310090_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

O-'6ivision of Water Resources
FacilityNumber 0 Division of Soil and Water Conservation
r 0 Other Agency
Type of Visit: Cycompliance Ins Aeration Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routin omplaint Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region;
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 10 ^ a Vk A rx ("1 r )� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -La er
Design Current
—V-R-ti.a cta
Pullets
Turkeys
Turkey Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 , No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ N ❑ NA ❑ NE
❑ YesrNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: '3 t - 9 Date of Inspection: 1 2 r
Waste Coiiection & Treatment ���
4. If storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes LtJ 0 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes E]-<o�❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th at, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [7 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[—]Yes
[—]No
❑ NA
�E
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
Ej'�E
acres determination?
17. Does the facility lack for land
Yes
No
NA
El'/NE
adequate acreage application?
❑
❑
❑
18. Is there a lack of properly operating waste application equipment?
❑Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
EIINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
1=J ; M
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 ❑ WeekIy 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
❑ZNE23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
❑ No
❑ NA
LJ
Page 2 of 3
21412015 Continued

[Facility Number: jDate of Inspection: L t 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA [2-lqg
r ��,
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ❑ No ❑ E NA TEE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA E`l-
❑ Yes ❑ No MINA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Ef No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [3' E
❑ Yes
❑ Yes
❑ Yes
�[_] NA ❑ NE
rNo'
NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES'answers and4r`any additional recommendations or any other comments.
Use drawings of facility to better explain sitd'ations'(use additional pages as necessary).
CIA i ]� O c 4. 1� i �o
p/' l'rU
Reviewer/Inspector Name: 041 I
Reviewer/Inspector Signature:
Page 3 of 3
✓t Phone: D -
Date: i 2
21412015

oC� DIVISION OF -WATER QUALITY
Water Quality Section
Complain t/Emergency►depart, Form
°ILMIMGTO-N REGIONAL OFFICE
Received by s�t� Date 1! �l ',/I fi Time
Emergency Complaint 1� city County
Report Received From
Agency.
11
Phone No.
Address C Phone No. —
Check One: Fish Kill
Stormswater
Nature of Deferral
Time and Date Occurred
Location of Area Affected
Spill Bypass Animal NPDES N.D.
Wedand Other, Specify:
Surface Waters Impacted Classification
Other Agencies
Investigation Details_
Investigator.
to
S.=S1SHELLS1REPORT. SHL
EPA Region IV [phone] Pesticides 733.3556 Emergency Management 733.3667 Wildlife Resources 733-7291
Solid and Hazardous Waste 733-2178 Marine Fisheries 726-7021 Wafer Supply 733-2321 Coast Guard MSO 343-4881
127 Cardinal Drive Extension, Wilmington, N.C. 28405-3845 0 Telephone [phone] Fax [phone]

ry
4
2 6.

NORTH CAROLINA
Department of Environmental dual

Division of -,Water. Resources * -
soF$cility Number 9-DivinofSml and Water Conservation
p
Q Other Agency_1
Type of Visit: Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: NLRoutine O Complaint O Follow-up Q Referral O Emergency p Other O Denied Access
Date of Visit: Q kj Arrival Time: Departure Time: /} / J County: J 10 Region:
Farm Name: S Owner Email:
Owner Name: S Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: (� � (`� � � 0,,n b
^ TEi
Certified Operator:
Back-up Operator:
Title:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number: 1 �6) 3 �'S
Certification Number:
Longitude:
Design Current Design. Current :.Design a Current;
Swine Ca Po
P aci ty P � ;Wet -Poultry: � Capacrty ::�:Pop:�: �.w. Cattle��. ":°.v , Capac�ty�
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
Layer
Non-Layer
Design. Current
Other
Poults
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
Is any discharge observed from any part of the operation? ❑ Yes 4 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
ZNo
❑ 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?
�4
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
-1 #4::]
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IX 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: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes A No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4fi 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
9
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
7�
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
0 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes IY1 No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
❑NA ONE
❑ Yes No ❑ NA ❑ NE
❑ Yes 8 No ❑ NA ❑ NE
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214120I5 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
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 Po
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
V9No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
9
❑ 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 exolain situations (use additional pages as necessarv).
- dal ii� �. crtii o� �► �,
kA't II
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
tV 1 t _A -A Phone: 1U — f
­10 Date: c1al I q
2/4/2 I S

U Division of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 7R.outine
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: Arrival Time: Departure Time: © County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: , "J " 4LGu—'fL
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Phone:
Integrator:
Certification Number. 9 $ i 9 35
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
DischariZes 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑Yes o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes Yvo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 21412015 Continued

Facili Number: 031 - Date of inspection: 11
Waste Collection & Treatment
14. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: (}�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 6 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes N1No ❑ 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 M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
© 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
Z No
❑ NA
❑ NE
acres determination?
No
17. Does the facility lack adequate acreage for land application?
❑ Yes
[a
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E240
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ❑ No
❑ NA
❑ NE
the appropriate box.
❑ W UP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
ONE
❑ 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

Wacility Number: - Date of inspection: lit
t4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(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 11 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o ❑ 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 dXo
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 dNo
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 Ef(No
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ 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).
kept
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phon� •�
Date: 1
2/4 015

Division of=Water: Resources �
Facility Number =0 Division of Sailand.,Water;Conser`vatwon'e
O Other Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O�coutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: 5= County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 1Y 'n Title:
yo Onsite Representative:lyA`r]4 0,0 =LLZP_
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
Other
Other
Latitude:
Phone:
Integrator:
Certification Number: y 6 1 r
Certification Number:
Longitude:
Design,Current Design Current :. Design Current
Capacity Pop., Wet.Poultry Capacity fop Cattle Capacity Pop.
_..,
Layer
Non -La er
�Design� Current
D Pou1 Ca aci `.pu ` ,r
Layers
Non -La ers
Pullets
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?
IDairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Yes �No
[] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes Z40
o
❑ Yes
❑ Yes Wo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility Number: - A Date of Inspection:
Waste Collection & Treatment
4; Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Z"No
a. If yes, is waste level into the structural freeboard? ❑ Yes []No
❑NA ❑NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes � ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rNo ❑ 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 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 d 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 [Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E;3/No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �10 ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
D4
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�10
[DNA
❑ 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
e
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ YesZNoo
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number. jDate of Inspection: 10 y`
24. Didthe facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Z/No
25,`Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes F2/No
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:
❑NA ONE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
PrNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�To
❑ NA
❑ NE
Other Issues
7
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
WNo
❑ 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
ZN
❑ 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 Oo ❑ 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 [�4o ❑ 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 [61190/
�]Noo ❑ NA ❑ NE
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 drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
t
Phone: riU j — v
Date: f > S�
/4 OI S

U Division of Water Quality
Facility Number❑ - ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 Co pliance 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: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
OnsiteRepresentative: �}Q�P1 {���� �� Integrator:
Certified Operator:
Phone:
� � i
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Non-L,
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0 No ❑ NA ❑ NE
a. Was the conveyance man-made?
[:]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[:]NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: 6 3
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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: OWL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 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 environmethreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes nta ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesVNo ❑ 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 ahematives that need ❑ Yes ZNo, ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
IS. Is there a lack of properly operating waste application equipment?
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 FJ [:3NA [3NE
❑ Yes ls/J Xo ❑ NA ❑ NE
❑ Yes ' ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ YesrNo ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Faeflity Number: - Date of inspection: d
24: Did the facility fail to ca ibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes WNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
/No
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes EN�,6 ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #):. Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pales as necessary). .
RF c ��yr ZMF OoOs6 Gr".
Reviewer/Inspector Name:
Phone: \9 1Q
Reviewer/Inspector Signature:
Page 3 of 3
Date:

=- t (0 Division of Water Quality
Facility Number 4 - aj O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: 0 7Routine
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 O Denied Access
Date of Visit: i► I Arrival Time: 3o Departure Time: 15 County: OUPtaj Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �f6NAtt1AN Wlll,I
Certified Operator:
Title:
Phone:
Integrator: q G
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Capacity POD.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Nan -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharp-es and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
❑ Yes No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

_ I I
acilityNumber: ?7 - Date of Inspection: !11 I4-3
MF tste 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: L &ft-N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes 1 o ❑ 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 [21/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[—]Yes O/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground D Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or-10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Yl�
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
1No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ 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 No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 ❑ 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

Facili Number: - Date of Inspection: it j
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 [ la ❑ 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 6 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C3No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes
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
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
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34, Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
❑No ❑NA ❑NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
VN
❑ NA ❑ NE
❑ NA ❑ NE
Ld l�o ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessarv).
CA C1Z& f*0A) 06E0 ED
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
L-� Fu_9 zo t3
Phone:
Date: 1 I +.{ 41,
2 orr

O Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: O Co pliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: (I Arrival Time: Departure Time: /O 20 County: �( Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: J6 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: q % q ! 3 �7
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Other
Poults
Design Current
Longitude:
Design Current
Cattle 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 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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
go
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
WNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Condnued

Facility Numbjer: - Date of Ins ection: r
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 1l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm2)0�o
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No [DNA ❑ 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 ZNo ❑ 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 VNo
❑ 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?
EKYes ❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [;]�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes d-114o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes FZN o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes VNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FacKi Number: 31-no Date of Inspection: tt
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes gNo/
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 0 /No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
❑ Yes 2 o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
ZNo ❑ NA ❑ NE
gN�o/
NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C &r0 r aop
Date: l/ V,
�z017

(O Division of Water Quality
Facility Number ©- Qb 0 Division of Soil and Water Conservation
Ci 0 Other Agency
Type of Visit: 0 Co�fpliance Inspection Operation Review 0 Structure Evaluation t) Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: y Arrival Time: Departure Time: /Q/U County: bar[ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
� _
Onsite Representative: livNRtAi41/ ML(,
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Vean to Finish
Vean to Feeder
eeder to Finish
arrow to Wean
arrow to Feeder
arrow to Finish
Tilts
Other
Other
Title:
Latitude:
Phone:
Integrator: c�
Certification Number: [ QtI
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Pullets
Other
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
Stream Impacts
1. is any discharge observed from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ 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
gNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: 3 - p jDate of Inspection: 11 Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): 3 Y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
eNo
❑ 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
ENo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
7. Do any of the structures need maintenance or improvement?
or environmen al threat,
3eYes [] No
notify DWQ
❑ 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
[3"'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
dNo
❑ 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 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
[:Ko
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
El"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C21<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
El"No
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
io
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
dNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
E(No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: -ell Date of Inspection: !1 3 i)
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 F!j"'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 [3No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ENo ❑ 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 L_I No ❑ NA ❑ NE
❑ Yes EI/No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
EfNo
❑ NA
❑ NE
Zf/No
❑ NA
❑ NE
J
❑No
❑NA
❑NE
FE11o
❑ 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).
W 0Rk F r::DEnl7" ��/ DUXE OA LtS
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 6
Date: li3/11
2✓412011

Facility Number 3 9
0 Division of Water Quality
0 Division of Soil and Water Conservation
O Other Agency
Type of Visit ('fTRoutinepliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �� �i% Arrival Time: Departure Time: County: d Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: V u NP1' 4 tq 0�3 Maj i. (rz-
Certified Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: E� o = j = « Longitude: 0 o 0 A
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
11 ❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
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:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑Yes
El No ❑NA
El NE
El Yes
El No ❑NA
❑NE
❑ NN ❑ NA
❑ NE
❑ Yes
❑ Yes
L/I N ❑ NA
[I NE
❑ Yes
No ❑ NA
❑ NE
Page I of 3 12128104 Continued

Facilr'ty Number: — d Date of Inspection
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ErNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? Cl Yes ❑ No ❑ NA ❑ NE
Structure I1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 .3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L/I 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 tthh at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes O No ❑ NA ❑ NE
maintenance or improvement?
Waste Ai mlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance/improvement? //
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑TTo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
7No
❑NA ❑NE
❑NA El NE
23 No ❑ NA ❑ NE
WN
�o ❑NA ❑NE
o El NA El NE
Comments.frefer to question #): Explain any YES answers and/or any recommendations or any other.comments.
Use drawn ..
gs of facility to better explain situations: (use additional pages as necessary):
Reviewer/Inspector Name t. Phone:b --
Reviewer/lnspector Signature: Date: t j
a��o 10 „F 2 1212810 Cantinued

