ........ ........
� . --•.
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 64 Longitude �• �4 «
. .
-.Current
DeiCren��Desgp ft
.
S '�; _ ,Ca aci ' Population
..
Poultry Ca aci ..Po elation , _Cattle _ Capacity ,P66nl8tioa _.r
❑ Wean to Feeder ID
Layer ❑ Dairy
❑ Feeder to Finish
❑ Non -Layer I 1 ❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder
❑ Other :.
❑ Farrow to Finish
Total Desl C8 ad -
P y
Gilts
❑ Boars
Total SSLW
;.Number of Lagoons
❑ Subsurface Drains Present ❑Lagoon Area
I[] Spray Field Area
❑ No Liquid Waste Management System
Holding Ponds / Solid Traps_
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)
❑ Yes 0 No
❑ Yes 0No
❑ Yes .❑ No
nI'-L
❑ Yes JZf No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ZI No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes A! -No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ,0 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..2-.S...l....... S Z_ S 'Z S Z S 3 S L S+
-•......................................................••-•....I.•.......... I............................. ........................... ......... ....................................
Freeboard (inches): q 1 4 Z q 7 q 6
5/00 Continued on back

Facility Number: 31 — j q I Date of Inspection
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes Z 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 ONo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 0No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes JO No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 0 No
12. Crop type Tb r+ n� Vd �Wi as yr, �, �� r ,M vcq zl q. S�-A 11 r^c1 Y►
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)7 ❑ Yes JEJ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes .TNo
b) Does the facility need a wettable acre determination? ❑ Yes 2f No
c) This facility is pended for a wettable acre determination? ❑ Yes Z No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reuuired 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?
.1�io yiQla�igtjs;e�r d�fc}envies ry re pQte� �l»!..... s�. • ... w>. . . .�. . . . ... .:...
66res0 ideiki alloiut this visit:
Oyes ❑ No
[:]Yes 21 No
❑ Yes J'No
❑ Yes ONo
❑ Yes J21 No
❑ Yes ONo
❑ Yes J21 No
❑ Yes ONo
❑ Yes ONo
❑ Yes j2'No
❑ Yes VNo
�s. Sorv,e GAF
deed 4-i,,e 6✓'n.`o4a
S
1
�-}-Zip
ALmp�'bVCOL
a,e 4vte✓ 4 e (A s cF ���
fa K�S �.� t Z) 131
i( - !$,
3 3 - 35 ) 38 - 41,4' ...$-' 7.
Reviewer/Inspector Name `� - 1.: �` et;✓ � � _ � , r -� � z ".� �°� �� .� � ° F
Reviewer/Inspector Signature: _ _ Date: 9 l Dv 5/00

Facility Nutnber. 3 — Date of Inspection p;
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below -0Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes '0 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J'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 ONo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes J'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ANo
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
S/00

Facility Number i Date of Visit: % Old Time: % � Printed on: 7/21/2000
0 Not Operational C Below Threshold
dPermitted [3 Certified ❑ Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: )" F`.'.+..: "``f `-e C Z- n.-I,-s ;" County: i� % i
.................................................................................................................. _ �.........................................
Owner Name:......
Al t/P-�1 �
.... ...............
�a "'i i
�.
�a' '� f Phone No
...........................................................
Facility Contact:
........................................................................
. Title: Phone No -
MailingAddress: ....................... ............................. ............
Onsite Representative: '1�L ���t-}o n�Trry�q p� KLv!Y1 Integrator*m�np�Z'"!.s.............................
I.... g ... 7 � ...
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location -of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 6 «
Des : - Current Design Current Dest Curr�ut
i'
�, B ,
�.. Svvibe Ca d Po elation Poultry. Cai ci Population Cattle . P elation .
Wean to Feeder ❑ Layer ❑ Dairy
- Feeder to Finish ❑ Non -Layer I 1 10 Non -Dairy
Farrow to Wean
Farrow to Feeder ❑ Other
Farrow to Finish Total Design Qi aci
Gilts P
Boars ToWa ,SSLW -=
Y Nxixn t of Lagoons 4 Subsurface Drains Present 10 I.Agnon Area ❑ Spray Field Area
Ht Poatis I Solfid:Traps ❑ No Liquid Waste Management System '
Discharees & Stream Impacti
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. II' discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
❑ Yes allo
❑ Yes i�rNo'
❑ Yes kNo
" A
❑ Yes 9No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ;R No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JgNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
Identifier: ........ ....l... I....... ... - �,...................�.3................... 2- ~'
•.........................
Freeboard (inches): S 3 q 9 56 44
5100
[:]Yes Xj No
Structure 5 Structure 6
Continued on back

