310131_INSPECTIONS_20171231

NURTH CAROLINA
Department of Environmental Qual

f
Type of Visit: UCom nee Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit- Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: C"� / Integrator:
Certified Operator: Certification Number: % �-O 7,f-
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
Swine Gapacity, Pop.
Wean to Finish
Design Current
Wet Poultry C++opacity Pop. Cattle
I I Layer Dairy Cow
Design Current
Capacity Pop.
We eeder
Non -La er
DairyCalf
eeder to Finish
Farrow to Wean
tl
22S
DairyHeifer
Design Gurrent D Cow
D_ r P,oult , C►a aci P,o Non -Dairy
Layers Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
OtHeurkey
Other
H
urke s
Poults
Other
Discharges and -Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes o ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ WE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
05Z] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No ❑ NA
0 NE
'of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P �lo�❑ 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): 2=1-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�NoO
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ 1o❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
2<0__E_1 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 ❑-go ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑1qo- ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑fiio ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I _I wo ❑ 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
L_I 5o ❑ NA
❑ NE
the appropriate box.
TO ❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. 0 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 ❑.A10--❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [E'No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 31 - i f Date of Inspection: Z`{
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes la-T `o "❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No 0-M-0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA
❑ NE
[:]Yes D< ❑ NA
❑ NE
❑ Yes E3No ❑ NA
❑ NE
❑ Yes alq ❑ NA
❑ NE
❑ Yes QTio ❑ NA ❑ NE
❑ Yes [ " ❑ NA ❑ NE
❑ Yes] NA ❑ NE
Reviewer/Inspector Signature: Date: 7 ZY l
Page 3 of 3 21412015

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: erRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: a a Departure Time: Z Q County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: f Title:
Onsite Representative: sCo L� �� T' Cam~ integrator:
Certification Number: / r -n 7 `S
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
Design Current
$wine C+apacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer I
Cattle
Design
Capacity
Current
Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
eeder to Finish
Z4.4
2-w7S
Dairy Heifer
Farrow to Wean
Design C*urrent
Drt P,ouft_r, C_a aci P,o ,
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
I
113eef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qthe.r
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [TNv--❑ NA ❑ NE
❑ Yes E No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
NA
❑ NE
❑ Yes
[T1'q—o`
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: 2- 3 Date of Inspection: (jr67
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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: _
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
D. Yes E31No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 6No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P< ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes r to ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E5' Imo ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ 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 Ld No ❑ NA ❑ NE
❑ Yes ❑'1` o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ENo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
ffNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3 No
DNA
❑ 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
[f No_
❑ NA
❑ NE
23. 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

[Faci!k Number: - Date of Inspection:
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fo ❑ 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 ❑ NSA - ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [31 A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes - ❑Tlo ❑ 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 PNo ❑ 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 VI'No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes Z7 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 Ef'No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes P-No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes []'1Qo ❑ NA ❑ NE
Reviewer/Inspector Signature: ���j� Date: �( /
Page 3 of 3 21412015

(Type of Visit: Q� Com ce Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Arrival Time: 1( Q Departure Time: 3 County: Region:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title: Phone:
Certified Operator: Sc 9±�_ /II- Ta.--
Back-up Operator:
Location of Farm: Latitude:
Integrator:
Certification Number: j fr 07 S'
Certification Number:
Longitude:
111111111111111luesighlim-urrent
Swine C•a aci
P h
Po Wet Poul
P try
Design Current
Ca aci Po
P ty P•
Design C•urr_ent
Cattle Ca-` a Po
p ty p..
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Design Current
Ca acity Pla ,
Dairy Calf
eeder to Finish
Farrow to Wean
y cl
L3SG
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
I)r, P,oult ,
Layers
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Other
F-TOther
Pullets
Beef Brood Cow
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [j-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - 3 Date of Inspection: / j-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0<0 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ErNo ❑ 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 ❑filo ❑ 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 Noo 0 NA ❑ NE
8. 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 ❑'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes . 'o ❑ NA ❑ NE
maintenance or improvement?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes D_N ❑ 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
E]-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
_
17. Does the facility lack adequate acreage for land application?
❑ Yes
0rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
�-
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
' No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes No ❑ NA ❑ NE
❑ Waste Application ❑ 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 4;ms[] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 21412015 Continued