Facility Number: — Date of Inspection 9
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other _1/
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ 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 ❑ NA ❑ NE
❑ Yes �70 ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LJA9'
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the.permit?
❑ Yes
& K
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the pen -nit?
❑ Yes
[4o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
P*o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[;X
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes qX'o ❑ NA ❑ NE
❑ Yes ❑] ❑ NA ❑ NE
❑ Yes[-o ❑ NA ❑ NE
❑ Yes ` X01 ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
❑ Yes [Wo ❑ NA ❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number 6 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Q) rRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Az Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: j o tq� Q-h-J
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
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= c = I 0 Longitude: = ° = ` 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Puults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2 o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Ld No
❑ NA
❑ NE
❑ Yes 2rNo ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: Date of Inspection o
I
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 29
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes la No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ILI No ❑ NA ❑ NE
❑ Yes D o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaZo
thr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E,-Wo ❑ 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 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 [IrNo ❑ 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
NNo
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rl-J
!_C_,I/No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Ell/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Lam! No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
7 "o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or'any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name j 014 dL.Df L I Phone: 5' 1 V73
Reviewer/Inspector Signature: ,,�� Date: u

Facility Number: Date of inspection 'Ali
keguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Ld Nc ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box.
❑ WUP [I Checklists El Design [I Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ENo
❑ 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
ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
C l�o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Q No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L"J No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
'No
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[:
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
C f No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
CI No
❑ NA
❑ NE
12128104

FadHty Number qD
0 Division of Water Quality
QWDivision of Soil and Water Conservation
0 Other Agency
Type of Visit qcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q/Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: j // y / 6I' I Arrival Time: Departure Time: County: I Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 6+��'i � WIJX _E(;�
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
RI Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =] ' = Longitude: [� ° =
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef 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 ET o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0
El NA
❑ NE
❑ Yes
�J No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — Date of Inspection l� O
Waste Collection &Treatment
�4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes No El NA [I 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): 351
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 environmenta7Nc
at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes d-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IJ No ❑ NA ❑ NE
maintenance/improvement?
H. Is there evidence of incorrect 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 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
0/No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
dNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
� o
[I NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
No
❑ NA
❑ NE
Comments (refer %o question #) Explain any YE5 answers andLor any cecammendations=or an4other comments L °
;Use draw
tngs:of facility to better explatn.situattons (ase additional pages as necessary) i
_Trb (*XN4 ,a jyi f
Reviewer/Inspector Name C74oA/✓ I Phone: 73 W
Reviewer/Inspector Signature: Date: b
Page 2 of 3 12128104 Continued

acility Number: — 6 Date of Inspection i
.Reauired 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 BNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
MNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
L�J No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
ck�(o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E1 o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
VNp
❑ NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E�l o
❑ 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?
El Yes
�,�,f/
Ly No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Additional Comments:andlor Drawings.;
.�
,yam ,- . r �p� .. � ..�.. y� �a �t,�,-r��. �t _ ..+-... , � ...,_ _ �"!�, •� ..�v=°'.=
Page 3 of 3 12128104

Facility Number `� D
V(Division of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
Type of Visit co"liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 46 Routine O Complaint Q Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: y,0 / Arrival Time: 7 S~ I Departure Time: County: Al C.J U Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
OnsiteRepresentative: LWAT)JAiJ Fx— 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
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 0 « Longitude: = ° = 1 = f{
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Da Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CoiAj
Number of Structures: F1
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 io ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
❑ o
El Yes
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

_ 96
Facility Number: 3) —!� Date of Inspection 2 r5
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: I 1;,OAJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): s�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ng ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.) //
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes EXq ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes No El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E5 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes O No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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?
l$. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
❑NA
❑NE
Vo
zoo ❑NA
❑NE
El NE
5❑NA
o ❑ NA
❑ NE
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
) �elpa e 5J i. �Am PL r= ✓E ),_? LAkG J t/#a �Prn P9wWf Kmt aw gq .
L
wer[Inspector Name A ( Phone: % J 7wer/Inspector Signature: Date: a
I7/7R/nQ r,,.Hd""ad

acility Number: — d Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate bo elow. [✓Yes ❑ No ❑ NA ❑ NE
ElWaste Application ❑ Weekly Freeboard ElWaste Analysis l Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes E�No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes DKo ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes 9 �No ❑ NA ❑ NE
❑ Yes FNo
< ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes E3 No ❑ NA ❑ NE
❑ Yes
2(No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
�o
❑ NA
El NE
El Yes
No
❑ NA
❑ NE
12128104

' v$ Division of Water Quality /
Facility Number O Division of Soil and Water Conservation ✓
-- ' — -- 0 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/O;ther [I Denied Access
U
Date of Visit: �e�� Arrival Time: �Q Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
l-�fl 2W
Onsite Representative: - C`+ v' ' _ _ integrator:
Certified Operator: Operator Certification Number:
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
Other
❑ Other
Back-up Certification Number:
Latitude: [::] o E:D ' F__j „ Longitude: [� ° = , = „
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
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 ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ft 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):
1W
q
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: r3 ajr
Page 2 of 12128104 Continued

Facility Number: — Date of Inspection 4 3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
(Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE.
❑ Yes ❑ No ❑ Ni, ❑ NE
r,.
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No f[I NA ❑ NE
Additional Comments and/or Drawings:
C
�S cS L4 Cyr e- U �i s L,�
ra ✓l4l
Page 3 of 3 12129104

10 Wean to Finish
❑ Wean to Feeder
Feeder to Finish y 31(, 4600
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Division of Water Quality J
- Facility Number R O0 Division of Soil and Water ConservationU�'E: Q Other Agenev
Type of Visit �Umpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C7 Routine 0 Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: l o Departure Time: 12eb County vim= Region:
Farm Name: Owner Email: - -
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: GENo }CfrNNE.Yj�
Certified Operator: 13Aa-O& Y IZ-Aoprs
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =] o ❑ ' 0 Longitude: ❑ ° = ❑
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
Fa eron-La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ENo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
El No
❑ Yes
[; No
❑ NA
❑ NE
❑ Yes
[3�No
❑ NA
❑ NE
12128104 Continued

Facilit� Number: 3 I — q U Date of Inspection 3 o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
,.,,(
El Yes [2 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: LW 6oaP 1
Spillway?:
Designed Freeboard (in): to,
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed?
,_,(
El Yes U 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 ENo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes EdNo ❑ 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. 2/yes FNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l 0 lbs El Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
LI Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) (3 EQ-w, U 0A (6-4-4) S C- 0- w A
13. Soil type(s) F1 J'i'ii-`('/:tl_"
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
❑ No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ No
❑ NA
❑ NE
comments (reie"r'to question #) Explam any"YE answers,:and/or�aay.recommendations or any other comments.
Jse drawings of fact. ty to be ter egplarn situations (use?adciifional1pages astnecessary).,
12�ei4•4���� _
GoNy;vjv& v. w;Dam. oo D,=kf,7 LvAuu Co%-Ckfk '6. Sow�%E G,.on.[c. 1=V4,Tjrc�JT
21.) ()9 oA -ram c aoP Y,LE t� Fa iz-v-,
?A.) WL)f oE4E_D5 To 13E )ZEd�S{.fl. Soo 16 Vwrt S5 usED, �'Ar_MO'
O JF��Qo t
DO lS OEo s�NACOPUT
t+W�N
Reviewer/Inspector Name Phone: (c1 m) 3�%'- 35a6 x2a3
n r„
Reviewer/InspectorSignature:^-nxX Date: 3[IoIVs.
12/28/04 Continued

Facility Number: 31 — go Date of Inspection -3 I 1p o S
Re aired Records & Documents 1
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes iNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Q Yes ❑ No ❑ NA ❑ NE
the appropirate box. Ef WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the pennit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge. freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes l 9 No
❑ Yes 2No
❑ Yes ❑ No
❑ Yes [ZNo
❑ Yes [�No
❑ Yes ❑ No
❑ Yes L' No
❑ Yes dNo
El NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA [I NE
❑NA El NNE
eNA L2 NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes
lt3 No
❑ NA
❑ NE
❑ Yes
eNo
❑ NA
❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
12128104

f
DiVisian_of Water .P_....`-:•':s.. �' ^
2 s - = c _..: Q �D1VLSiaY1Of Sound Water CanSei'VatiOII -«`"' �`
x
v-
a _
Type of Visit OLCompliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit 1(1!� Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Date of visit:
Facility Number
Permitted I. Certified ©Condition/Ially /Certified
Farm Name:...........�.Ae.�'_9X._..._...�C.hO/iP1...................................................
Owner Name:
Time: �
Q Not (Operational O Below Threshold
Date Last Operated orAboveThreshold: .........................
County:........ ..............
PhoneNo: _.............................. ......
Mailing Address: - - — - _�..._. ....._......_ . — --- - --............ ..._._ ...
Facility Contact: ................. Title:................... Phone No:
Onsite Representative:0 Integrator:
Certified Operator: .................................. ................................................I......_............-•---- Operator Certification Number: .......... ................... .........
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �' �" Longitude �• �' �"
W -��
Des3,
ign C urrent - a Desaga Cefrrent = _ ,� tl Cnrriiit°
Swine Ca:._ ci Po ulatian . Y"oultr]'W=. Capacity .Pooerlataan�= ;Cable, _ _. , ...Cabacitv.'-5 ulabon_z
F ❑ Wean to Feeder
Feeder to Finish
El Farrow to Wean
Farrow to Feeder
j
El Farrow to Finish
Gilts
Boars
❑ Layer
❑ Dairy
❑ Non -Layer
':��
❑ Non -Dairy
Other
�` �Nnmber alf Lagoons
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [:]No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifcr: ._ _ _ .. ..._.. .. _.. - ................ .- - ----••............ -.....
-•.........._ .. _
Freeboard (inches): 32
12112103 Continued

Facility Number: 3i -- < 0 Date of Inspection
IF
5. Are there any immediate threats to the integrityQof any of the structures observed? (ie/ trees, severe erosion,
❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ 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
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ 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 ❑ No
❑ Excessive Ponding ❑ FAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
A�
Comheeats (refer to:quesban #) w F.xplaw _aay YES answers oran neaidaiaons or aay other comments. t, -
Use drawings of iacshty to better explain sitaatio (use addrtwaal gages as ne`cessary)❑ Field COPY ❑Final Notes '
�' �; l �Q� pit✓ � �arn l Z, g r
M,
Reviewer/Inspector Name �x L �, ..r Lg
Reviewer/Inspector Signature: Date:
12112103 Continued

Fatuity Number: 3 — Date of Inspection
l9 C4P-c
Required 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?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
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
❑ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

f
(Division of Water Quality
0 Division of Soil and Water Conservation
C Other Agency
Type of Visit O Compliance Inspection O Operation Review ®'Cagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
Not O erational Q Below Threshold
0 Permitted 0 Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: / C 01 / County: A4,0 f %
Owner Name: / �Ir Phone No:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title: Phone No:
Integrator:
Operator Certification Number:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' Du Longitude 0 '
Design Current
swine
feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Gilts
Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dai
❑ Non -La er JEJ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 0 ❑ Subsurface Drains Present ❑ La oon Area ❑ S ra Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Laizoon ❑ 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 gat/min?
d. Does discharge bypass a lagoon system? (lf yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collectign & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Freeboard (inches):
05103101 Continued

I fFacility Dumber: — 9' O Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
l aste Application
10. Are there any buffers that need maintenanceiimprovement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PANT ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVI'MP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
=: 18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WliP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22_ Fail to notify regional DIVQ of emergency situations as required by General Permit?
(ie! discharge, freeboard problems. over application)
❑ Yes
❑ No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0 No violations or deficiencies were noted during this visit You win receive no further correspondence about tliis visit
Comments ferto uestioA : E- lam. YES snswei^sandlor,sn recomupeadattensrnam+otet oaatments; ; d_
Lse.drawrngs of facffity to better explain sltnatrons:uaditio (se dnal pages as necessary)
• Notes
a ❑ Field Copy ❑ FinalAL
._ -_
�_•jm::��.?'
/l0 see
Reviewer/Inspector Name
Reviewer/Inspector Signature: r Date:
O51031'01 C/ ` Continued

