310091_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quaff

ivision of Water Resources
Facility Number O Division of Soil and Water Conservation
p Other Agency
Type of Visit: Compl' a nspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: z / Arrival Time: 9 Departure Time: 2 9 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: SGI r`� �' a^�� 1� V Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.:;.
Wean to Finish
We to Feeder
eederto Finish
ir—o
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Certification Number: I -7 L`—
Certification Number:
Design
Current
Wet Poultry
Capacity
Pop.
La er
Non -Layer
Design
Current
Dry Poultry
Capacity
POD.
Pullets
�.Iurke s
Other",T ITurkey Puults
1 10ther
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
' `Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes E2-Ko 0 NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No NA . ❑ NE
❑ Yes ��o�NA ❑ NE
❑ Yes ❑ No ❑ NA ONE
Page I of 3 21412015 Continued

Facili Number: JDate of Inspection: �. /
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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �= ---- _ Z
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 P40 0 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 fo DNA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes to❑ 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 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �NA ❑ NE
maintenance or improvement?
I I- Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ET5o ❑ 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
[!IXN❑NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ej NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ll No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
N ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 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.
[ 1 Yes E3,Wo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers t
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
�❑
❑ Yes 0'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 31
- Date of insection: L-Ir
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 EJ-N ❑ 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 ErNA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Divo ❑ 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 ErNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ❑'No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 'ffNA ❑ 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
KNo
NA ❑ NE
NA [:INE
NA ❑ NE
i�yr�y riy11111.]r11�44Vi i�uu��.. - � ■ �s��i�.• 1w L 1 u' /J7 �
Reviewer/Inspector Signature: `�'�`� "L Date: /
Page 3 of 3 21412015

Division of Water Resources
facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of visit: Utompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: d Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /� J
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time: ® Departure Time: l Jy—J County: b� jr1) Region:
Title:
Owner Email:
Phone:
Onsite Representative: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:
17
Certification Number: 1 4-
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Dry Poultry
Layers
Non -Layers
Pullets
Turks
Turkey Poults
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [4No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA 0 NE
❑ Yes �o
❑ Yes o
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA [] NE
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l AGaW7i
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.)
t
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 orgYesD
ironmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes C1 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C6 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes LEI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload -❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[] PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[� o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
' No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
� o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
[ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E,No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FZ/N o
❑ 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 E6No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: -ZI 1 jDate of Inspection: 6
24.`Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 0 3No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes ZNo ❑ 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 [Zr) ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[—]Yes rNo ❑ 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 Rl"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 dNo ❑ 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 21"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 2] NN ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes g
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ YesNo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional pages as necessarv).
q. ) YOW �J9A5s 1EE060 OrW l�G�r/ .t?� !✓pu.,
Reviewer/Inspector Name: 12> FA Xy C [ Phonk �U
Reviewer/]nspector Signature: /&."'� Date:
Page 3 of 3 21412015

Facility Number. =0 Division ofSA and Water Conservation
-® 5
Agency.,
h M,
Type of Visit: 7Routine
pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: ® County: ZkPL) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: N1aT�R/ irj�.(�(� Integrator•
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 0 2� b
Certification Number:
Longitude:
Design CurrentDeslgn �Curre11t7:' Design Current
Swine ..,'Capacity WeP � aci p tyPo p. t _ �� oultry ,Cap "Pop _.Cattlel. ,_ ".Capacity. .;Pap_. ,
Wean to Finish
Wean to Feeder
k Feeder to Finish (J
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
La er
Non -La er
a Design Current-:�-,em.
k
"dDr �Poul Ca "aci 1Po
Layers
Non -Layers
Pullets
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
_n
Turkeys
Other Turkey Puults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes [�No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes ❑ o [DNA ❑ NE
2, Is there evidence of a past discharge from any part of the operation? ❑ Yes Eo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facilitv Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2
Identifier: LA 6m� i A
Spillway?:
Designed Freeboard (in):
❑NA ONE
DNA ❑NE
Structure 3 Structure 4 Structure 5 Structure 6
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 [Z(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 d- o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [-]Yes Ed-
❑ 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 ONo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes [Z/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
r] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 6140
❑ 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 �Ko
❑ 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 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 21412014 Continued

Facility Number: - Date of Inspection: 'i
24. DiNhe facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E!(;Ilo ❑ 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 YNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2/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 Ld 1V o ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes M/No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[/NNo ❑ NA ❑ NE
E ❑ NA ❑ NE
Z❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinss of facility to better exvlain situations (use additional vases as necessarv).
Rev iewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: Ito 6 _ IM
Date: O�
214,12015

U Division of Water Quality J
Facility Number - O Division of Soil and Water Conservation
q O Other Agency
Type of Visit: Co pliance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: cj Arrival Time: Departure Time: County: DL)R.:,pj Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: O a LLPCI pO ,'P� i _ 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: '
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Dry Poultry Capacity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes [t] No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes 17
No
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page l of 3 21412011 Continued