Faeili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [E'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Fo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NAB❑ NE
❑ Yes ❑ No D A ❑ NE
[:]Yes No ❑ NA ❑ NE
[—]Yes ❑'No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
N�oN, ANo NA ❑ NE
No ❑ NA ❑ NE
1\[.Y1GW[.1f 11L1�11.V LVl 1�0.1116. r11V11G. I - - \
ReviewerlInspectorSignature: ��., __-_--_ --_ Date:
Page 3 of 3 21412014

Division of Water Resources
Facility Number - Division of Soil and Water Conservation
� Other Agency
Type of Visit: j3Tompliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ' /. Arrival Time: 1 /0.3 Cy eparture Time: County:ve,00, Region: C
Farm Name: q[iyLL Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �r r, fJ �� Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
C►urrent Design C*u�-rent
Pop. We# Poultry Capacity Pop.
I ILayer
11
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
I Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other Turke Poults
Other Other
Dischar es 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 [2^No ❑ NA ❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
pNo
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes PNo
❑ Yes ,� No
❑ Yes &NO
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3
21412014 Continued

Facility Number: - Date of Inspection: 4,
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 P No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
U'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
[ZfNo
❑ 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
ZpNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
LTo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ONo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P
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 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
JZ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
F No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
JZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J?fNo
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0No ❑ 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'0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ,d N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes V ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: 12LIZI
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes [ZNo ❑ NA ❑ NE
25. Is, the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JETNo ❑ 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 EfrNo ❑ 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
�jNo
❑ 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
[2 No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Q No
❑ NA ❑ NE
34, Does the facility require a follow-up visit by the same agency?
❑ Yes
2 No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any. additional recommendations or any other:commen&.7�1 1
Use drawinus of facility to better egulain situations (use additional naves as necessarv).
("-s # JL-L . kA Sed G. -71 -for w c�, s4_
71,1-e1ll y o .q c., Vk.4,- � n ma_t� �_ -5� I-) a d� Y
13 z
,S u V"P-. �C_ GQ tI eC4-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
to.5 ao rt -
0 e ra t ( -r,u r-m f f-e cotes
� n S° lid e >r s'r
Phone: L �
Date: L
24 0114

Division of Water Quality
Facility Number ®- Division of Soil and Water Conservation
DQ Other Ag nc_
Type of visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: /Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: MEV�E Arrival Time: : p Departure Time: County: J,/u///) h Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Certified Operator: f _O�a_fj\ J , ICE Certification Number: Kura
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
C►urrent
Pop.
I I
Design Current
Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Dairy Cow
C•usrent
Pop.
Wean to Feeder
I
INon-Layer I El
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design C►urrent
Dry Cow
Farrow to Feeder
Farrow to Finish
Dr Pmoult . C_a aci_ Pao ,
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
OtherL10ther
Turkeys
Turkey 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?
❑ Yes Vf No ❑ NA ❑ NE
❑ Yes
F No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
;6No
❑ NA
❑ NE
0 Yes
LZrNo
❑ NA
❑ NE
Page I of 3 21412011 Continued

facility Number: - Date of Inspection: - 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONO
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
DNA ❑NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
u!1-1
Observed Freeboard (in): 130-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes gyNo ❑ 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 4No ❑ 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 VTNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes PNo ❑ 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 �TNo ❑ NA ❑ NE
maintenance or improvement?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? to
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Vf 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
n No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
PfNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Yn No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
TT
❑ NA
❑ NE
Required Records & Documents
have
19. Did the facility fail to the Certificate of Coverage & Permit readily available?
❑ Yes
[ZrNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
PNo
❑ 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
VrNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections [:]Monthly and l"Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Z No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
5fNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Fa6li 'Number: 3 - Date of Inspection: 'j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus toss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
[�fNo
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes 7No ❑ NA ❑ NE
❑ Yes [?fNo ❑ NA ❑ NE '
❑ Yes j f No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 4No ❑ NA ❑ NE
Comments (refer to question ft. Explain any YES answers and/or any additional recommendations or any other comments."
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: p�5a~15i
L,QVst vat_ Date:40
21412011