Facility Number:.?! — f Date of Inspection Printed on: 7/21/2000
5. An-ethere any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes INNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure'plan? ❑ Yes XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes gNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes WNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ;B:No
Waste LkpAlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 'TRENo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload q ❑ Yes PTNo
12. Crop type �+�, r�14 ��'"r�?UciQ , 4� tiA . M I les i 1?4e 1 Ce �^ n 5 ""� 11 6 q i --w
13. Do the receiving crops differ with those designated in the Certified Animal! Waste Management Plan (CAWMP)? JKYes ❑ 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?
J9 Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes JETNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ff No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc-)
❑ Yes
JRNO
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
)KYes
❑ No
20-
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21-
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22-
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
No
(ie/ discharge, freeboard problems, over application)
❑
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
�gNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
25'No
0:
I.Ifl yolaftoris:ot- &flcje tfi-_s -*ere noted- dtttirtg tbis'visit: • Y:oiif Will -receive iio further
coriesporide_ce: ab_ult: this visit. ' :::::::::: - : - : - . - . - . - ::. ' :::: ' . _ . ' ::::::.:.: ' :. :
Comments (refer to question #): Explain any YES answers and/or any recommendations or any.other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
13. F:e ld 2 ; s C� AIL",%a im n 14!�ar-� o ' �r'e ld is car r►0-7e
l�tn-
IS. Woek 4o beg er4,xbi1sh d ex,' ^q-jcd r;eje r a►,l IaN-a 7"-1
Ikete 4rWA-f , ,�$ur-e 9aod njOva, S4qn > t ," Welds S1 D �-b 13.
IS, Need CT7 q netae-S-1 ee_rA� in ezCe,.�.
vie .�a deci� h.,4C frapt,r C r&p O,1, So: j SA+ti fjeS. 9e s v r e Mcrrapyc T
on TRR- Zrsp ,,..t"ACA_ wgrye pJ�,►, brcrce,� r- Be sore J1;j� Fr"Im "✓✓Gfd�' �
,�rov+1 i�.JC� 3�E �lA�'t OYI,�J�—ZrSJ Fitrd !t 3s Go,•'t'1 GS��h.���f �kjbi+�/`!.►!j�}a�►�'[fS, �
Reviewer/Inspector Name �5q"e 4 jS
Reviewer/Inspector Signature: W404X.� Date: 1 o 0 5100

Facility Number: 3 —' Date of Iuspection 11' 00 Printed on: 7/21/2000
OdoC Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or Wow 0 Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes RTNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes � No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes O 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 -0No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes IS No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? E{ Yes ❑ No
Additional omments and/orDrawings:
5100

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
Murphy Family Farms
DM Farms Sec 2 Sites 1-4
692 Bonham Rd
Magnolia NC 28453
Dear Murphy Family Farms:
6111?ew'A
IT
A&4;1 0
AV
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
December 30, 1999.
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number 31-17
Duplin County
This letter is being sent to clarify the recordkeeping requirement for Plant Available Nitrogen (PAN)
application on fields that are part of your Certified Animal Waste Management Plan.
In order to show that the agronomic Loading rates for the crops being grown are not being exceeded, you
must keep records of all sources of nitrogen that are being added to these sites. This would include nitrogen
from all types of animal waste as well as municipal and industrial sludges/residuals, and commercial fertilizers.
Beginning January 1, 2000, all nitrogen sources applied to land receiving animal waste are required to
be kept on the appropriate recordkeeping forms (i.e. IRR1, IRR2, DRY1, DRY2, DRY3, SLUR], SLUR2,
SLD1, and SLD2) and maintained in the facility records for review. The Division of Water Quality (DWQ)
compliance inspectors and Division of Soil and Water operation reviewers will review all recordkeeping during
routine inspections. Facilities not documenting all sources of nitrogen application will be subject to an
appropriate enforcement action.
Please be advised that nothing in this letter should be taken as removing from you the responsibility or
liability for failure to comply with any State Rule, State Statute, Local County Ordinance, or permitting
requirement.
If you have any questions regarding this letter, please do not hesitate to contact Ms. Sonya Avant of the
DWQ staff at [phone] ext. 57 L
Sincerely
ti
Kerr T. Stevens, Director
Division of Water Quality
cc: Wilmington Regional Office
Duplin County Soil and Water Conservation District
Facility File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recyde&10% post -consumer paper