�Fheility Number: J i - !i 1 jDate of Inspection:
Waste Collection & Treatment
4 is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ONo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2? Structure 3 Structure 4
Structure 5
Structure 6
Identifier: i !�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
�NoF
❑ 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 environmhreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes enta ❑ NA ❑ NE
�y
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
0 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes [.2/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes YNog
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes Ey o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes EJ/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes Flido
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No 0 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 /N0 NA ❑NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Fakility Number: IDate of Inspection:
24" Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes WN(o
6o ❑ 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 Rio ❑ 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
NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
2/No
❑ NA
❑ NE
❑ Yes
CfNo
❑ NA
❑ NE
[:]Yes E o ❑ NA ❑ NE
❑ Yes [r�Co
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional oaees as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1-1
V��
Date:
21412 I4

�41 © Division of Water Quality
r Facility Number ®- 0 Division of Soil and Water Conservation
s
0 Other Agency
Type of Visit: Co fiance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: F County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: J O1-�44AO Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
can to Finish
can to Feeder
!eder to Finish
.rrow to Wean
.rrow to Feeder
.crow to Finish
Other
Other
Latitude:
Phone:
Certification Number: t�22
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Canacitv Pon.
Layers
NOD -Layers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
0 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
yNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
g
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili4y Number: - Ok Date of Inspection: 1 a
)Vaste 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): 4'z- `W
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
C;�No
❑ NA
❑ NE
waste management or closure plan?
If any of,questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes < ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E)'lw ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Q No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
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
6No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EffNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes
ZNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
L:14o
❑ NA
❑ NE
l8. Is there a lack of properly operating waste application equipment?
❑ Yes
[;[-IGo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
I �J
❑ 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
o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: a t - Date of -inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes d1N1YNo
❑ 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 gNo ❑ 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
El Yes
—
p, lWNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
l__I 1V
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ YesrNo
❑ NA
❑ NE
34. Does the facility require afollow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: v a W tj e,
Reviewer/Inspector Signature: Q'e,
Page 3 of 3
Phoriolw f -C(,, 112f
Date: tU
2/4 2011

ti 0 Division of Water Quality
Facility Number `31 - R 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 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: 1, Arrival Time: f ?ids Departure Time: D[7 County: OLPLU- J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ♦ A M Integrator: 4
Certified Operator: Certification Number: 1722 g
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish 5$9a `{
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Pullets
Other
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 ZNo ❑ NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ YesXo❑ NA ❑ NE
Page 1 of 3 21412011 Continued

l aciliNumber: Date of inspection: to
I Z
Waste Collection & Treatment
4:ds storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E21<o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA
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
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
Ed/No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes � o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes WNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ 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?
1 I . 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):
1.3. Soil Type(s):
l4. 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?
❑ Yeszo
❑ 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 N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Re uired 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 E"No
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 11
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 " ❑ 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

Facility Number: Date of Inspection: Ili %r
24. Did the facility fail to calibrate waste application equipment as required by the permit ❑Yes dNo ❑ NA ❑ NE
15. 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 �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [3 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
ZfNo
❑ 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
EfNo
❑ 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
WNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
1
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
❑ NA
❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
W�lo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yeso
❑ 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 exnlain situations (use additional napes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: l 33 b
Date:
21412011

UDivision of Water Quality
Facility Number ©- f�`_`___,� O Division of Soil and Water Conservation
• O Other Agency
Type of Visit: Co liance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 16 .t � Arrival Time: Departure Time: '3 County: cLiptm/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ) j jJ A -'NAZI N1 y
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
Owner Email:
Phone:
Title:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -Layer
Non-L
Pullets
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?
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 ❑ o ❑ NA ❑ NE
[:]Yes [go ❑ NA ❑ NE
❑ Yes No ❑ NA D NE
Page 1 of 3 21412011 Continued

Facility Number: 7 1 -ql Date of Inspection: !d g 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 0 NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier. LA krj 0610V2�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): qj L ?/
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes WNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 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 �oo ❑ 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 WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ONE
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 101bs. ❑ 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 0o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ YesrNo
❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes o❑ Yes ��4
0 NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes�Zo ❑ 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 E3<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 rNo
11❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 7 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes�EJ�N
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 ON ❑ 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 o ❑ NA ❑ NE
33. Did the ReviewerAnspector fail to discuss review/inspection with an on -site representative? ❑ YesVNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone> 1D)"16
Date: ! d A.
21412011

1,
0 Division of Water Quality
Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit (Z5 toutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ()Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: �Ip Arrival Time: 0 Departure Time: County: flUR, Ed Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 0 A
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 4 Longitude: = ° = i = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
6�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
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?
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: j I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
6�
❑ NA
❑ NE
❑ Yes
f No
❑ NA
❑ NE
Page I of 3 12128104 Continued

I
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 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: [.A(,=�l 1 pu4 rj6-6N L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �Z
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 t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N [_1 NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes .L No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Wo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes VNo
[1 NA [I NE
15. Does the receiving crop and/or land application site need improvement? El Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes E3 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ElNA
[INE
l8. Is there a lack of properly operating waste application equipment?
ElYes❑
VNo 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 Phone: IU 9I; —_T3
Reviewer/Inspector Signature: Date: 1 411,41 it)
Page 2 of 3 1 12128104 Continued