I
Type of Visit V Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit (B�-Routine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
Facilitv Number 3/ 9 Date of Visit: II 6Z Time:
IQ Not Operational Q Below Threshold
® Permitted M Certified OConditionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: /5d_e # V /Q j, 4.f County: A'011^
f le
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: Ad Zewi . atz - Integrator: 001 �>
.01
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Lahtu'de 0' 6 " Longitude ' 6
Design
Swine
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feedej
❑ Farrow to Finish
❑ Gilts
❑ Boars
Current Design Current Design Current
o ulation Poultry Ca acity Population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -La er I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons l LL Subsurface Drains Present JLJ Lagoon Area JLl Spray Field Area
Holding Ponds / Solid Traps 0 ❑ No Liquid Waste Management S stem I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lalzoon ❑ 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 gat/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
identifier:
Freeboard (inches): 3 7-
05/03/0I
❑ Yes t9 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes k No
❑ Yes U1 No
❑ Yes 19 No
Structure 6
Continued

11
Facility Number: 311 — 'fh Date of Inspection �Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
& Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type f'WA'_XA ` S 6-61
❑ Yes N No
❑ Yes ® No
❑ Yes ® No
❑ Yes 59 No
❑ Yes 1,M No
❑ Yes 01 No
❑ Yes m No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
2.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?
H Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ER -No
Required Records & Documents
17_
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Z[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.)
El Yes
pQ�
)K No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
F No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
El 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
A No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
FgNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question ft Explain any YES answers and/or any recommendations:or at y_©ther comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): ❑ Field Copy ❑ Final Notes
iQ45 t>t xi %.t A-eti -ec:sr j �rl 7 Is f/��-. a7� -We
,yeei rl,4 of -41 ow v�
jro �O/C.
W Co-1-5 Goo,,& 4,0 `
Reviewer/Inspector Name I�
Reviewer/Inspector Signature: Date: C ll Q
05103101 r
Continued

w
Facility Number: 31 — 6 Date of Inspection G
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?
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes E.No
❑ Yes P!�No
❑ Yes K No
❑ Yes 6TNo
❑ Yes OfNo
❑ Yes � No
❑ Yes C2(No
05103101

I
of Visit @) Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
r
Reason for Visit@Routine OComplaint OFollow up 0 Emergency Notification 00ther ❑ Denied Access
Date of Visit: Time: 430 Printed on. 10182001
Facility Number 3I 90I — rQ—Not Operational 0 Below Threshold
N Permitted 0 Certified E3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: U.&C.Fnrox ............................................................................. County: DUPAU ------------------------------------ VURQ ------
Owner Name. Barney------------------ MM&L --------------------------- Phone No:
Mailing Address: P.Q.B.01.4.Q6.7 ................... .......................................................... 5.urf.C1tx...N.0 ....................................................... 28445..............
FacilityContact: ........................................................... Title: ............................................... Phone No:.......
Onsite Representative:
Certified Operator: Bamey .................................. Rhodca .............................................. Operator Certification Number. 17.17.5............................
Location of Farm:
North of Greenevers. At end of SR 1954 off of Hwy 50. First farm on path. F-1
Ca Swine [I Poultry 0 Cattle 0 Horse Latitude =51 s...... iT Longitude
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ;
........ .....
Deli
gn ..... -
...............urre... ......... . . . . . ................. ... . ........... ..................... ........... ....... . ..........
Swine
P
........................... .. .... 0 ... 0 try-
p ....... ......... .................. ......... ... opul
E] Wean to Feeder
Feeder to Finish
4896
❑ Farrow to Wean
[]Farrow to Feeder
0 Farrow to Finish
[I Gilts
0 Boars
ILI Non -Dairy I
. .. .. ...... .
.. ...... ..... .. .
. .. ...... ......
.. ............ ...... .. .. .. .. .. .... .
960
Discharges A Stream Impacts
1. Is any discharge observed from any part of the operation?❑ Yes ®No
Discharge originated at: [I Lagoon [] Spray Field E] Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 0 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? El Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? Yes IR No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway [I Yes JZ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........................... .......................... .......................... ...................................................... ...........................
Freeboard (inches): ............ 4.0 ..........

v✓i v.n va
r I FacA ty Number: 31-90
Date of Inspection 9-19-20Q1
Printed on: 10/8/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ApBlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Graze) Small Grain Overseed
❑ Yes N No
❑ Yes N No
N Yes ❑ No
❑ Yes N No
❑ Yes N No
❑ Yes ® No
❑ Yes ® No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? N Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? . N Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15, Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reuuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
N Yes ❑ No
❑ Yes N No
❑ Yes N No
N Yes ❑ No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes N No
3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Field Conv 171 Final Notes
. Inner dike wall overgrown with weeds. Broadleaf herbicide needs to be applied periodically for control with more frequent
towing. Probably wouldn't hurt to lime when fields are done next fime.
Need to replace the hose connecting the pump to the Z-pipe.
13/15. Fields A & D have no cover crop established at all. These fields must be sprigged in 2002 between Feb -April. Will
need irrigation access for establishment. Soil reports call for heavy lime and perhaps some micro nutrients applications, !
copper, zinc, etc. Apply 1.5 tons/ac of lime to each field by end of October this year. Cont. on Page 3 '!
Reviewer/Ins ector Name
p Dean.HuQkele . ....::.. .... -
Reviewer/Inspector Signature: Date:

O5103101
41 Facility Number: 31-90
Date of Inspection 9-19-2001
Continued
Printed on: 10/812001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
® Yes © No
❑ Yes ® No
Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
0 Yes ® No
with Tim Hall, NCDA agronomist, for recommendations. One application of poultry litter this fail or spring may be
14. Site needs to have Wetted Acres completed ASAP. May want to look at combining waste systems between 2 sites.
19. Claiming more acreage for Field B than in waste plan. Plan = 11 & Records = 12.9 Need to reduce until Wetted
Acres completed. Try to utilize July for pumping rather than waiting for Sept. into Oct.
Will follow-up with appropriate Notice for lagoon, fields, and perhaps Wetted Acres.

Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 0 Date of Visit: ^C Time: 3
Q Not Operational Q Below Threshold
Permitted © Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
'[� ( to
FarmName: _... �.1..4..�rh�.......................d. �.................................................... ......... County:........�.1..�..!►'1...........................
OwnerName: ............................................................. Phone No:................................................................. .»» .......
Facility Contact:
Title:
Phone No:
MailingAddress: ..................................................................................................................... ......... •......................... - ............. ..................... .
Onsite Representative: � Integrator: �...._.
..............►.............------------.............-......... -
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude • 4 64 Longitude • & «
Desi " Current' 'Desi Current Cnrreat
Site Ca aci Po ulation Poultry Ca aci " Po Population `., . Cattle `. Cs aci Po itistion
❑ Wean to Feeder ❑ Layer ❑ Dairy
r Feeder to Finish 10 Non -Layer I I ❑Non -Dairy
Y ❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑Farrow to Finish Total`Dtisign'CapBcity..
❑ Gilts
❑ Boars TotaI.SSLW
Number of Lagoons " . ❑ Subsurface Drains Present I[] Lagoon ❑ oon Area . Spray Field Area
Holding Ponds 1 Solid:Traps; ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
b(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
C] 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
XfNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
D�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
tfNo
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ........................................................................................................... ................................................................
.................................
Freeboard (inches): q0
5100
Continued on back

F6ei:lityNumber: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes , No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? CKYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ff No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes .TNo
Waste Application
10, Are there any buffers that need maintenance/improvement? ❑ Yes t No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes XNo
12. Crop type g—. , 54
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
Oyes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
KYes
❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes
JWNo
Reauired Records & Documents
17,
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
14 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
KNo
(ie/ WUP, checklists, design, maps, etc.)
❑
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
J�rNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
N(No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
O No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
14 No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
9No
yi41001Woi•. def ejen, .. . ore POW- it�rring �his:visit; - YoO wits-tecoiye lid fuf fth
correspmideIIce. about this visit... .. - .. .. .
L_,4 - , r ,, LA
ii
Reviewer/Inspector Name a _
Reviewer/Inspector Signature: CX Date: O g/pp

Flicilify Number: 31 — Q Date of Inspection c{ O
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
; yes;
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes eb 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
JYNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
broken fan blade(s), inoperable
Yes
WNo
or shutters, etc.)
❑
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
KNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
M No
AdditionaMomments an of rawtn .
►� � Yo �� � �S �1�c�-1-� ass 1 Cc' %e�- f 2`��- c t
A.
lrt
8\� 4:7A\
11i1 �, 1
k �GG\cz. CS 4:::-J3t-'Lk
L'JOkl <::�C V-� ct-u
T
5100

Im
Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency -
Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number
Date of Visit: Q- �^'� Time: © Printed on: 7/2112000
�
Q Not Operational Q Below Threshold
Permitted E3 C[�ertified 13 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name:........l�-VC......................................................................................... County:................. �tl _.................
.......... �.....................................
OwnerName: ................................................... ........................................................................ Phone No........................................................................................
FacilityContact:.........................Fitle:................................................................ Phone No:...................................................
MailingAddress:...................................II.................._.................1....................................................... ......................................................................... ..........................
Onsite Representative: , t }� �-� '}r{ `1 I` o e�� (ntegraior: D.Qi
r......1�.......... ...:.: 1........i...........................................................................
CertifiedOperator: ................................................... ............................................................. Operator Certification Number: ..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4
�E
3
w
Longitude �• �s 0��...
Design Current Design Current Design Current
Swine Capacity Population Poultry_ Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
Feeder to Finish JE1 Non -Layer I I JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagwbn Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. 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 m',uf-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
Stl'UCLure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes
J�(No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes PTNo
❑ Yes ['�fNo
❑ Yes YNo
Structure 6
Identifier:......................................................
Freeboard (inches):
5100
Continued on back

~ Facility Number: Date of Inspection Printed on: 7/21/2000
5- Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
r
13. Do the receiving crops JiffeT with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Rio viQlaEigns:or deficiencies were nbtea during this:visit; Yoi� will receive Rio further • . •
:-:-corresporitieince:about this:visit.:�:-:-:-:-:-:-:-:-:•:•:-:-:-:-:-:�:•:•:-..:..:.:.........
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
[]Yes )<No
❑ Yes ONO
❑ Yes b(No
❑ Yes KNo
[:]Yes jRrNo
❑ Yes XNo
❑ Yes XNo
❑ Yes ONO
❑ Yes XNo
❑ Yes No
❑ Yes ❑ No
❑ Yes JXNo
f
❑ Yes �No
❑ Yes XNo
❑ Yes XNo
❑ Yes r—
❑ Yes ONO
❑ Yes 9No
❑ Yes .ONO
❑ Yes ONO
❑ Yes 9No
❑ Yes J9No
I$ AM C, G CA - J, r C L., -5 9P
�_r
w
Reviewer/Inspector Name IQ 3q 5 W f\
ReviewerlInspector Signature: Date: Q^ 5100

Facility Number: G Date of Inspection GG Printed on:
7/21 /2000
Odor Issues A
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge AL/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation? `
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
roads, building structure, and/or public property)
29. Js the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes XNo
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 C4 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �4No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ;K No
J
5100