Division of Water Quality
Facility Number�nDivisionToitbot1 J l and Water Conservation
Q• Other Agency
Type of visit: Q Compliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral Q Emergency O Other 0 Denied Access
Date of Visit: I Arrival Time: Departure Time: L_Ls..t __�___J County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: ) 7 T
Certified Operator: M IC1414i L S. RI,l/1('TI✓R—
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Intr: Mo:
Certificatioon}1Number: �� 5
Certification Number:
Longitude:
Design
Swine Capacity
Finish
C►urrent
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
DairyCow
Design Current
Capacity Pop.
Feeder
Non -La er
DairyCalf
o Finish 4J[
DairyHeifer
o Wean
to Feeder
Design Current
Dr. P,ouIt , Ca _aci Pao ,
D Cow
Non -Dairy
EFarrow
to Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Turke Points Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes )kNo ❑ NA ❑ NE
[]Yes ❑ No
❑ Yes ❑ No
❑ Yes [] No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

FaciliNumber: - Date of Inspection: jO
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 I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: (,Cl600 AJ
Spillway?:
Q
Designed Freeboard (in): T!,
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
0
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes *o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 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 Accceeptaab�le Crop Window ❑ Evidence of WindDrift [3 Application OutsideofApproved Area
12. Crop Type(s): Jla PERa �- m 1 L[- �" L ��1"� �G5[..L,
�l'�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 9No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ YesWo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
Q WUP El Checklists Q Design Q Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the ap ropriate box below.
Yes ❑ No
❑ NA
❑ NE
Q Waste Application 0 Weekly Freeboard Waste Analysis ❑Soil Analysis
❑ Yste Transfers
[] Weather Code
Q Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minu a nspections Q 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?
[:3Yes tNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

[Facility -Number: J - 1-3 / jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes No ❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes �No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes Wo
❑ 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:
IF
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 5No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 5INo ❑ NA ❑ NE
Comments (refer to question #):. Explain any YES answers and/or any additional recommendations or anyother comments:
Use drawings of facility to better explain situations (use additional pages.as necessary.).
Cpo&t.A )XVV 1t�-KC 94l a
gJao��a o,�-1
o ,cib
91.
AfiR�s15 1S`f�'(EN b0�5
Q'F'
o-�F�G`�mP1�G �vGNiS �� o�� -C e?
011- �4�0 so,L �.�
- 14o SOIL rfla. a
Ds.
Nb
Reviewer/Inspector Name.
Reviewer/Inspector Signature:
Page 3 of 3
CEal-4 R 1Q- C)*-+ 217)--
Phone:
Date:
21412011

Type of Visit: ZFCompliance Inspection 0 Operation Review 0 Structure Evaluation ()Technical Assistance
Reason for Visit: �§Aoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Q j j Arrival Time: Departure Time: County: [ 1J1/ Region:
Farm Name: �?47(4- 1-A 1a 0A S Owner Email:
Owner Name: 1 ' r ict4OC-L- L _ I -A cA /,/I C Phone: 9 jo -09 -3 1-0 1
Mailing Address: U a Acr_SdN SJ-ou_ F-U [ LP31 LLC
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Sc=-r PAAWTE (L Integrator:
�IQCertified Operator: SCOTT �/TE?- Certifiic1tion Number
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
i.16-i S
Design Current"
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry
@apacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
iry Cow
Wean to Feeder
Non -La erJ__
iry Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oult ,
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Puults
Other I
10ther
IF
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
0 Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
IR
No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Facility Number: 1 - # 3 1 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes D No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9. 5
Observed Freeboard (in):� _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et .)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
��
12. Crop Type(s): �1 ��Q� L I It LLV Y �SCCACio�--1 / 1JE 1 `
13. Soil Type(s): _ LUIL5 <)qd
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 4No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists Q Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
Q Waste Application ❑ Weekly Freeboard [-WastAnalysis ❑ Soil Analysis [j Vaste T ansfers []Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspecti�on,.,s( ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes b[J 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 21417011 Continued

Facility Number: IT - 131 Date of Inspection: /d 1CI1/ .
24. Did the Tacility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 ONA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
XNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
j� No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
'T
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
w• -�t - rlly 66 S CA" TO-) A1'� A wA5_1E- s r'#rtPL-E wfln!
�&itR L"
IJVC1 e0EN J
3APJ�L'5l i
1 1� ec oS�SI QF1"1&
S��vE
Soy
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: gin --41 t -ml
Date: 100111
21412011