Faciliiy Number: — Date of Inspection b !D
Re uired 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 Mans El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes L✓1 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 N ❑ 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 2"No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes �o ❑ NA ❑ NE
❑ Yes LJ N ❑ NA ❑ NE
❑ 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
ZNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
2K
[INA
❑ NE
If yes, contact a regional Air Quality representative immediately
7
31. Did the facility fail to notify the regional office of emergency situations as required by
ElYes
El NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L N
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality
Facility Number 3 Q O Division of Soil and Water Conservation
0 Other Ag encv
Type of Visit
C mpHance 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: Arrival Time: 4't�lp Departure Time: County: Lk P Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: vvQAP
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Phone No:
integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 = « Longitude: = ° 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
[N Feeder to Finish
S WO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -layers
❑ Pullets
❑ Turkeys
❑ Turkey Puults
❑ 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?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dai Heifer
E]Dry
Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: E]
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 R No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
YIN,o
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

i
Facility Number: 31 — 9 Date of Inspection
Waste Collection & Treatment ,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes CJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i Ar o-tW f (A &­,,J 2-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `1 o 43
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
RI 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
El No
El"
❑ 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
EKO
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
d/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
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. Cl Yes
,�
LI 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
El No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
L2No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
'swornmndfosorythecommnsoComments o
Use drawingsof facility to..better explain situations (use additional pages as necessary). k ter'
j
ewer/inspector Name L j.IN y��A/� [Phone:ewer/Inspector Signature: Date: 9
v..no � ..r z 12/28/04 .nntinuvd

I )facility Number: 3 ( - g r I Date of Inspection 4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes n No ElNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E3 No ❑ NA ❑ NE
the appropriate box. ❑ ATUp ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
�No
ElNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
E No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
o
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
�'No
❑ NA
❑ NE
Other tissues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,,__,.,,//
o
❑ NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
WNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,�
L� No
❑ NA
❑ NE
'If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
dNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ON.
❑ NA
❑ NE
12128104

U
Faeility.Number
Division of Water Quality "
0 Division of Soil and Water Conservation Y
O.Other Agency
Type of Visit 07Routine
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:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: I ! 49 o7 Departure Time: C] County:. d1111 A) Region:
Owner Email:
Facility Contact: Title:
Onsite Representative: _�joNpTTi%l,,j / r �]� -9j—�%'K-
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
Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: c = [= Longitude: [� ° [= ` ❑ «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
Layer
Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
DischarZes & Stream lmoacts
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 ErNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
El Yes
FNo
El
❑ NE
El Yes
❑ NA
❑ NE
11/18104 Continued

Facility Number: — Date of Inspection 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 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LIAGCO0 1 (A 6-6-oit! 7-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ILA 3 C
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
Ll 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
E No
El NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes
EJ 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
[5"No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ENo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
LI 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
t 2. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
9No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
0"No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LI No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
6/No
❑ NA
❑ NE
v ;.` a �!-r s,� n' _4 : sr�ee:.�:.
Comments {refer to queshonV Expiain any*YES�answers andlor�anyxecommendations or anyptde comQtents ,
Use drawings of faciliity to better explain situation (use additional page's as necessary.]
'- .,.. `� +» - " .; mow" �' S:".'i�`•;'"" _m G :s:.ae'e, r _..a,� _
u
Reviewer/Inspector Name OA(AI �I,10w cc Phonek 91 - 7
Reviewer/Inspector Signature: Date: 5
poop? of ? 12128104 Continued

Facility Number: --9 Date of Inspection dS °
Reauired Records & Documents
1�'Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � o ❑ NA [I NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes Wo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 20 ❑ NA ❑ NE
25. Did the facilityfail to conduct a sludge survey as required b the permit? ❑ Yes TNo ❑ NA ❑ NE
g Y q Y
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ]� ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes WN o ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ZN(o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes NNo ❑ 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 M 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 �/Wo7No
El NA El NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑ NA ❑ NE
Addihonal Comments antl/or'Drarvidgs `;�
Page 3 of 3 12128104

IE1
Facility Number 31 9 1
U Division of Water Quality
Q Division of Soil and Water Conservation t/
Q Other Agency
Type of Visit Q Co7pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: O h 7 Arrival Time: /Z4�S" Departure Time: County: 6UPLIXI Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: v] °Nf-rHAAJ ftLt,�L 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
Operator Certification Number:
Back-up Certification Number:
Latitude: = c 0' = Longitude: = ° =' = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I❑ 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
E]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?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
LAN
[I NA
El NE
El Yes
No
❑ NA
❑ NE
12128104 Continued

Facilitrt Number: f 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?
StructurerI Structure2 Structure 3 Structure 4
Identifier: � j �T d�r (sue N J (A IJnM N/t-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L/3_
dN ❑NA ❑ NE
No ❑ NA ❑ NE
❑ Yes 4Z/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �/No
No ❑ 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application /
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EJ ElNA [INE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes o El NA [I NE
15. Does the receiving crop and/or land application site need improvement? [I Yes YN ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑Yes 7Z40 ElNA ElNE
18. is there a lack of properly operating waste application equipment? ElYeso ❑ 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):
/Q) IV Ec,✓ '. C
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
If Wulf
73Pa
/ o
Continued

Facility Number: — °f 1 Date of Inspection
Required Records_& Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
f�Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
O No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design
g p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E).4o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and F Rain Inspections
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,
o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
L.y�o
ElNA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
�o
❑ 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
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
VNo
❑ 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
G3 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
0 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
iJ N
ElNA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
l:J No
❑ NA
❑ NE
[Additional Comments and/or Drawings:
12128104

s-
Facility Number
,01Division of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
Type of Visit QfCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 19'Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: r Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Sack -up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Boars
Phone -No:
Integrator• .&,An
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 1 Longitude: = ° = , = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
T Ii ❑ Non -Layer -- - - - - - - - -
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
Turkeys
❑❑
Turkey Poults
—EE]
❑ 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
i
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
r'
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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
g24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes ❑ No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑ No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
7131106 ;2. $� cc
37
c-21 <<
Page 3 of 3 IF 12/2&04