0 Division of Soil and Water Conservation = Operatian:Aevtew -
: fer Conservation - Complrance Inspection Division of Soil and Wa
Diyision'of Water Quality'- Compliance Inspection
Other Agency - Operation,
Routine O Complaint Q Follow-up of DWQ inspection Q Follow-ue of DSWC review Q Other
Facility Number Date o1' Inspectionso Z
Time or Inspection jj- 3o 24 hr. (hh:mm)
;Permitted 1P Certified [] Conditionally Certified © Registered © Not O erational Date Last Operated:
Farm Name: ..............D. s::...... vky-.ri................................. I .......... ................................. County: .....
3)L.�?�i�................... ................... ........................
Owner Name:.........................tax .j............ Afs.................................................. Phone y\'o:....Lq.���. ". ;Z� .....
Facility Contact: ................ ......... Title:................................ - .. Phone No:.......................... .
MailingAddress: ........ ....d...•.....�,OG.............................................. ................. . ��. �r1.. �. ........................... ... .... ......
p T...... 1
Onsite Representative: .......... .I�Os ......... �1eZ.S..............................I.........I......... Intel;ratc�r:....... R. +;.%I:SQ......................................................
Certified Operator:.....................&fn...M.:....... [(.\Ch.fj.............................. ..... .... Operator Certification Number:..........................................
Location of Farm:
ELYr1.. SI! 14<_11 . I It P.✓W n.•. :fin .. - lI
r.... .............. ... .i .
Latitude Longitude � • �� �°°
Swine Capacity Potmiation
❑ Wean to Feeder
Feeder to Finish
tr
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holding Ponds / Solid Traps JE3 No Liquid Waste Management System
Discharges & Stream Impac
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance ratan -made?
h. II' discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon systern?
2. Is there evidence of past discharge from any part of the operation?
1 Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure: Structure 4
Identifier: f/
Freeboard (inches): ..........3 •• ..............
Structure 5
❑ Yes ~� No
❑ Yes No
❑ Yes No
Cl Yes No
❑ Yes No
❑ Yes No
❑ Yes M No
Structure 6
116/99 Continued on back

ky
l�acilitOZf umber: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (icl trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any pact of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
I I - Is there evidence of over application'? ❑ Ponding ❑ Nitrogen
12. Crop type ................ �eir.Y►!LU 4 ....................5F:!' .Vt...... 1�n, Pl....................... ..............
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application'? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel 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 certified operator in responsible 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?
�P....
: No:violations:or: deficiencies :were ntued dtirin Nils:visit:: Yoti mill:receive na further :::
correspondence: about: this visit.:: ::::..:. ::: :::.. :....:::::::::::
❑ Yes EA No
❑ Yes 1�5 No
❑ Yes M No
[A Yes ❑ No
❑ Yes �@ No
❑ Yes [;R No
❑ Yes 0 No
❑ Yes ® No
® Yes ❑ No
❑ Yes ® No
❑ Yes � No
❑ Yes 0 No
❑ Yes 0) No
❑ Yes 9 No
❑ Yes 1B No
❑ Yes M No
❑ Yes ® No
❑ Yes No
❑ Yes No
Comments.(refer to question #): Explain any YES answers and/or any recommendations or any other comments - }
Usedrawing's of facility to better explain situations. (use additional pages as`necessary)
Y wrzGS -\+\ 5�01 titfiU S v�a �e rtn4vU �erm�
vo,w-� o cNw GvoP
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: _ 4- 1]/6'/99

❑ Division of Soil and Water Conservation [3 Other Agency
19 Division of Water Quality
Routine O Complaint O Follow-up of DW ins ection O Follow-u of DSWC review O Other
Date of Inspection o
Facility Number Q
Time of Inspection 3aC1 24 hr. (hh:mm)
U Registered [3 Certified © Applied for Permit Permitted 10 Not Opera
erational Date Last Operated:
j
Farm Name: C Count ''�
Owner Name:.......L r O�!....��:odeS...............................................I................ Phone No: ... 3M.:.3..�9'!............ I—— .....................
...
1\
Facility Contact:... ............. .. Title: O� ....,. Phone No:
---..... 'r .......I....................................................................
....'1!f.......................... �. S
Mailing Address .,....... ....
Ontiite Representative:. ! .....................................!...4..-�c.�n.�-, ..�? BLS.---..... Integrator:--��r- Lxx" ......... . .............................
Certified Operator:..........t ...........
Operator Certification Number,..
Location of 'arm:
al-�....��......... f .......... ............. ` �-i................................................................................................................................... . T
Latitude 0 d 46 Longitude • ' it
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes KNo
2. Is any discharge observed from any part of the operation? ❑ Yes X No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ONo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min? l�
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [XNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes El No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 0gNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes M�No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes )I No
7/25/97

k•
i:' Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes XNo
Structures (Lagoons.11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 1�(No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft)::.............................................
....................................
10.
Is seepage observed from any of the structures?
❑ Yes
[ANo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
9No
12.
Do any of the structures need maintenancelimprovement?
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
0 No
Waste_ Application
14.
Is there physical evidence of over application?
❑ Yes
MNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ...........�z ......................... ........................ ..... ................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
QJ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
9No
18.
Does the receiving crop need improvement?
(Yes
JjNol
19.
Is there a lack of available waste application equipment?
❑ Yes
[jrNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
®No
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Uf No
22.
Does record keeping need improvement?
MYes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
0• No.violations-or. deficiencies:were-noted doting this.visit.-_ You:will receive.no•flirtlier
::�correspondenceatiou�this:visit.-: , :�::�;�; . :-. ;,.:..:.:.�.- _,:.;::�.::
�2) T►�hQ� �',�e �.,�. V\P_ - �2 r ow�i �.�ee�is c� Rl V� 1o,,� oa Vk_r VL fit"
Cyey8k t;•«. w pig �4-��
l7
d`IPP�� > t,a kati,�a�h�ye� LV4efd�cw-�e•.,�� , 3 �•e'�ro� I -Eesls ����� c�c��'
rpm
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: CA. _ Date: <��qQ

Facility Number ]lute of Insricctiml
1/29798
Time of insirc-cti,oil L. 24 hr. (hh:mm)
p Registered M Certified p Applied for Permit ■ Permitted 113 of Operational Date fast Operated:
Farm Name: R&C.Farm..................... ...... . County: Duplin WIRO
OwnerName: Barney .................................... Etbadim ....................................................... Phone No: 9.111-MS-3Z95 ..........................................................
Facility Contact: ......................................................... ..Title: ... Phone No:...
MailingAddress: F.O.B►ox.44b►7........................................................................................... Sut:>v.l it}...IY.C....................................................... Z8445 ..............
Onsite Representative: ................................................................
Certified Operator: Ba.mic..M............................. Rhodes...
Location of Farm:
ntegrator: Murpthy..Fate.ily.Farims....................
Operator Certification Number:172.7.5.............................
Latitude ®• ©• �' Longitude ©•' ©
Design wren —estw -Curren
`:Swine_ Capacity Population Poultry Capacity Population.
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to can
❑ Farrow to ee er
p Farrow to Finish
p Gilts
❑ Boars
r-...,,.....►
pLayer
p on- ayer
vesign _: f—urrent
Cattle Capacity'Population
r❑ airy
13 on- arty
❑ ter
Total'Design Capacity 4,89
Total SSLW . 660,990
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: p Lagoon ❑ Spray Field p Other
a. If discharue is ohserved. was the conveyance man-made.,
b. If discharve is ohsetved. did it reach Surface Water? (If ves. notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon systent? (If ves. notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than -from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes p No
❑ Yes ❑ No
❑ Yes ❑ No
p Yes ❑ No
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes p No

W
Facility Number: 31_90 71
8. Are there lagoons or storage ponds on site which need to be properly closed?
(3 Yes
p No
Structures (La2oons,Holdina Ponds. Flush Pits. etch
9. Is storage capacity (freeboard plus storm storage) less than adequate?
p Yes
3 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ..........................................................................................................
................................
Freeboard (ft):
10. Is seepage observed from any of the structures?
p Yes
13 No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
p Yes
p No
12. Do any of the structures need maintenance/improvement?
p Yes
p No
(if any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
I3. Do any of the structures lack adequate minimum or maximum liquid level markers?
p Yes
p No
_Waste Application
14. Is there physical evidence of over application?
p Yes
(3 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type........................................................................................................................................................................................................................•...
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
p Yes
(3 No
17. Does the facility have a lack of adequate acreage for land application?
I3 Yes
p No
18. Does the receiving crop need improvement?
p Yes
❑ No
19. Is there a lack of available waste application equipment?
p Yes
p No
20. Does facility require a follow-up visit by same agency?
p Yes
p No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
p Yes
13 No
22. Does record keeping need improvement?
p Yes
p No
For Certified or Permitted Facilities Onh•
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
p Yes
p No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
p Yes
p No
25. Were any additional problems noted which cause noncompliance of the Permit?
p Yes
p No
a -.. o.vio tions.orI.t~rencies.were.note nringt rs visit:. m .receive no_ nrt er.:.
:,cerxespoodOiee about .M4 visit:' : ' ::.: - : . - ::.. :.. :. • .
was made to assess if tactlity is a likely candidate for State groundwater study. Ubservations of spray tield borders were
public roads.
1 fields are set back away from the state road. No houses or wells appear to be close to these fields.
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Z

-771 t it', VP N,`Si.;,
Ul"Z ,
m
, ­' 5 W.\ - t,•

1
Routine O Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review O Other
Date of Inspection
Facility Number 3 q Time of Inspection : 5 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
gCertified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: ............ ..._.... ........... ................ .. ................
Farm Name:! ....�:'� .... _ .... W.... _ County-'T""17 i.. it! .
Land Owner Name:
.. .... _..... ........ Phone Na: _.... 7.1 ..l
Facility Conctact:..... -.._...-........................................ .. Title:
Mailing Address: 2l.l�-•{� --.. ��� .... _.... � _.... —_....
Onsete Representative:.... _...... ..._a'[AL...
Certified Operator:.... E!'<S. met .........L�.._........_..-. des . ...............................
Location of Farm:
....... .--•---. Phone No: ..... . ..... . .............. . ...... . . ..............
.. KC F �..� ._...__ ...._..... .44 ..
Integrator:
Operator Certification Number:.._..-jZ 75 ..............-...
Latitude 4 " Longitude • ® ©
Type of Operation and Design Capacity
all
❑ Wean to Feeder❑
V Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑
g�Desegn Curent 'a C
Cattle'Design V urr nf'
Ca ace =,Po ulati6n P°ultry _Ca actPo ulateon Y,:m.-.Y f . „Ca aeiPo ulatton
La er ❑ D
❑Non -La er ❑ Non-Dairyl
_
TotalDesignpaerty
v w,
..__
x h
NuIn e� of L�agooas f Iieldmg P ids ❑ Subsurface Drains Present i
❑ La goon Area ❑ Sway Field Area
neral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
e. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system.? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes 19 No
❑ Yes ® No
❑ Yes H No
❑ Yes Ej No
❑ Yes
® No
❑ Yes
® No
❑ Yes
MNo
Pq Yes
❑ No
Continued an back