Revised AP zil 24 1000
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number
Farm Name: r►'l 1~grs �eC. 2. Sis
On -Site Representative: T fr e
InspectorlReviewer's Name:< � � ► S
Date of site visit: 1 1 OLqq
Date of most -recent WUP: S t q . r
I
Operation is flagged for a wettable
1-4 acre determination due to failure of
Annual farm PAN deficit: 2 35 pounds
Part 11 eligibility items) Fl F2 F3 F4
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
�" Operation pended for wettable acre
determination based on P2 P3 .
Irrigation System(s) = circle #: 1. hard -hose traveler, 2. centei-pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; v. st=tionary sprinkler system wlportable pipe;
fi. stationary gun system wlpermanent pipe; 7. stationary gun system wlportable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Pari 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D�D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 -Adequate D, irrigation operating parameter silent, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part Ill. (NOT E_75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part II. Complete eligibility
checklist, Part 11- F1 F2 F3, before completing computational table in Part 111).
PART Il. 75% Rule Eligibility Checklist and .Documentation of WA Determination
Requirements. WA Determination .required .because.opembon fails fin_ a of the .elicibiii y
requirements listedbelow:
_ F1 Lack.ofzcreaoewhichTesultedinDvermpplicarionmfwasieW,-=ter-.(PAN) on:spray.
fields) accordinafodaFm'sJasttwo Ve2rs mf-imGation7-e-cods.�.
F2 Unclear,-ifleoibile --or lack of informationlmap.
F3 Obvious-fleld -limitations -(numerous 3iItches,3ailurefo_deductTequired:.._
buffer!setback-acreage;-or2b%-of iotaf.2creageddentiziedanMAWMP. jncludes
small;-irreoulady-shaped.fields- fields-less7than-5acres-for.travelers-or.less.tnan .
2 acresJor -stationary sari.nklers).
F4 WA determination required becaus= CAWMP credits Tield(s)'s acreage in excess
of 75% of the respective field's total acre Qe as nnt-H in fmkim m­ Ill

17
Facility Number 3) - 0
Revised April 20, 1999
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD TYPE OF TOTAL
NUMBER'S IRRIGATION ACRES
SYSTEM
CAWMP
ACRES
ffFIELD
COMMENTS3
I
I
I I I
I
1
I I •_I
I
!
I
I I I
I
!
FiLLD NUM$�_;;F:' - hyd, ant, pull, zone, or. -point numbers may be used in place of field numbers deoendinc on CAWMP
and type of irrication-system.- If pulls, etc. crossmore#han one field, inspectorireviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMSER=- must be clearly delineated nnm2 --
COMMENTS' - back-up fields with CAWMP aceaage exceeding 5% of its tota:_acres -and having Teceived less than 50%
of its annual PAN as -documented in the farm'sprevious-two years' (19e7 & 1298) or Irricatlon-records,-cannot serve -as -the
sole basis -for requiring a WA Dare:mina#ion::B2cC-uo:fields-rnus be -noted in the-commentthe-commeri,
tzecnonznd must be zccessib[e
by irrigationsystem.
Part IV. Pending WA Determinations -
$"�Pl Plan lacks. foIlowinainform2ti0n: S�)nd►•V.dvet��v�ls
P2 Plan Tevision -maysallsfy-75% rule based on adequate overall PAN deficit and by
adjusting all field -acreage--to below 75% use rate
F3 Other (iefin process of installing new irrigation system):