F
Facility Number
UrDisrision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit �C(ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit CJ Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
]Nailing Address:
Physical Address:
Arrival Time: -t36 Departure Time: 0D County: f�V Region:
Facility Contact: ` �� 1 Title:
Onsite Representative: ETA WjIy ey
Certified Operator: U\ b Jsc
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
ISA"10
I Ea,44
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [ o [ [= Longitude: 0 ° a j
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
1.
❑ Layer
ILI Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ 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 Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes WNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑fNo El NA ❑ NE
❑ Yes VNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
12128104 Continued

facility Number: 3 f
Date of Inspection t Ur
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA . ❑ NE
Structure l Structure 2 Structure 3 Structure
4 Structure 5
Structure 6
Identifier: _(19f rror� 11LA '� Z
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): 31
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
2 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
dNo ❑ 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
VNo ❑ 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?
I l . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
L' I 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 Drill ❑ Application Outside of Area
12. Crop type(s) ER r► 'Jon CG) S G O C..o_ T"nj
hVITA
13. Soil type(s) A U Q r 1(-- re s
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA [I NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
�
E114o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',❑ Yes
}FEl NA El NE
17, Does the facility lack adequate acreage for land application?
El Yes
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
El
❑ NA ❑ NE
__�
?. z •tea
_.
�omments (refer to question;#) Explain any YES answers and/or any recommends
se d>ra�tngs"oi facilityto-better:e -' Iik'in situntions' (use additional pages4smecessa
al) (JPDA K- C&O F YzecA ki,66a2.425,
FAa'j'^ �Slj tw O D 514 da PE,
Reviewer/Inspector Name } . I Phone: (1116) 3IF 79XI 4, Z63
Reviewer/Inspector Signature: Date: o
12128104 Continued

Facility Number: Date of Inspection �O O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropirate box. ❑ ❑
w ur ❑ Checklists ❑ Design Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
/Yes
[:]No
❑ NA
❑ NE
❑ Waste Application ❑ We ly Freeboard El Waste Analysis ❑ Soil Analysis El Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
l" No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
'
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ZN E
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ZNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2 No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�,/
LQ 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
W�o❑ NA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
��No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
LJ o ❑ NA
❑ NE
Comments and/or Drawings:
12128104

t
, jo Dtvisi©a of Water QualityQ Division of Soil and Water Conservation ' -
0 Other Agency
Type of Visit E) Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Ji Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Rate of Visit: D� Time:
3
Not O erational QBelowThreshold
Permitted p Certified [3Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: 0 tAS a �f f County: : 4 �t
Owner Name:
Mailing Address:
Phone No:
Facility Contact: '� Title: ,�JPhone No:
Onsite Representative: ,,.4I rf.? �[L4 9?Zoe—_ _ Integrator: ,Ag_tAl
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° u Longitude ' 6 K
Design Current
awtne Ua achy Population
In Wean to Feeder
U Farrow to Wean
❑ Farrow to Feeder
Gilts
Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca acity Po ulation
❑ Layer ❑ Dairy
❑ Non -Layer -I I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
Holding Ponds 1 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 man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: /
Freeboard (inches): 3e 33
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
05103101 f Continued

0
M
Facility Number: 3/ —
Date of Inspection I z D
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?
S. 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?
11"aste Application
10. Are there any buffers that need maintenance/improvement?
I I_ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ hydraulic Overload
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA AMP)?
❑ Yes
❑ No
14_
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records _& Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
ElYes
❑ 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 notiffi- regional DWQ of emergency situations as required by General Permit?
(ie% discharge, freeboard problems, over application)
❑ Yes
❑ No
23_
Did Reviewer/Inspector fail to discuss reviewrinspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
..�._--:L,.,..�--'�.-:�
Commenfs {refer to gnestton.`'Ezpl ally YES'answers and/oratey recommendations or anv..otiter comaients:� m a
Use drawinof facility to better explasn situatwns {utse additional i s pages as�ueeessary) ❑Feld Copy ❑ FinaI Notes
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101
Continued

Facility Number: '>/ - IQ
Date of inspection
Odor Issues
26_ Does the discharge pipe from the confinement building to the storage pond or la_ -loon fail to discharge atior 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 anv evidence of U•ind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads. building structure. and/or public property)
24_ 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.I
l . Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ )'es Cl No
O5103101

f N.
Division of Water Quality
0 Division of Soil and Water Conservation .
0 Other Agency'
Type of Visit 19 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Q(Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
13 Permitted Q ertifi!ed ElCondi . nally Certified— Q Registered
Farm Name:
Owner Name: �TliiQ� /V
Mailing Address:
Time:
Date Last Operated
dd}or Above Threshold:
County: k /l
Phone No:
Facility Contact: Title: =Ay
Phone No:
Onsite Representative: Inte ator: —
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a f ff Longitude a
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 ❑Non -Layer I I❑ 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 ❑ La oon Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
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 gaUrnin?
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
Stuicture 1 cture 2 Structure 3 Structure 4 Structure 5
r � 1-
Identifier_
Freeboard (inches):
❑ Yes A No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
0 No
❑ Yes
No
❑ Yes
No
Structure 6
05103101 Continued