Faclity Number: —.q Q....
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures.(1,agoons and/or HoldingJ!onds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes No
❑ Yes ® No
❑ Yes No
❑ Yes [&No
Structure 5 Structure 6
Wastg Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type _1Q..e!`�Ae� ............ . 1: v—drsrnar-a...................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
2 1. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified, Fagilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes J'No
❑ Yes E&No
,Yes ❑ No
❑ Yes RNo
❑ Yes IS No
❑ Yes allo
❑ Yes ® No
K Yes ❑ No
❑ Yes KNo
❑ Yes $ No'
❑ Yes JR3 No
❑ Yes J9 No
❑ Yes & No
® Yes ❑ No
ComsTients {refer to greshan # Explain aj.ny YES answers and/or,any recommendations or any other conunentsfi `
Usedrawings;of facilityto better explain sstuahons (use additional pages as necessary) 4,
.,
,Via'. ..cl,ti
5 - f>v i 1 cL Jv r b ,,, , c A,-w _ v%-1cL = y-t'j A4 -a v__ft +� LX t a ;, + �_-���. � F 14..L ..
frt-t,% CL 1 C�i'�� l �/^
. /�}4- Lw/ A-cJ� I�
Cl. S 9 L /�[t-Y�-�VV.
G C•6- C. 1 •S r`' c^�, • L 4 r r Q C. w1 o- i �f V t s dL
S� C-i t t& a.-ti-c1 re,/ a �.e, v �+�., p i S�..#-) Vq t LJ- ti, t.o�� L� o o �
J
6 oK z O_ -e•-o. a v, t o vim..-x�r- a o v � a o-, "'Fa t I.
1 J
is- C-4 v rr_ -t U--,� L+, "
y� 43 i e..� c r I v It a. i s v`s L^^ v j 2 d b •� V L a.-v- i C- �^- o p t -
,
d�o It Ita.+ a t ci.¢.�
t^i %,, 1 - 2 lqJ. LL�� v, 60 4 !
1 kl s s S V- 6 0 W ]n..c_ d.a V _e
a
Reviewer/Inspector Name M.
v�
,., w , . a.. ,:, .� �.: . ._�. , . _ .�°,;:sew »,`�-� ;,•
Reviewer/Inspector Signature: Date: -r
C 7I"
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No. _ -7
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: S 3 1995
Time: J bQ
Farm Name/Owner: -a , 2 5
Mailing Address: 4067T 5jrf' Cj28 S ^_
County: _ D 4 j ►rl
Integrator. rim Phone:
On Site Representative: Phone: 2 99 ` q-�q 1
Physical Address/Locadon: _QC SO iL2n '.,Arl SLAle- 7 ►r►i .e2Sf rcr1h-t-
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 4� q(19 - Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 34' ° _�5L_' 6Q.V" Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (9 or No Actual Freeboard: 3 Ft. O Inches
Was any seepage observed from the lagoon(s)? Yes or� Was any erosion observed? Yes ols
Is adequate land available for spray? es r No Is the cover crop adequate? es or No
Crop(s) being utilized: - r2 er'N'1�) (')
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o CINO)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes OG If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

NUH I H UAHULINA
Department of Environmental Qual

0 Division of Hater Resources
"Faci Number - 3 w Ds oo.of Soil and Water Conservaiton""
Q Other Agency
Type of Visit: Q Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Q Routine Q Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: ,GU Departure Time: County: 1!0 Region:
r
Farm Name: - L(e_ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design ' C6t+ent
°Design
Current
a Design 'Current
Swine" .` Capacity Pop.
Wet Poultry
Capacity;
Pop—, ; ..
Cattle;Capacity Pop:
Wean to Finish
Wean to Feeder
[]Non-Eer
Feeder to Finish
.
Farrow to Wean
_
f Design
Cu&ent
p.
Farrow to Feeder
Dry PoultryCapacity
Po 3�
Farrow to Finish
Layers
Gilts
Non -Layers
Boars
Pullets
r
Turkeys
Other
TurkeyPoults
Other
Other
Dai Cow
Dairy Calf
Dairy Heifer
D Cow
Non -Dairy
Beef Stacker
Beef Feeder
Beef Brood Cow
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation? [—]Yes L,I4o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes D 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
❑NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
VN❑ NA
[] NE
of the State other than from a discharge?
Page 1 of 3 2/4/20I5 Continued

Facility Number: �, j - Date of Inspection:
W to Cdllection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes l_�J"17O ❑ 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): 43 LP)
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ <o ❑ 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 ❑.I❑ 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 PI-0 0 NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes to ❑ NA ❑ NE
maintenance or improvement?
1. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Do ❑ 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
ELi-Ko ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
nj�'o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E21No ❑ NA
❑ NE
acres determination?
ev❑
17. Does the facility lack adequate acreage for land application?
❑ Yes
B NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
Vo ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [g<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes To ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 21b ❑ 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 [/] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ No D NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 51 - 9 jDate of Inspection:
24.; DiAie facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 10 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ No ❑ NA FINE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El 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 EfINo ❑ NA D NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 0-M-A ❑ NE
Other Issues �
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E2-1( ❑ 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?
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 ETNo ❑ NA ❑ NE
❑ Yes EjXo_ ❑ NA ❑ NE
❑ Yes [Z?I�o [] NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes (2'No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes UNo [] NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Q No ❑ NA ❑ NE
Comments (refer to question #): Eiplain :any YES answers and/or any additional recommendations or any otlier comments.
Use drawttt s of fac�[�to�better eg la�o-�tuanons g ty' p ' (use additional pages as necessary)..... a
16t4�,J 0,V.1 IVA-(
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
l.� Phone:
Date: joZ
214120I S

ivision of Water Resources
Facility Number O Division of Soil and Water Conservation
�' O Other Agency IZ/
ryp of visit: Ciance Inspection Operation Review O Structure Evaluation O Technical Assistance
leason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: { 3 2 Arrival Time: Departure Time County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: �� �C l e-- 6,-, F �� Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification [number: 172D �
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish
Wean to Feeder
eeder to Finish u O
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -La er
Non-L
Pullets
Turkey Poults
Other
Design Current
Design Current
Cattle Capacity Pop.
iry Cow
iry Calf
iry Heifer
V Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
Dischar es and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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)
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 [�-Rltf ❑ NA ❑ NE
D Yes E]4 ❑ NA ❑ NE
Page I of 3 21412015 Continued

1~acili Number: - Date of Inspection: 2 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �❑ 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: I _` I? —
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �p _ 47
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ej 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 C3No ❑ 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 ff'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 ETNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [TNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EnNo ❑ 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
ENO
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
FZ/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
21-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
dNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ f o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[o
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: 12 2 EQ
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E.-T—No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes io ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No E]INA ❑ 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
ffNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes El"No
❑ Yes g�No
o
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: 2Z
Page 3 of 3 21412015

`= UDivision of Water Resources /
Facility Number ©- 0 Division of Soil and Water Conservation V
0 Other Agency
Type of Visit: Compf a Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7 Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: t�� �� C.r I ,f re -1 Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number: / 7l-, Y
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
F
erNon-Layer
Wean to Finish
can to Feeder
Feeder to Finish
'-{ (A 10
0­_V,
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Poultry Capacity Pon.
La ers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Cattle 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 DW R) ❑ 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 D__�"O ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑-NaA0 NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - Date of inspection: y
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�'I IC-o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I
Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes Io ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
L� o ❑ 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
ETNo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes IG o ❑ NA ❑ NE
maintenance or improvement?
1 1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �E] NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i0 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): +i y
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
Io
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
KNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps []Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 �K ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes TNoD ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: ) CJ rJ f T
,24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes IQ 1VO ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑- o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑Yes [i]'N0 r❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA 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:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes CNo DNA ❑ NE
❑ Yes rNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
No . ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessarv).
`O o A 194n4
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: N7 9
Date: to,7
21412015

Division of Water Resources
Facility Number ©- ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: z Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 y Arrival Time: Departure Time: County: T Region:
Farm Name: F hue (9(LI rr F/N P4(L/K Owner Email:
Owner Name: 1F bK>l G '& Cq_1F1P11y Phone:
Mailing Address: SAo �3 eAGIcA uxLE , / vC D RS)
Physical Address:
Facility Contact:
Onsite Representative:
Title: Phone:
Certified Operator: ` -bD i e !F- . L19- If F IN
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:
Integrator:
,D61 4
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La He r
Non -La er Ed
Non-L;
Pullets
Other
Poults
Design Current
Discharizes 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:
—4D --1 S
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes tt(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes 0� No
❑ Yes $ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility N mber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I— ell
Spillway?:
Designed Freeboard (in):� )9. S
Observed Freeboard (in): S 6 '
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes]
No
❑ NA
❑ NE
maintenance or improvement?
7�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 9 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): Sczt
13. Soil Type(s): ALA�01u-�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ANo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
S..c No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application Q Weekly Freeboard Q Waste Analysis ❑ Soil Analysis
Q Waste Transfers
❑ Weather Code
Q Rainfall ❑ Stocking Q Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
JX No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: jDate of Inspection: 0 1 /'V
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes MNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 1� 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? 54
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [] Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 4�
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes jNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yeso ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yeso ❑ 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.necessarv).
w. A . 1 a
5f C%y r.3S c�3 o.
Daiy
u c
�LL"Lo6CPU
sgmP
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
IU PO4 C AivC S
Phone:
Date:
21412014

fi�rDivision of Water Quality
Facility Number � - O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency 0 Other Q Denied Access
Date of Visit: � i Arrival Time: Departure Time: 1 a County: Region: ilk► tAb
Farm Name: JE 46e [TI%1 AWW, Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: Integrator:
Certified Operator: &U41r f,
a y;�AA—'W, Certification Number;
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Poults
Design Current
Longitude:
Design Current
Cattle 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 ETNo ❑ 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?
0 Yes
kTNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ETNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

5
•
Facility.Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 21 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�allo
❑ 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
jo No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
WrNo
❑ 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
ONo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
21 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
WNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4 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
IV,
gNo
❑ 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
53'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Fe No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
?I —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 effNo ❑ 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 ! 5 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

}
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes eNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes KNO ❑ 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 ZfNo ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes RTNo ❑ NA ❑ NE
❑ Yes 0 No 0 NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
Z No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
VrNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes
G!rNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/201I ''

Division of Water Quality
Facility Number - _ O Division of Soil and Water Conservation
O Other Agency
type of Visit:
Compliance Inspection 0
Operation Review O Structure Evaluation
p Technical Assistance
Reason for Visit:
W Routine O Complaint
O Follow-up O Referral O Emergency
O Other O Denied Access
Date of Visit: uz�M] Arrival Time: © Departure Time: County Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 4AINA (SCUE E Inte rator:
O Certified Operator: E�� I C , t 7 �i (-/JJ Certification Number: pIs
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.
La er
Non -La er
Pullets
Other
Poults
Design Current
Longitude:
Design Current
Cattle 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
X'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility AWmber: 3 1 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: I l
Spillway?:
Designed Freeboard (in): 9.5 19._
Observed Freeboard (in): yL/S0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo [DNA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan? Lrl
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 o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yeses No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et .)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ac� �LES�=Q
13. Soil Type(s):
CbIIW_U M
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes I
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes kN
o
Yeso
OWUP ❑Checklists ODesign ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;VNo
0 Waste Application Q Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑ Waste Transfers
Q Rainfall ❑ Stocking ❑ Crop Yield Q 120 Minute Inspections Q Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Q Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility." umber: "3 j -Y5-R-7 I Date of Inspection: f j $ j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes �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 ;kNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes LNo ❑ 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).
ink A- - .
l
p' C
g/j3%g
_4jj'1.6y
Ll
G • � 3
'buc 90) L/
LAN Tl L gc�l +
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2✓412011

Division of Water Quality
aciliity Number L [ I -F 8 Y O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: (p J / Arrival Time: � Departure Time: County: ) rI1J Region:
Farm Name: �� Q E l --a 1 6:7 FIAT 4"/4 I? l�A Owner Email:
Owner Name: p01 r 1 . G9-t FIN Phone:
Mailing Address: 2 3 CO / v C M E U C A U 1 ULE / v G 'QR S) 9
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: ANDL� ( (Lt FF/n/ Integrator:
Certified Operator: �t bu E �—_— . _G 2r �1N Certification Number: �� Pc)5
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.
La er
Non -La er
Non-L
Pullets
Other
Poults
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
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
[]Yes [] No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facie Number: jDate of inspection:
Waste Collection &_Treatment
4.Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No 0 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: I — - 01
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3R L 9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) TT
6. Are there structures on -site which are not properly addressed and/or managed through a [!]Yes $LNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? P�No
l1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 5a &__�L Cps
13. Soil Type(s): to 7 2 yul L r-
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 JKJ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
ONE
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 QChecklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
Q Waste Application Q Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑�ste Transfers [] Weather Code
[] Rainfall ❑ Stocking ❑ Crop Yield Q 120 Minute Inspections 0 Monthly and 1 " Rainfall Inspections [] Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes j No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: (p
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
9No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
�[
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
IXI No ❑ NA ❑ NE
"7A
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
Wo ❑ 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
Ix I No ❑ NA ❑ NE
'"[1
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA ❑ NE
34. Does the facility require afollow-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 drawings of facility to better explain situations (use additional pages as necessary).
1011-4111 6-c4
u60710u Vc„& aC)I
C-,xF_M pr Gk/V71L
Reviewer/Inspector Name:
ReviewerfInspector Signature:
Page 3 of 3
(316- (14- Spa-S 6r-itC)
Phone: 910 —"3 16 _41
Date: /Og A0/1"
21412011