0 Division of Soil and Water Conservation Operation Review
q
...i [].Division of Soil and;Water Gonsergataon Compliance Inspection
' ;Division of Water Qualtty, . Gomplaance Inspection a "
i
m 13
Other Agency: Operation Review ." r
rt s
Routine 0 Complaint 0 Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number 3 1 1 Date of Inspection IM57
Time of Inspection 1 ZO eq 124 hr. (hh:mm)
®Permitted © Certified © Conditionally Certified © Registered E3 Not Operational Date Last Operated p . ..........................
M F-a,r r.%s ...._5-c4 p!'�...2...` -jr-5 4..... • County, .... .u.1P..1! o.........................................
Farm Name: ......................................... ........ .. .. �.'...
Owner Name:............1�� 'r`"`s .......... �g ►°�291 � (A3 9 e-d 4423
�i......................................... Phone No:....................................................................-.
--
Facility Contact: ..... e.........................Title:......... ..-... G....._........................... Phone No:
'Flailing Address : ......................... ...................................................... ........................... .....................................................-
............... ............... ........ .... ..........................
Onsite Representative: Bmrr rGi Terms ~%q-� a Integrator: yam} U N TR �� t 4�"�
Certified Operator......,,Tc,i",?",,, ,,,, a e.................................................... Operator Certification Number:,J„.6..73`/...... .......
Location of Farm:
Latitude 0 • ° •4 Longitude ' C 41
='= Design Current -.,-_ Design:_ Current._:.. Design Curr&W
Nuumber. of Lagoons.: �i 'i I : ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holdmg•Ponds /Solid Traps ❑ 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?
h. 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. Dees 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: 2-1 Z— z Z— 3 2--1�
Freeboard (inches): 2 O Z ....Z :5............................................... ......
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes '0 No
seepage, etc.)
Continued on back
3/23199
❑ Yes ,® No
❑,Yes
RgNo
❑ Yes
5d No
hA
❑ Yes
® No
❑ Yes
Jo No
❑ Yes
FX'No
❑ Yes E.No
Structure 6
....I .......................

Facility Number: Date of Inspection 11176Aq
-6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes :i 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? R Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? 10 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
a No
11.
Is there evidence of over application? ❑ Excessive Ponding 10 PAN
S-j161410 Yes
®No
12.
Crop type tay ^t ►►�� C �� �i� y yrt VdG C 6 �"�� . 177al tzG
A ii el. Rye �) S_mc, I I
e r4 i n
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management
Plan (CAWMP)?
❑ Yes
RfNo
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?
IM Yes
❑ No
15.
Does the receiving crop need improvement?
� Yes
El No
16"
Is there a lack of adequate waste application equipment?
❑ Yes
'g No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
E9 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
9 Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
.K Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ErNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
F[No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
jS No
23.
Did Reviewer/inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
59.No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
.S No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
§9 No
0: .io yiolat: -' or deficiencies were noted• diWhit! fhis:visit; • Y:oir :will•reeeiye iiti #'tiirther -
...................................
:: ctirresp&fide* 'e:ab' fthisvisit:
Comments (refer,ta .questirin #): ;Explain any YES answers'aad/or=any recommeiidations or -any other comments
Use,drarvings of.f4cilrty, ta' better'explain srtuations (use. aidditional' pages as necessary)
7. +o es�gbl►s�, 9JJ.ass uc�rr� ,o�6� �40'e 'leecis aF lhyoo►�s
S. jo jeonS me-jr 4c vat►p
kook Ur hn e s . On s ire clef f c fe n.-� ^ 4 +'Ve sa ; t( -r�-i t, s �0.yy � 4CU e 40
c,;r Vent yel eare , S-Fe�s s�a+�id [fie 4-a.ke✓) _1�-e fa,revet��covt�a;,�
was,'G r'cjcascd +r nea,- fLy;n 1ocer4ioji,
IS. C + aories 6'r la oo>-, �E�; �1s and �'ecf9 _
Reviewer/Inspector Name 1 ST >2� , a 1-
Reviewer/Inspector Signature g4/1A72!j; to
Date:
un ke( e
ear mr vie -key- leirn
3/23/99