}
Facility Number: 3 /— M Date of Inspection ! iJ
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?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
E No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
�No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
ElYes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
`
elevation markings?
❑ Yes
(i�' No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ YesY�aI4.
,�J
o
11. Is there evidence of over applicativ /? ❑ xcessive onding El PAN ElHy ulic Overlo
6—',0
❑ Yeso
12. Crop type V L !%
13. Do the receiving crops differ with those designated in the Irtified Animal Waste Management Plan (C WMP)?
❑ Yes
o
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
o
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17_ Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
it o
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Elyj_
o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yeso
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
o
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
,�(
(ic/ discharge, Geeboard problems, over application)
El Yes
JLJ No
23. Did Reviewer/Inspector fait 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
[3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Camine"nts (refer to,gnestion #): Explain any YES answers and/or any recommendations or any. bt r corumen#s; ^ `
Use�diawings of facility to better explain situations. (use additional pages asnecessary) Field Copy ❑ Final Notes
A_eO )5 4i64Me1_1V MeF,41,_
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
O5103101 Continued

Facility Number: — 1771 Date of Inspection [#*
r
Qdor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ Yes
XNo
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
o
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
o
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
31.
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
4No
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Additional Comments and/or Drawings: ;
A.
05103101

Facility Number Date of Visit: �G Time: Q GQ
0 Not Operational O Below Threshold
Permitted [3 Certified 13 Conditionally Certified © Registered Date Last Operated or Above Threshold: ...__� �....
County 4_h:.....171. .....
Farm Name: .........i�
.�.4s 1^..............................................................................
Owner Name: ................................................... ................... Phone No:
FacilityContact: ................................................................I.............. Title:... ................ ........ ..................................... Phone No: .................. ................ . ..... _
MailingAddress: .......................................j./................._............................................................................................... _
Onsite Representative: F-..,�` Integrator: �
''.............................................................................................................._.............
Certified Operator: ................................................... ........................................................ --- Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° 66 Longitude • 4 u
_
Desiigp " Current `
Destgp Current Desrgi% F Cannreat
Ca ci ;Po vlatiou Poultry
Ca cii ;-.Po elation _ "^ Cattle ; . Ca aci Po 'uiatioii=
y
Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
G ❑Non -Layer
❑ Non -Dairy
Farrow to Wean
Pro,Other
Farrow to Feeder
❑
❑ Farrow to Finish
Total Design Cspactty
-❑
Gilts
IJ Boars
Toga SSLW
Nombe of Lagoons .-
❑ Subsurface Drains Present © Lagoon Area ❑ Spray Field Area
„ T HoldinguPoiids /Solid Traps_: r ❑ No Liquid Waste Management System - _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 4No
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 WNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
❑ Yes O(No
Structure 5 Structure 5
Identifier: ........................................................................ ... . ...............................
Freeboard (inches):
5/00
Continued on bock

/Facility Number: 31 -9 1 I Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
PfNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
OrNo
(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
ArNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
t�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
XNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
4 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
J�(No
�t 4
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
VNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
�;tNo
b) Does the facility need a wettable acre determination?
❑ Yes
�1 No
c) This facility is pended for a wettable acre determination?
❑ Yes
RNo
15. Does the receiving crop need improvement?
❑ Yes
[YV0
16. Is there a lack of adequate waste application equipment?
❑ Yes
2(No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
�9No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
h(No
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
,kNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
tf No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
�rNo
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
lkfNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
t8[No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
allo
N *-Yi0FAtiunjs;0jr 0eficji6nd0 ►ire noted 00 ii. g 4Ms:visjt; • Yo>j« will-te. ft fu4 t�g�
,correspo deli& allout this visit
Use dravrin[gs of faciiltty to. better eatplain situations useadciitivnai pages as necessary}[ ` w;'
l...e lick ,
r
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: -- j--[ S/op

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 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 r'No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ['No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes k, No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes P(No
A4dffional Comments an or' rawtngs:'
A.1
S/00

Division of Water Quality
f _ t O Division of Soil and Water Conservation
O'Other Agency
Type of Visit OCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit iX Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility 'Humber
Date of Visit;; aft '-IDrD
Time: . 30
Printed on, 7/21/2000
O Not Operational O Below Threshold
© Permitted [3 Certified D Conditionally Certified (] Registered Date Last OperatedorAbove Threshold: .........................
Farm Name: RDu............... ✓. Sr..
An:...................
Count': .......... .1............................. ......... I ......
Owner Name:......+�1r.> ........ ...... E.V.-A..y
.....
Phone No:
Facility Contact: u +.1...................Title:
.....................................
Phone No:...................................................
MailingAddress: ............................................................... ..............
.................................. .......
.......................
v
Onsite Representative:...... t tt G ,,., ........
r
Integrator: ............._.rs7�`
Certified Operator:......................................I...............
....
Operator Certification Number:.............
Location of Farm:
lxswine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �� Longitude �• ��«
Design Current
Swine Canacitv Ponulation
❑ Wean to Feeder
Feeder to Finish
�g'17
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer rj Dairy
❑ Non -Layer Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present I ❑ Lag1�on Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
((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
1�(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
�Qo
Waste Collection & Treatment
4- Is storage capacity (freeboardplus storm storage) less than adequate? [I Spillway
El Yes
KNo
Structure Strture 2 ucStructure 3 Structure 4 Structure 5
Structure 6
Identifier: .................................................3 Z "
........................................................................................................................................I......................
Freeboard (inches):
5100
Continued
on back