Division of Water Quality
Facility Number L___?J__ J 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
Compliance Inspection
O Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
10- Routine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: )V Region:
Farm Name: EoajC-_ L'1�J1F_Fjnr! _rt4(?_M Owner Email: -
Owner Name: Eb Jr —a E r I_FF)'A/ Phone: - 10 ~ a J a -5 d (DC4
Mailing Address: l/ n1' C I 4€ IJeucp u I LCL fic 94 s I S
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: hQ M QL.A _ G9_t Ff-%/V _ Integrator: t
Certified Operator: �L 1� �_• G l F1 JU _ _ Operator Certification Number: OCd
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
Back-up Certification Number:
Latitude: = = , = H Longitude: = ° = A = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
---�—s1 JEJ Non -Layer -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
DischarLyes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Coyj
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 'KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104' Continued

Facilify,Number: 3 - g Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElYes No ❑ NA El 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: Oc
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 J�No ElNA ❑ 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 '0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes hNo ❑ 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 No [:3NA ElNE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
P-No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type�`� s) }} ''�Z ( P lJ
13.
Soil type(s) AxI QCAU1CL-f---
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
' No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
`4No ❑ NA
❑ NE
Comments (refer to question#): Explain any YES answers and/or -any recommindations or any`other comments.
Use drawings of facility to'better explain situations. (use additional pages as necessary):
r
ReviewerllnspectorName Phone: qy)- 3�
Reviewer/inspector Signature: ouay Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection F `�--`f J61
Reauired 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
X
ElNA
ElNE
the appropriate box. 0 WUP ❑ �'� Design [] Maps ❑Other Checklists
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�kNo
ElNA
❑ NE
0 Waste Application 0 Weekly Freeboard 0WasteAnalysis ❑SoilAnalysis [IWaste Transfers ❑ /nual Certification
EI Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
(,No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
94No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
§4No
❑ 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
ANo
❑ 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
E4,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
4No
""",�No
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Comments and/or Drawings:
b4o g co
�-/��lia ►,1 �.a
Page 3 of 3 12128104

)Division of Water Quality
fFacliity-Nuittber 3 S� 0 Division of Soel'and Water Conservation 3,
0 "Other' Agency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit i LRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name: NRJ(=-. �<QU FFJN jgQm _ Owner Email: nn,_`,
Owner Name• _E lDI e �(L_l ! N Phone: D-a�g` Sd&q
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:: Ft�zl C tAxg �+ I- CL-t Ffr//J
Certified Operator: t--rst is E • QJ FF/N
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish W41 ja
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other,
Phone No:
Integrator:
Operator Certification Number: _ 1 _+S[a5
Back-up Certification Number:
Latitude: = = i Longitude: = ° = ,
'Design Current
Wet Poultry Capacity Population
❑ Laver
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design' 'Current'
Cattle Capacity .Population'
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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?
A
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes U No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Stru2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): . S
Observed Freeboard (in): 5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Anolication
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
12. Crop type(s) z CP
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
kNo ❑ NA ❑ NE
[X No ❑ NA ❑ NE
No ❑ NA ❑ NE
rN
o ElNA ❑ NE
o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recomniendations or any other commeuts' �!. a
Use drawings of facility to better explain situations. (use additional pages as necessary): °
loliala�
Ca j gal 09
Reviewer/Inspector Name ae0gAloA . F}/W S
Phone: 9/0 1 (9BOP
Reviewer/inspector Signature:
Date: Ks LS 1 109
12128104 Continued

Facility Number: 3) — 00' Date of Inspection
Reguired 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 XNo ❑ NA ❑ NE
the appropriate box. 0 WUp 0 Checklists Design 0 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
Ej Waste Application 0 Weekly Freeboard El Waste Analysis 0 Soil Analysis ❑ VAte Transfers ❑ Annual Certification
0 Rainfall El Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections /O Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27, Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 L Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
C f)LVP 1 T,C'3N DUE IN "C'
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
;jNo
❑ NA
❑ NE
❑ Yes
ONo
ElNA
[INE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes IN No ❑ NA ❑ NE
1228104

v IV Division of Water Quality
Facility Number M
g U
O Division of Soil and Water Conservation -- Q Other Agency ✓
Type of Visit '0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: �Arrival Time: ® Departure Time: County: E_I/V Region:
Farm Name: Owner Email:
Owner Name: Phone: 9 10 -off CIS( 5 atoL/
Mailing Address: JL N /VQ I E UxLA ui LLB
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: _ G b b i F E. (S
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
Phone No:
Integrator:
Operator Certification Number: 1-4&6 S
Back-up Certification Number:
Latitude: [=] o [=] ' = Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
f❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ='
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 W No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
�(No
❑ NA
❑ NE
❑ Yes
fxNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: "3 }
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 1 a
Spillway?:
Designed Freeboard (in): ) !, S 19,
Observed Freeboard (in): SQL
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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 XNo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ NE
❑ Yes
0 No
❑ NA
❑ Yes
9No
❑ 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 XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 11� No ElNA ❑ 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
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
y No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
IN:D10
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name ji[ A Phone: a9%-
Reviewer/Inspector Signature: Date: 1 a
Page 2 of 3 12128104 Continued

Facility Number: 3 1 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ ycs 14No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 15�No ❑ 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 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
%LNo
❑ 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
NNo
❑ 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
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ANo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes d No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document 0 Yes 6No ❑ 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 4No ❑ 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 KNo ❑ 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 0No ❑ NA ❑ NE
Page 3 of 3 12128104

t
Facility Number
AQ- Division of Water Quality
Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 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 [3 Denied Access
Date of Visit; / Q Arrival Time: ; %Q Departure Time: © unty:
Farm Name: Owner Email:
Owner Name: _ %0,02�� L� /� z ��Z�/ Phone: _
Mailing Address:
Physical Address:
Facility Contact: C Title: /
Onsite Representative: /'.Z2a t�-_
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
Phone No:
i
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: &/-Sty/
Latitude: =] o =]' ❑ Longitude: [_—] o = ` ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
1 IEJ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ 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 Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
l
❑ Beef Feeder
❑ Beef Brood Co
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes;PlNo
❑ NA
❑ NE
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
St t ctare 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:! 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 8
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 2fNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes'21No
❑ 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?
ElYes ,�f No
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes �� No
[INA ❑ 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
improvement?
❑ Yes No
❑ NA ❑ NE
maintenance or
/
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes/j�lNo
❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ NA ❑ NE
e�'No
❑ 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 Windoyt ❑ Evidence of Wind Drift ❑ Applicatioq Outside of Area
12. Crop type(s) &W ,4 1 ) , �_l,� • l Ur/i
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 91'o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes gNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes A No
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes No
❑ NA
❑ NE
Comments (refer to question ft 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):
dW'e'e'qc / /'44/n
�p_10
Reviewer/Inspector Name C-rfff7`r Phone: �VO/,
Reviewer/Inspector Signature: Date: O
I2128104 Continued

Facility Number: 15 1 —,5 0 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 19 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes to No ❑ NA ❑ NE
the appropirate box. ❑ W­Up ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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
XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�dNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
/❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�No
El NA
El NE
Oh I
t Or ssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes )21 No ElNA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ElYes �No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (iei discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
12128104

Facility Number `
Q Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit D'Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 11 bb Ob Arrival Time: Departure Time: County: 'p1.40 _1?j Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: "oxc- G T Fr m ►J
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = { = Longitude: = ° = 6
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
i
❑ Wean to Feeder ❑ Non -Layer
El Feeder to Finish
I q (. 4,0
1 i/ [JG
U Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
E]Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: =
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes YNo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
12128104 Continued

Facility Number: 3 — Date of Inspection o6 sV
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes EtNo ❑ 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 6-6a Zi
Spillway?:
Designed Freeboard (in): M , s !9 +5
Observed Freeboard (in): �/ y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [a No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElE 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 environmentalthat, notify DWQ
El7. Do any of the structures need maintenance or improvement? Yes �No [I NA [I NE
8. Do any of the stuctures 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 O No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Lt1 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) _ 3 U') S G
13. Soil type(s) A V—P{Z11 1izk L(
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[allo ❑ NA ❑ NE
ONo ❑ NA ❑ NE
ff No ❑ NA ❑ NE
E['�6 ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name F Phone: (!(J 716 ` ? 3
Reviewer/Inspector Signature: Date: /I d d

• Facility Number: 3l — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes u No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L/ I No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? El NNo ❑ NA ElNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes M!o ❑ NA ❑ NE
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
D o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L2No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
El No
❑ NA
❑ NE
27, Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
D o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E! No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
1:1 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
Lr 1 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
2 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?
El Yes
,.,/
I�TIo,
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ff No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

dDivision of Water Quality
Facility Number 3 1 g Division of Soil and Water Conservation
O Other Agency
Type of Visit dCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (3�Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 1� 110 V S Arrival Time: a� Departure Time: �� County: V Q
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Ca ?"I �
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Region:
Back-up Certification Number:
Latitude: 0 0 = t ❑SA Longitude: = ° = 6 = {!
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Layer
❑ Non -Layer
El
❑ Wean to Finish
Wean to Feeder
Feeder to Finish 1 4 LJO
❑ Farrow to Wean j
❑ Farrow to Feeder i
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkev Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dai Cow
❑ Dairy Calf
❑ Dai Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Ca
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes L�'N ❑ NA El NE
El Yes Ld'N0 ❑ NA ❑ NE
12128104 Continued

Facility"Number: - Date of Inspection o 0
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 2Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (A 6-0-0 CA G -OOA`
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Zy
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes C1 o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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 environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes �J No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �
9. Does any part of the waste management system other than the waste structures require ElYes M<. ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes b No ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes El No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus - ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) l�; e a~ nA. L G ) S % o
13. Soil type(s) A V'YI- y 0_-VL+,. r,--
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes❑
7No
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'❑
Yes
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
Yes
ElIl
E�,'N_
N�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
. -. ��
Comments'(refer to question•# 'Explain any YES answers and/or any recommendations or any�other comments`
,Use dr`awtngs:of facility to better.ezplaiii situations. (use addihoaal pages:,astnecessary
Ei7it,to 0 D tLk-"1Z-- c6
Reviewer/inspector Name SG tJ ti I Phone: (_q/Q)- q6 - 7 (
Reviewer/Inspector Signature: Date: /o Vo p.�
12128104 Continued

Facility Number: 31 - d Date of Inspection o 2a o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections, /El
Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes 2No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes UKo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 04/0 ❑ 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 EEC Noo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ElD Yes o ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes Z No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Bl o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes 2 o ❑ NA ❑ NE
❑ Yes L7 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104

Type of Visit O CCopliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: �DiI roue: I Z o a
NNot erational Q Below Threshold
Permitted Ce r"f a 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: --.
Farm Name: .. G iA n_ County:. W'? Ip
Owner Name:
Nailing Address:
Phone No:
Facility Contact: Title:._ Phone No: ..
Onsite Representative: (ja—JIntegrator-.------------CA�-k S
Certified Operator , , , _ .- _ _ _ Operator Certification Number:......._.._........__...____,
Location of Farm:
r14
❑ Swine ❑ Poultry ❑ Cattle ❑ horse Latitude • " Longitude • 4 it
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Na
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in galltnin?
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 Mzo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes L
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: _ _ _.. . - . 71 ___
Freeboard (inches): yy y�J�
12112103 Continued

Facility Number: Date of inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste APO
kation
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload [I Frozen Ground [I Copper and/or Zinc
12. Crop type Q
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVVMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ff <o,
❑ Yes 10
❑ Yes DKo'
❑ Yes Leo
❑ Yes Io
❑ Yes 01,10
❑ Yes 0<0
❑ Yes
C' o
❑ Yes
pfi_ Tom
❑ Yes
Yes
CWo
Rio
❑
❑ Yes
040' zo
❑ Yes
No
❑ Yes 21 To
❑ Yes 3-No
❑ Yes ❑*o
❑ Yes Q No
12112103 Continued

Facility Number: — Date of Inspection
Re uired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the. Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakeis on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDFS required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes EfNo
❑ Yes 24
❑ Yes [�Zo
❑ Yes To
❑ Yes No
❑ Yes ,QNo
❑ Yes Li' O
❑ Yes L'12
❑ Yes
es No
❑ Yes �ro
�Nv
El Yes
❑ Yes io
❑ Yes
❑ Yes [ ro
12112103

ra
Type of Visit f6 Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit`-95 Routine O Complaint Q Follow up O Emergency Notification O Other
Date of Visit
Facility' Number S
Permitted ❑ Certified ❑ Conditionally Certified ❑ Registered
Farm Name: 4�wzz ....' r�Z—.FE.T .. �.. ,�......�_._ .....
Owner Name: .......... ,G..V F....6 W-- .f F ...
MailingAddress: .........................................................----------•-.....------
Time:
❑ Denied Access
10 Not Operational O Below Threshold I.
Date Last Operated or Above Threshold: ..... ...................
County:....(''......................................................
Phone No:
Facility Contact: ......................................0..
_........ ... Title:..................... Phone No:...................................................
Onsite Representative:.....!:..P 1 .....z..... .......... Integrator:..�,,.��Q�,�..........................•I.....................
Certified Operator .............................................. ..... .......... ........ ........................... ........ Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` K Longitude • 6
ElWean to Feeder ❑ Layer ❑Dairy
eeder to Finish ❑ Non -Layer < ❑Nan -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish :- nr..+::i .,R..., r +......::. -.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes A No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a_ If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
& Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge froze 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
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes A No
❑ Yes ONO
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes /No
Seture I Sture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ... .?".............. ............................. ..... .................... ...... ........ ................... ...... ---
Freeboard(inches): ............ ................ .......... L.......................--••--......................_............I........................... :..........................