Facility Number: 3 �-- Date of Inspection I /I /Q
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below CgYes ❑ No
liquid level of lagoon or storage pond with no agitation?
2T Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes KNo
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 -ONo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 54 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ig No
Comments an or- -_rawmgs..... _
'Additional_
j -�e. S �tt�� �-�.F¢+R -F rat �i¢(ds.
sQ{ �S h e'� Y >�(-/`AJrs QY
LA R —215 56tl,14 W M4 rt, (AcrecLC es /n Was-f e p lAn . q�P riG�t �r'onS
Motile in Or.}obe.0 4ice-re4;4ed 7LaL-.,Q.-d v-n:pe�
ncz'redtt�ed rye; inves�ir+e c,Q-M'vVf'-'r
14, Pic-; 1.+y k
1S. W,, 40 es-�,R6 [ t-S4 q n r, n/" ov, ev, e-yt4, re 4
-Tn e lergl -,t`iGtd.!C qve ir2 �oac( Genii r" }�. S�sMr l,lced
w.a t 6 i 5 ne'edded -
i
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
10,Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection 100 24 hr. (hh:mm)
13 Registered Wertified E3 Applied for Permit © Permitted 113 Not Operational Date Last Operated:
c 1 {{
Farm Name. � �� `a.. �('!-sS. l� County:.....�''.`.p-1 �.....................................................
.......................................................................... .................
Owner Name: Phone No: C — a " naQg
..................+.�F._............................................................�.....................................
Facility Contact: ..,..!r.. 4.....-v--s.........................
T�itle:.................... .......................................... Phnne No: N�'�d)a.6�
l`.Q
Mailing Address: ............ tJtn�w' ..... .................................................... .......................
Onsite Representative:....`!...!-!/ +- 1_....1'�i...Integrator:.........................................................
CertifiedOperator................................................................................................................ Operator Certification Number;..---- .................................. ...................
Locatio of F
......................... .. .............�..........------..---.----�..--.----...............................................k kkkw � .....e.............................................................................
...111.. ... ............... .I......................... ....--...........------..--.-----.........----....
Latitude ' 0' " Longitude ' 4 "
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes 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 gailmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes EgNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ONo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes V No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes O No
maintenance/improvement?
6. 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

Facility Number:' j —
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
%No
Structures (Lagoons,Holdine Ponds, Flush fits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
allo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: "�,— � .................................... ..............- ................................................
...................................
n
Freeboard (ft): oZ . r.� G col •............9..,�....................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
V(No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
XNo
Waste Appl.ication
14.
Is there physical evidence of over application?
❑ Yes
bi(No
(If in excess of WMP, or runoff entering waters of the notify DWQ)
15.
%State,
2t
Gw �+tio.— f (( �.
Crop type .� �'`�...........................`'�':.:.....:......9.`2:........:.......................................----.............---......
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
9 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
[ No
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
[9 No
21.
Did Reviewer/Inspector fail to discuss reviewfinspection with on -site representative?
❑ Yes
fffNo
22.
Does record keeping need improvement?
.3 Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
0 No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
04 No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
(dNo
[3' No.violations or d6f ciencies.were-noted-during this:visit.• You:will i-eceive,n' 6-ttirttier : -
correspQndehce A oid-this:visit:•" :
� ` .-�, 2:-t 1,,��,�, L�.� �ry.��e� 4,-e�-� � s� ►tee �--e_�
4:r\ F
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: ��LB (�� ��,��� Date:

I
LDate of inspection. -I
Facility Number:
Additiqjn'a'l C6mfiieints and/or Drawinks:
4/30/97

Site Requires Immediate Attention:
Facility No. 'ZL-r
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIO S SITE VISITATION RECORD
DATE: Z 6 , 1995
Time:
Farm Name/Owner: N14,2
Mailing Address: �_ k/
County:
Integrator: �l^r'12 Phone: 00
On Site Representative: � ',( 6 if / S Phone: C9— g
Physical Address/Location: I!f-(
Type of Operation: Swine Poultry Cattle
Design Capacity: c%o� �_ Number of Animals on Site: Z
DEM Certifi a 'on Number: ACE M Certification Number: ACNEW
Latitude: ' �" - Longitude: � //y ' 1-:7" Elevation: Feet
T
Circle Yes or No
Does the Animal Waste Lagoon hap fficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) e r No Actual Freeboard: — —3Ft. Inches
Was any seepage observed from the lagoon(s)? Yes oeWas any erosion observed? Yes o&
• Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
0
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings. Y or No
100 Feet from Wells? 0 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o&
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes 06
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oea If Yes, Please Explain.
Does the facility maintain adequate waste management reco ds (volumes of manure, land applied,
spray irrigated on specific acreage cover crop)? e or No
Additional Comments: roG�or � �n za _ .... ..
cc: Facility Assessment Unit Use Attachments if Needed.