Facility Number: —q Date of Inspection io Printed on: 7/21/2000
5- Are them any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes JNo
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?
S. 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 AP_ J 7( j
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination'?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & DocumenLs
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? (ic/ 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?
U_ NO •yiolatioris :oi- &rJcWnc' Jes -mere noted- during Ibis; visit. • Voit will teeeiye tid further
- corresaoride' 'e: a�aut thiS visit. .....:.::::::::::::::::::.:::::::: :
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explla�iin1 situations. (use additional pages as necessary):
❑ Yes K No
❑ Yes EfNo
❑ Yes kNo
❑ Yes D�No
❑ Yes KNo
❑ Yes 19 No
❑ Yes EgNo
❑ Yes VkNo
❑ Yes ONo
❑ Yes No
[]Yes E No
❑ Yes ANo
❑ Yes ($f No
❑ Yes J�No
❑ Yes Q(No
❑ Yes EkNo
❑ Yes No
❑ Yes -No
❑ Yes No
❑ Yes XNo
I� 0loyoK
I Prn_ws /DOS o�� _- Yet- � I-e ve f ",Ta gnfetr-�- -
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: % S/00

Facility Number: — 1 Date of Inspection Printed on: 7/21/2000
Od,or Issux
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes *0
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes kNo
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 PrNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
3 L Do the animals feed storage bins fail to have appropriate cover? ❑ Yes d'No
32_ Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ;(No
�e
J
5100

...,[]'DiAsion of Soilaii&*ater Conservation
st
Division olSbil and _Water Conservation :Compliance Inspection
" ® DiAsion-of Water Qua ty ',Eompliance lnspectiQn` _;� - `, -
u m ©=Otlier Agency Operation Revrew
10 Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number 3 Q �_ Date of Inspection
Time of Inspection Z Q 24 hr. (hh:mm)
13 Permitted © Certified © Conditionally Certified [3 Registered 0 Not O erational Date Last Operated:
Farm Name: .......... 01I aH �O Gl s CU l q county: Vp /1 ...............
.....................................................y.......-........... ty:...........-......-.................... -
Owner Name: ........... (S J1A t.Y
..- Phone No: ........
. ...............................................................................
Facility Contact: .........
Mailing Address: .........
Onsite Representative.
Certified Operator:,_..,,
Location of Farm:
................................................................... Title:
.............................................................................................
XOMSC
..........................................................................................
.....................................................................................
Latitude =° =11
Design Cu
S-mne Capacity Popi
❑ Wean to Feeder
® Feeder to Finish
S
$ O 6
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Phone No:
................................................................................... ..........................
Integrator: ... s aye...... ...........................................
Operator Certification Number:.. ........................................
................................................................................................................................................................i T
Longitude
Ct...p,
Desi ,..- .
Current.Design urrenm
a acitCattle Ccity Po ulatRonuon. pCP__
] Layer Dairy
] Non -Layer ❑ Non -Dairy
.-.-- .--
------------
❑ OtherI t. .
Total Design_ Capacity
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (I€ 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: !� 1 Z
Freeboard (inches): ........... L. z".............. ........ 3
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
0
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes )ff No
❑ Yes 121 No
❑ Yes X No
Structure 6
❑ Yes )k No
Continued on back
3/23/99

Facilitx Number: —q Date (if Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 9 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes � No
8. Does any part of the waste management system other than waste structures require main tenance/improvement? ❑ Yes A No
9- Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 9No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
gNo
1 I. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
9 No
12. Crop type 5"P� (? %SSG i Co✓n , 6"GrArlOY1
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
B No
b) Does the facility need a wettable acre determination?
❑ Yes
X 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?
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.)
t9. 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 •yiol;atioris ;ot. deficiencies •were itofed• during this: visit. • "ik ;will •reeeiye iio #'urther
6 res• orideizce: ahoutt: this visit
❑ Yes J4 No
❑ Yes 29 No
❑ Yes Z No
❑ Yes No
❑ Yes No
[:]Yes 5dNo
❑ Yes 54 No
❑ Yes JX No
❑ Yes W No
❑ Yes Jj No
Comments.(refer to _. ^ � . _. w
question #}: Explain any YF,S answers and/or any-recommendi3t�onsor anyother comments
Use drawings of facility to better-explain-srtuatrons (uge additional pages'as necessa W rt ,
�)
Fq►.� ;s ;� e.xce�len} cdnd;-�ioh.. •
Reviewer/Inspector Name ,S�p h C w., �J -- ! 1_0_ • ' 5'3 . 2)__ • •_3 y';
Reviewer/Inspector Signature: ia.�'i M4_& / - Date: eflfV fAy
3123/99