Faeilit� Number. g Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes N0
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notih, DWQ)
7. Do any of the structures need maintenarim/improvement?
❑ Yes X No
8. Does anypart of the waste management system other than waste structures require maintenance/improvement?
❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
i`� Yes 1`0
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes A No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
Yes No
12. Crop type O GCr �!, ..
13. Do the receiving crops differ with those designated in the Certified 43imal Waste Management Plan (C WMP)?
Yes ,INo
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 a= determination?
tEl Yes /❑ No
15. Does the receiving crop need improvement?
❑ Yes X No
16. 1s there a lack of adequate waste application equipment?
0 Yes jNo
Required Records & Documents
I 1
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readiiy.available?
!!!!!
(ie/ WUP, checklists, design, maps; etc.)
❑Yes o
19. Does record keeping need improvement? Cie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes No
20. is facziitynotin compliance with any applicable setback criteria m effect at the time of design?
❑Yes o
21. Did the facility fail.to`have a actively certified operator in charge?
❑ Yes No
..2..Fail to noti"gional DWQ of emergency situations as required by General Permit?
Cie/ disebarge, freeboard problems, over application)
❑ Yes N
23. DidReviewer/mspector.fail to discuss review/mspectio�n with on representative?
Yes . �z
24. Does facility require a follow-up visit by. same agency?
Yes 1 o
/-No
25. Were anyadditional. problems noted which cause noncompliance of the Certified AWMP? .
❑Yes
0 No violatkms or:deficienei:were-moted during this visit You -will -receive no further.correspondence:about-thisvisiL

f' 1
Facility Number: — Date of Inspection
r� nt
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of -properly within 24 hours? ❑ Yes o
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 IZNo
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 4o
Do the animals feed storage bins fail to have appropriate cover? ElYes i7NO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? El Yes /❑ No
Addithinal Comments and/or Drawings:
sZTE 15 I/EK� �E/� il/12r�1s
05103101

�7ype of Visit 0Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 6 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of Visit:
Permitted El Certified O Conditionally Certified 13 Registered
Farm Name: ......�� iC.... .....:.. ?:a..i'1.........a.! !'... ...............................................
OwnerName:........ .!. .....Gf.l:f-: /7.............................................................
O Time:
r Not O erational Q Below Threshold
Date Last Operated or Above Threshold: .........................
County: VT . 1 ..+!1................................ ....._W . W_
PhoneNo: ................................................. .......... . ..
FacilityContact:............................................................................... Title:............................................................... Phone No:...................................................
MailingAddress: ............................................................................................
Onsite Representative: .N...ndl. S7'� � T.�. '� ........... Integrator: •. ....................l _........
L..............................................I...................
Certified Operator:...... .................... Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° 61 Longitude • 4 46
Design ''. Current Design :.Current Design Current
=.Svnne
=_ -PuPopulation r;Ca ap op "ahon:Ca aci ..Population- :otry city, P- ❑ Dairy to Feeder ❑Layer :
Feeder to Finish = : ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish TOtal ]ie,Sl '
Gilts gn.:CaP#0
❑ Boars Total SSLW
47
- Number of i;agoons Z ❑ Subsurface Drains Present ❑ I-agoon Area ❑ Spray Field Area .`
Haldmg Ponds 1 SoVd Traps __ ❑ No Liquid Waste Management System<
�c
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 gaVmin?
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?
Structure 1 Structure 2 Structure 3
Identifier: ......................................... .......................... ..............
Freeboard (inches): 43 ` 6
5100
❑ Spillway
Structure 4 Structure 5
❑ Yes ,�rNo
❑ Yes ffNo
❑ Yes ONO
hJa
❑ Yes XNo
❑ Yes Ff No
❑ Yes ,EfNo
❑ Yes XNo
Structure 6
Continued on back

Facility Number: 3 —g Date of Inspection 2 A
5. bre there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes YrNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes �'No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ]Zf No
8_ Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes IffNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes O No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Ef No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ONo
12. Crop type rWi~r 1VA4t (-6VV4r01 GrrvtZe , 5► ,-4 � G rqr'v%
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes j1(No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes J No
b) Does the facility need a wettable acre determination? ❑ Yes j2f No
c) This facility is pended for a wettable acre determination? ❑ Yes .;dNo
15. Does the receiving crop need improvement? ,UYes ❑ No
16, Is there a lack of adequate waste application equipment? ❑ Yes ,f No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ZrNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(ie/ WUP, checklists, design, maps, etc.)
❑
F1No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
$No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Z No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
JZ No
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
j2YNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
j2fNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
j!jNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JZ No
to•yiotatit?mis.ot. 0orldenctes v►6re mote# 00 iiig this;v�sit� • Y;oj>� wiii�•teb "iye oo 4itt1 g •
comes' oridence. about: this 'visit.: ...
iments e(r' i e to="question "#): Explaiii< any YES answers an or any reeommen"tions or:'a
drawings aftdxpanitn,;(saddanipaes:snarbtoy) rv.
A.
`T e �'a�,'1;�� anol mco,-dS qre well ke�,�.
15) Wn,rk +e Bil i e vto-%6,rrvlVdA, 1fWff->Cra+j-ield,g Ar1.Gl Q34ubl�5h .
� 6cVdA i n -�-i,ese etre,0 .
i. r
Reviewer/Inspector Name
Y
Reviewer/Inspector Signature: - l% �/" Date: lc 2 a 5100

Facility Number. 31 Date of inspection
Ottor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes J3111
0
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 10 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 �Q 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 9No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes JZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Yes ❑ No
-. wings: —
_.
5100

& Division of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason.for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: B QQ Time: 35 Printed on: 7/21/2000
3d 88
Q Not O erational Q Below Threshold
® Permitted © Certified ❑ Conditionally Certified E3 Registered Date Last Operated or 1Above Threshold: ......................
Farm Name: ...... ..'..e.....gr. �TT:.t'�...t`rl.r'R......... Count': ... Poe!i✓1........................................................
.........................................
OwnerName:......Cz1.!................ ... tf..!1........ Phone No:......................................................................................
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: ....................................................�...............-'._........_.....---..._....................................................................... ......f........................_...._. ..........................
Onsite Representative: ...... A,±\A.�..... .r�..'.�..'...!�..i.�...................................................... Integrator: .... C.Our.rR11.�:`....................................................
Certified Operator: ................................................................. Operator Certification Number:...............
Location of Farm:
OSwine ❑ Poultry []Cattle []Horse Latitude �• �� Longitude �• �� �
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer ❑ Dairy
Feeder to Finish Q ❑ Non -Layer JE1 Non -Dairy
❑ barrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons Z Subsurface Drains Present ❑ Lag-nn Area Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
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 estOnaled 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 0
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ........ ................................•..._..............................................................................................................
Freeboard (inches): 3 5 35
5100
❑ Yes �3 No
❑ Yes 0 No
❑ Yes No
n/'
❑ Yes P No
❑ Yes 9 No
❑ Yes Pj No
❑ Yes I!q No
Structure 6
Continued on back

Facility Number: 3I -06 Date of inspection B OQ Printed on: 7/21/2000
f4
5.1. Are t%re any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion, ❑ Yes 3 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 Jj No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes H No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
19 No
Waste Application
10. Are there any buffers that need maintenance/improvement'?
❑ Yes
[3 No
11. Is there evidence of over application? ❑jExcessive Ponding [IPAN ❑ Hydraulic Overload
ElYes
0 No
12. Crop type Se_-S1 ud 6e'.?4 "a 4f Gr-c ze S- ► Xr d l
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
3No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
O No
b) Does the facility need a wettable acre determination?
❑ Yes
[21 No
e) 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
F] No
Required Records & Documents
IT Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
Vj No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
4
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
ZNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
,®•No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
A No
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes
[5;No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
FfNo
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
KNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
2�No
0:Rdifciences were ooed- duithis:visit'• Yopwll •reeve iW furh& .g
• rori espori e>Rce: ahou 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):
%S LJQ' �a re^co�a�r' grasScs E�Qm SQI�}i4n ��rn,vde, �r'��d •Z
?7--
rl
w
Reviewer/Inspector Name -5710146VA M 04 i r
Reviewer/Inspector Signature: �' f d Date: d 3 5100

Facility_Number: 3/ — Q8 Date of Inspection DD'
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
M 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
0 No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
[9 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
;ff 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
JRNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
�9 No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
El Yes
❑ No
Xddifionaommentsan OP eIeFYIIIgS
7

Q Division of Soil and Water Conservation- Review -�
-�" Q Division of Soil and Water Conservation _;Compliance Inspection
w ivision of Wiiter Quality -Compliance Inspection
n t ye
-
Otlier Agency,--,OpYeratloo
:
,UPPR"outine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection 7
Time of Inspection 24 hr. (hh:mm)
0Permitted'Wertif ed © Conditionally Certified 0 Registered JE3 Not Operational I Date Last Operated:
Farm Name: Qn1Q ......-G � i �F �`/� .......... I,�!V�.................................... County:...... b a
.............
Owner Name:...,_,,.. Phone No:
Facility Contact: ..................................... Title: ................................................................ Phone No:
MailingAddress: .......................................................................................... ........................... ..............................................................................
Onsite Representative:. �c7.{ ... %*f ........
.....�t.� F ....:!�.... Integrator:....,C%+Ai�-J. LL_.�5 ..........
...! ........ ................ ...................... .....
Certified Operator:
Location of Farm:
............................................................. Operator Certification Number:
A
T
Latitude �` �� Longitude
Design Current:' .Design'_ CUCCenE, -, Design,..
Current71
Svi±ine_. 'A'° -= Ca achy Population :Poultry:=;Ca aeity Population Cattle Capacity
Population
v ❑Wean to Feeder ❑Layer ❑ Dairy
Weeder to Finish 4 ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean _
❑ Farrow to Feeder ❑ Other
-
❑ Farrow to Finish Total Design Capacity
❑ Gilts ;..
❑Boars `" ^ ti u. - s: - Total''SSLW '
-. Number of Lagoons - ❑Subsurface Drains Present ❑Lagoon Area ID Spray Field Area
Holding PondsJ Solid Traps N ❑ No Liquid Waste Management System
_
Discharges & Stream Imp
1. Is any discharge observed from any part of the operation?
❑ Yes VNo
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 J�ZNo
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 RfNo
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes VfNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes B'No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L�
Freeboard(inches): ...... z......................... Y.1.................... .................................... ................................... ......................................................................
5. Are there, any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Vlo
seepage, etc.)
3/23/99 Continued on back