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

'ot No an Wa
7: .-
•`of.Soil and Wa
of Water Quali
gene} = Operati
tine 0 c-omplaint 0 holirnr-nis oy i 1 :+ t 1 inspection 0
Facility Number
0 Registered a Certified p Applied for Permit ■ Permitted
Farm Name: Gar:dan.Romse.J.ve1:.Farmt
-up of u,N►vi_ review 0 vnier
!►;sir (If•tnxnrctifm
�)f 1T1Sj ,-1inn 24 hr. (hh:mm)
17 Not 01atnona I)ate last Operated:
County: Duplin WIRO
Owner Name: Gardan.Roxtse.................... Eve.)........................ ... Phone No: 9.19-:08.48fift ..........................................................
Facility Contact:...............................................................................Title:
Mailing Address: 3ZfI.1:iey.Rd.................................................................
Onsiie Representative: ...............................................................................
Certified Operator:Grandam.R............................. Ix.c'N ..........................
Location of Farm:
Phone No:
Mt—OHYF.Ac........................................................ Z8.165 ..............
tr t el; i i to r: Prestagg.Far.tuts.....................................................
....... Operator Certification Number:1.7.2Z$.............................
Latitude ©•®® longitude ©•< ®'
esign urren
Swine Capacity Population
❑ Wean to irceder
® Feeder to Finish
Farrow to can
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Lurrent.Design Current
Poultry-.,-',,' Capacity Population Cattle- Capacity Populatiot
❑ Layer ❑ Dairy
❑ Non -Layer 1 ❑ Non -Dairy
❑Other
Total Design Capacity 51H80
Total SSLW - 793,800
Number=:of-Lagoons Y Holding Ponds - T ❑Subsurface Drains Present ❑ Lagoon Area E3 Spray t ield Area
p No Liquid Waste Management System = s
Cener-d
1. Are there any buffers that need mairttenaricc/improvement? ❑ Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑Yes ❑ No
Discharge originated ,-i3: Lagoon ❑ Spray Field p Other
a. If discharge is ohservcd. %va, the conveyance man-made? ❑ Yes ❑ No
b. If discharge is ob:crved, dirl h rcach Surface Waier? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharec is wh:nt is the estimated no, in ,al!nlin?
d. Does discharec hvpa, s i lii ocm system? (If yes- notii:, DWQ) ❑Yes ❑ No
3. Is there evidence of past discharge fi-om any part of the operation? ❑ Yes ❑ No
4. Were there any adverse impacts to the waters of the State other than from -a discharge? ❑ Yes ❑ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ❑ No
7/25/97

act ity Number: 31-91
8. Are there lagoons or storage ponds on site which need to be properly closed? p Yes p No
StrLJCtnrCS Vils. rtc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? p Yes ❑ No
Structure I `'!rurInrc ? Structure , Structure 4 Structure 5
Structure 6
Identifier: ................................................................................................
...................................
Freeboard (ft)_
10.
Is seepage observed from any of the structures?
❑ Yes
p No
IL
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-I2 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?
p Yes
p No
Waste Application
14.
Is there physical evidence of over application?
p Yes
p 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
p No
17.
Does the facility have a lack of adequate acreage for land application?
p Yes
13 No
18.
Does the receiving crop need improvement?
p Yes
p 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
p No
22.
Does record keeping need improvement?
p Yes
p No
For Certified or Permitted Frcifitit 011Iv
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
p No
24,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
p Yes
p No
25.
Were any additional problems noted which cause noncompliance of the Permit?
p Yes
p No
Q oi'�es�yop a e� p-viaabQl1�t uringt this visit:. You wM l receive nofurther.-.
•
Ujis
.:
Visit was made to assess if facility is a likely candidate for State groundwater study. Observations of spray field borders were made
from public roads.
Another hog facility (Grady Farm) is located across SRI306 from Ivey farm.
Spray fields looked relatively dry, although some darker (possibly wetter) areas were observed.
One house (older) is located on east end of spray field #1.
Approximately six manufactured homes are located on east end of spray field #1. One possible well (metal cover) is located along
field border. Two more wells were observed in this area.
One house is located oD site in between spray fields. No well was seen.
One house is located across SR1306 from spray field #2a. A well was seen (brick cover). 7/25/97
Reviewer/Inspector Name +Andrew G. Helininger ;,4
Reviewer/Inspector Signature: /I _ „ _ Date: �_ y

- L., . ii
1-facifity Number. 31-91 sctinn
Additiona['Comments;."And/or-Drai%,inirs:
M, %=MPOM MR. P
One abandoned house is located across 6R]306 from spray fields #2a & #L A well was seen (cinder block cover).

-Fla
.............
OF —
MOM

❑ Division of Soil and Water Conservation [3Other Agency
® Division of Water Quality
1$ Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Date of Inspection 1G—t4G--f($
Facility Number
Time of Inspection O d 24 hr. (hh:mm)
0 Registered ® Certified [3 Applied for Permit OPermitted JEC031 Not O erational Date Last Operated:
Farm Name:.. . .. ........F!5:!::�� ..--...... County:.................. ........................---- .......................
V...........--- r
Owner Name:......0....................... .... Phone No:G.........................
Facility Contact:........................................................................ Title. Phone No:
Mailing Address: � �-#u�'�. 1�U 1. d.w� \\1.3�.......................................... ..........................
(� t �?
OnsiteRepresentative:.O.W, %e-.l...G .... �- Integrator:.....]..!' ............. .Q.... > ..............................
Certified Operator; ................... ............. Operator Certification Number,.........................................
Locati2y of arm
.............. .. .....................s Vs
a.......Jt i+ 4.3..... ......�� ;.
.................................. .. ..........---................... ........ .... ,
Latitude • ' " Longitude • "
Subsurface Drains Present IILJ Lagoon Area J❑ Spray Field Area
U No Liquid Waste
(general
1. Are there any buffers that need maintenance/improvement? ❑ Yes KNo
2. Is any discharge observed from any part of the operation? ❑ Yes " No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes q No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 19No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ((No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes KNo
maintenance/improvement?
tvf
5. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes `q No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 0 No
7/25/97

Facility Number: "3 j — 1
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1
Structure 2 Structure 3
Identifier: ................
01
................................... .................................... ....
Freeboard (ft):.........,3.......................................�✓.....a�............
.........
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)
❑ Yes P(No
❑ Yes RNo
Structure 5 Structure 6
............................................................................
❑ Yes CANo
❑ Yes ONo
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess 1of WMP,1or runoff entering waters of the State, (notify DWQ)
15. Crop type L.....1C..:...,��......!''...L.S�.....................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP) .
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
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?
❑ Yes q No
❑ Yes 9No
❑ Yes D4 No
❑ Yes
allo
❑ Yes
9 No
❑ Yes
O No
❑ Yes
NNo
❑ Yes
0 No
❑ Yes
19 No
❑ Yes
�(No
No.vio'lations•or de kieneies.we're-noted duiirig this', visit., Yo'dY611 receiv'rn' 6 ftirthier'
: correspondence d out this:visit:-
❑ Yes No
❑ Yes i� No
❑ Yes M,'No

❑ DSWC Animal Feedlot Operation Review
UDWQ Animal Feedlot Operation Site Inspection
Routine 0 Co laint O Follow- uE of D WQ ins ection O Follow-u of DS4'1'C review 0 Other
Date of Inspection
Facility Number
Time of Inspection = 5 Z4 hr. (hh:mm)
© Registered ® Certified Cl Applied for Permit [3 Permitted JE3 Not Operational Date Last Operated:..,...
Farm name: ......�..a r..c� o y....... County:.... i,. ^ �.........
Owner Name:...Aso• a.».,....Rtam,.i.t:...Xv... ................................................... Phone No:....�.q.l...q�...�.�.�....--....�.�.1�. �................
FacilityContact: .............................................................................. Title:............................................................ Phone No:.......... .............................................
MailingAddress: ... Z-1- O.......L..t. ...... ................................................ .... ..t.:.....5].�..I. .e ......�...�. .................... .�.. .. ..1. .
OnsiteRepresentative: ..-(=9.vn•......... �f. V ........................... Integrator: .....-..{
Certified Operator:....p..a.,,,�,.......�....-.-.u........................................ Operator Certification ivtttnber:....17-.�.............
..
i.ru-atir�n of Farm:
..7/k:1...N.O..Y.: L.1n......t.�..L:. ....... ....i.�.. r.�.�..M.. .... .....A..u'. ..1 ..i�M1..4!►.!�.ii.............. .......Q--.. ..... Y!"A.. -s...... —4—.{.. ............�.yC1...�R.il..............
..........................1.
Latitude Longitude EM` ®:
Design Current Design Current :Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity. Population
❑ Wean to Feeder ID Layer I ❑ Dairy
KFeeder to Finish ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
ElFarrow to Finish Total Design Capacity , s gg
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons / Holding Ponds. ❑ Subsurface Drains Present ❑ Lagoon Area ID Sprat Field Area
❑ No Liquid Waste Management System
General
L Are there any buffers that need maintenance/improvement? ❑ Yes 9No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge oriL inated at: ❑ Lagoon [ISpray Field ElOther
a. If discharge is observed. was the conveyance man --made? ❑ Yes ® No
b. if discharge is observed, did it reach Surface Water? (If yeti, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gaUmin?
T
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 0 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ONo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® 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 0 No
7/25/97 Continued on back

Facility Number: 31 --
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes RNo
Structures (Lagoons,flolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes QdNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft): ....... ................................. .:..;s..............................................................................................................................................
10. , Is seepage observed from any of the structures?
❑ Yes
allo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
29 No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
ONo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
12"No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type t AS ............... ._,n.................................. 4.nr:.........._..............._...
. u.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
RNo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
O No
18, Does the receiving crop need improvement?
❑ Yes
® No
19. Is there a lack of available waste application equipment?
❑ Yes
No
20, Does facility require a follow-up visit by same agency?
❑ Yes
No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
G&No
22. Does record keeping need improvement?
❑ Yes
® No
For Certified or Permitted Facilities -Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
®,No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0 Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
19 No
No.violations•or deficiencies were noted during this.visit..You-Will receive -no further
. - correspondence aboitt this visit: -
Comments (refer.to question #): Explain any YES answers.and/or any,
ny recoinmenidat[ons;or any,gther{conirt n
Use drawings of facility to better,explatn sttuatiiins-(use additional pages as necessary) „ x
._ W
[Z . }s {tS-
2-q . A a,.o�� � [�+w� ws o L S ear-v- Lk i v� I Vv o 11n. or wv 6 V—
C-"
r� 1
E Xt- 4-6- ln, a i of o ri, Yo . e-, t 0 04 Q 0 (� .
li N c P Le. d
�a
kf'SFbscc
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: -1 1 1