Facility Number:. J -gg Date of Inspection I t► // 7 Q�
6. Are there'sfructures on -site which are not properly addressed and/or managed through a waste management or�`�`J
closure plan? ❑ Yes JJZ'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 ZINo
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes P(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 '1_1�o
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes p'flo
12. Crop type C _ '?U_'Avpp, % S. C R-sa:
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes o
14. a) Does the facility lack adequate acreage for land application?
❑ Yes _
b) Does the facility need a wettable acre determination?
',
❑ Yes NVo
c) This facility is pended for a wettable acre determination?
❑ Yes XNo
15. Does the receiving crop need improvement?
❑ Yes O'Nlo
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑'lo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? '011es #Ko
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 X No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports) ElYeso
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 ANo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes O'No
23. Did Reviewerlinspector fail to discuss review/inspection with on -site representative? ❑ Yes ZNo
24. Does facility require a follow-up visit by same agency? ❑ Yes �No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes�No
yi. . . io-. . .o..... en... were noted• during i. s'visjt' • You Witl•reeeiye ti6 further : :
.,r....................................
correspondence. about this vtstt.
ti_ _
Comriients {refer to question #): Explain any YES answers and/or any recommendations or.`any:other eomments;=
W
Use,drawings of facility to better explain•sttuatibns (use additionmipages asmecessary) `$ -
/ r.l /i 1/� v 0 2 N i��3" C 7J Gz� 14►.m :+�`o$�`R C.� Ty
Reviewer/Inspector Name
Reviewer/Inspector Signature: r, Date:
3123/99

Facility Number: :I — 9
Date of lucpection
Odor Issues
`26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
21Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
,�No
roads, building structure, and/or public property)
29-
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
E'1Go
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
�o
31.
Do the animals feed storage bins fail to have appropriate cover?
[:]Yes
J'No
Do the slush tanks lack a submerged fill pipe or a permanent/temporary cover?
Yes
❑ No
I-Additional.Comments an or= rawtn - _
iI
3z) ?F,1o'-tCA0X- (-SAS V151kAkU-1 l�vA�tn�� ���� (F f�CYC-t.�
�trz�

Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number 3 Time of ��
Inspection _ 24 hr. (hh:mm)
p
© Registered 11 Certified 0 Applied for Permit' Permitted 1[3Not Operational Date Last Operated: ....................
Farm Name. .�AA.t S........6t._��.Z11.......�e r"'.. County:...�tf�?�±.x-................................................................
'............................................
Owner Name:.. ............. 6
............. ��....W46.--..................... ...:.. Phone Flo:....��.ilt�..��t�:..�G�..........................................
FacilityContact:...................................:..................................I....... Title:.....................:.......................................... Phone No:..................................................
Mailing Address:.... 3.31n....... /U:....N. ..... ..[U... :................... . ................ ...!?.t1l�pvr�4 hl.G........................... ��i.�'...... f.
Onsite Representative........... ;,. A."[. ........... G.r..tiner.................................................. Integrator:.......�t3 x 4..i................. .......................................
Certified Operator;...... t G� Operator Certification Number,.--i...!.7�.....rs. ................. ....... I....
Location of Farm:
..east..a.f..... ....................................................................:........-----------....------...................
..... .................. . ...I....... .................................
Latitude Longitude
Design;, Current .
Design Current Design'. Current,,
Swute ~: Capacity Pouulahon
Poultry ><. Capacity ;Population Cattle Capacitye;Populattan
x'
Wean to Feeder
❑ Layer
❑Dairy
Feeder to Finish
f[E]
E Gt{d
a:
❑ Non -Layer
❑ Non -Dairy
Farrow to Wean
K°
❑ Other
❑Farrow to Feeder
❑ Farrow to Finish
Total Design Capacity
r
,.f
❑h
Gilts
❑Boars
`Total SSL,W (j 2_6 p
Number of Lagoons 1 Haldtng PondslCgSubsurface
Drains Present ❑ Lagoon Area IM Spray Field Area
h
P ❑ No Liquid Waste Management System
u,
.
General
L Are there any buffers that need maintenance/improvement? ❑ Yes M No
2. Is any discharge observed from any part of the operation? ❑ Yes M No
Discharge originated at: ❑ Lagoon' ❑ Spray Field [I Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notifv DWQ) ❑ Yes [j No
c. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? Of yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes [9 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes i19 No
5. Does any part of:the waste management system (other.than lagoons/holding ponds) require ($Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes [,U No
7/25/97 Continued on back

Facility Numher: 3� --
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoops,llolding Ponds, flush Pits, etc.}
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 'Or .....__.. #
.................................................... I .......I ............... _...... _... .............................
Freeboard(ft): ........... ................ . 5...................................................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes N No
❑ Yes &2 No
Structure b
❑ Yes [3No
❑ Yes (2 No
12.
Do any of the structures need maintenance/improvement?
i 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
[X No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type.Q4.rY&U&.........................aw.\AU� ._..Y"'V ......................._. a .............SR!���r......._..G�.`.:>�......._......_............................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMI')?
Cl Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
0 No
18.
Does the receiving crop need improvement?
❑ Yes
® No
19.
Is there a lack of available waste application equipment?
❑ Yes
Q No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative".
s
❑ Yes
[A No
22.
Does record keeping need improvement?
V] 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?
Cl Yes
Qg No
24.
Were'any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
W No
:3 No -violations or deficiencies were noted. during this. visit..You.will receive no further
.. correspondence aboiet this.visit:•
Comments (referto question #)::Explain any:YFS answers and/or anv recommendations -or any other Comments
Use drawings of facility to hetier explain situations. (else additional'pages as necessary) 'y { r
a
CID4 "yvt j iwe �ros+e p�le,%J rya .I,
12.. �xosror o-r[as or
1�.)t�a
Wvou in[ c� Ske"I V toe.. 6 [k All �f- rt-Se4 t� . &A., e.vtp S D r� i>`Yulr �1 Let[ S O �' �pQ^�✓
t�ga0-"
gkOLZ 6e- M_W_yVk4
6 6r 41,C k3 C� q" rrwrr9,64, s iwult hQ 4or lw-mJ .
rd
Y0.�L �or c4v�,> 67 ice. �1.' L� 4vv� lmk3 , "_A-1IW,. Lf a�ao a� 1.4Y��L Shod 4 t- M.tcjd
7125/97
Reviewer/Inspector Name
Reviewer/Inspector Signature _&-.._Z - Date:

❑ Division of Soil and Water Conservation 0 Other Agency
IM Division of Water Quality
Routine O Complaint O Follow-up of DW2 inspection Q Fallow -up of DSWC review O Other
Date of Inspection % -7
Facility Number 3
Time of Inspection 24 hr. (hh:mm)
13 Registered ® Certified Applied for Permit
© Permitted
10 Not Operational
Date Last Operated:
�[3
FarmName: ............ ....! r5.r#an...... rYxn.-...............................
... County: ......... 4lik.*....................................... ............
�] tt
OwnerName........ Q.i........f!.-f't-in ...........................................................................
Phone No:...�`f .P. ..2-9Y-. Q4-4..........................................
Facility Contact: ............ ..r.!r....................................
Title: .......... ?f4f....p....................... ........ Phone No: `�J4).�5�_`,s~4,.'.}...... .....
l4lailingAddress: .... 3�r.... .... .... 44?1..��............................................. ....1`.�i g&aL&... tl'Nja-:................................. .... ....�"a.I........
Onsite Representative :.......... ...........................
......... .-.............................. Integrator: ........ Crwad.S.......................................................
Certified Operator: .............................
Location of Farm:
t � Lod
......:............................... Operator Certification Number,.........................................
-:..:...UkRl.............................................................................................................................................................................................
Latitude Longitude �• �� ���
r
Designo Current'y Designs +Curreni .Design
_y Current
Swme <°
Capacity Population Poultry Capacity Populahoti Cattle < Capacity PopulatiI on
c
: ...
M
,..
❑ Wean to Feeder
� ] ❑ Layer ry
Feeder to Finish
FDE
qu ❑ Non Layer Non Dairy
,
❑ Farrow to Wean
Y F.
:. ❑ Farrow to Feeder
❑Other ,
❑ Farrow to Finish
Ts g otal Dela Capacity
f.-0 '
❑ Gilts
❑ Boars
' Total SSLW -
Number of Lagoons /Holding Ponds1,11M Subsurface Drains Present ❑ Lagoon Area
[&Spray Field Area
` ❑ No Liquid Waste Management System
,*ram
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes 10 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-at/min?
A. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes M No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ®Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97 Continued on back

rf
r
Facility Number: 3 i -- V
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,11olding Ponds, Flush Pits, etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2
Identifier: ................
Freeboard (ft):.......3.:.9................................ 1.4 ..............
10. Is seepage observed from any of the structures?
Structure 3 Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
•13. Do any of the structures lack adequate minimum or maximum liquid level markers?
14'aste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes N No
❑ Yes ® No
Structure 5 Structure 6
...................................................................................
❑ Yes t;No
❑ Yes No
Yes ❑ No
❑ Yes R No
❑ Yes 0 No
15. P type � "" .. y .. sm.giA ..........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes [34 No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only -
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
® No:violations-or. deftciencies�tivere notedAu' ritig this" visit. - Yoit�wiU reCeive`ii&furtlier : -
correspondence &out this =visit.- -
❑ Yes t4 No
0 Yes 5d No
❑ Yes [, No
❑ Yes RNo
❑ Yes -RI No
5, Yes ❑ No
❑ Yes §4 No
❑ Yes JANo
❑ Yes ;K No
•.c. 4& �Yk: ¢x'� 2G k - zip 9c -. � �. �} -:-•� i K -._ €,p .,_ 2`....5' .SYa" ;F.. fir•. ",� ,�,. 3dPt �P9H3 'O. W- .:.44F � ?
�om�t ( er to£queshon #) 'Expta�it any,YES�ans�wers andlnr ��� r�o�nenagt�a� or any outer camtne�tts _�,.� r
Use drawings of factltty to better explain sttuatians (use addttEonal asnecessacy)
pagers
� ��� ,�<
-VO i mTyp%1L raSS e� t rt/J�•y �Inrou tI\ (ea5� 5 L �'�t m Llt?YmS S�+Oc�l�
i
�. 1�i 1� oro�r� 1v,�draH•�s 1 � a�� r�a� di 1-t.6• Itt� .
12, l rUt�- �t�e� 6� �(� � aoa15 sV+od�d � Qxfi�dtkl qw�� `f+l..c etrts�2C� a►•tcc� �loc.`'��+Ei,ld Win
aid r�ettleci. pStor. war '% at. tNru� mjoli of (o,pov, } � SkaJld be A (4 j W aaj
'y
reseea?Ie.� ,
Z ��w c���+tMary S�taUII� �Oe ir• ccvt4-;�
7/25/97
. ° r 7.
Reviewer/Inspector Name K 33,
Reviewer/Inspector Signature: Date: �0

II
•
-2IGo
34bo
•
is
.1
Site Requires Immediate Attention: 'JD
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: g , 1995
. e Time: 4 �)-&t _
Farm Name/Owner:
Mailing Address: 3.3G 72_1g 51$
County:
rrv--P L.1 'i
Integrator. S - Phone: tl 6 4
On Site Representative: Phone:
Physical Address/Location: �C-s _ s 2 l `-t 6 �-
Type of Operation: Swine Poultry Cattle
Design Capacity: 4(o 4o - Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: -3 4 ° SUt ' a S' -" Longitude? 7 ° 4 $ - 0-7 " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) &or No L ) Actual Freeboard: 3 Ft. Inches
Was any seepage observed from the la oon(s)?
Is adequate land available for spray? es or No
Crop(s) being utilized: C �s L
Yes or No Was any erosion�obslerved? Yes or No
Is the cover crop adequate? %!;Dr No
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwellings? Yes oANoJe-
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other -
similar man-made devices? Yes or No ' If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Wr4 --
Inspector Name
TQS1
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.