Type of Visit XCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit xRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I -j/�1 Arrival Time: %O Q� Departure Time: County: ")V Region:
Farm Name: ['��]l%�E2 ���Fis Owner Email:
Owner Name: ti C H A EL (_ , u� TE(Z Phone: ! /0
Mailing Address: 940JAclrsou Jjc�LE lam' &_LLAU 1 LLC ' VC dSS19' (D&<�)Q
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: TT e IqTEi _ Integrator:
CQnj
Certified Operator: 1C'—�� t- AtAq�P peratorCC�ertificationNumber:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = [= 1, Longitude: [� ° = r
Design Current Desigu Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle C*apacity Population
❑ Wean to Finish
I I
Layer
❑ Dairy Cow
❑ Wean to Feeder
I
JEJ Non -Layer
I
❑ Dairy Calf
Feeder to Finish
N (�
ElDai Heifer
Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Non -Layers
❑ Pullets El Beef Feeder
❑ Beef Brood Cowl
❑ Boars
❑ Turkeys
Other
El
❑ Turkey Poults
❑Other Number of 5tnsctures:
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ANo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Cl Yes
VNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: ] —13 I
Date of Inspection tb
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LA &W11I
❑ Yes XNo
El Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Elyes 4No ❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ❑ NE
maintenance/improvement? '
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ,❑E�vidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) � ?C A-(ZL 1 + y1I[fLET 1 GOL J;:,� 56tA f--
13.
Soil type(s) F—Q,2GSTC0A:
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
td No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
VNo
El
18.
Is there a lack of properly operating waste application equipment?
ElYes
❑ NA
❑ NE
ComItlentS(r.e: fer to ua,. estlon #)- Expliin'any YES answers and/or an ``Cecommendatons or.an other c4iiiueafi*.-
, � -
Use drawings of facility to better explain situations {use additional pages as necessary}
RevtewerlInspector Name A' }—,5 [-� �, �}=<�I , Phone: 9f0 + 6
Reviewer/Inspector Signature: Date: � [ S
Page 2 of 3 12128104 Continued

Facility lumber: — j 3 Date of Inspection S
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,A..,/No El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LYNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists Design 0 Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
[] Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ �aste Transfers ❑ Aual Certification
0 Rainfall 0 Stocking ❑ Vop Yield ❑ 120 Minute Inspections 0 Monthly and V Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes )4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes A.No
❑ NA
❑ NE
0
❑ Yes X-11
El NA
El NE
[3 Yes N
❑ NA
❑ NE
❑ Yes ,XNo
❑ NA
❑ NE
❑ Yes ❑ No ANA ❑ NE
❑ Yes]
No
,\
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments'and/or Drawings:
O
o'
F R�L-- 09 �t..-r t� � SZE�o2fJ S
QIySCALTS �u.i U_' E coRDS
�L- So m L� �� �& 3
&T COSg Q-T�F�-�E�uLTS1VOr G3h�
/U SA�i - �
Page 3 of 3 12128104

Type of Visit (Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit $ Routine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: '-- Arrival Time: Departure Time. County: U/V Region:
Farm Name: O NTE(Z PAQ(ns Owner Email: r�
Owner Name: 1 t 1fC-n�L 14j kLA.,,J7C(Z Phone: 9ja- d�J��-3y�}► _ /-G
Mailing Address: 'Qti d S W jf_SC_W S-FO��-
Physical Address:
Facility Contact: (; Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: E=] 0 0 ' [:] « Longitude: [� ° = 6 0
di
Design Current
Swine Capacity Population Wet Poultry
Design
Capacity
C►urrent
Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
ID Non -Layer I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
ElOther
❑ Dry Cow
❑ Farrow to Feeder
❑ Nou-Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Finish
❑ Gilts
[]Boars--
Other
❑ Other
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
EkNo
❑ NA
❑ NE
❑ Yes
*No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

facility Number: 31 — ) S I Date of Inspection
Waste Collection & Treatment
UfNo
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
1
Identifier: C�/Y
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Jl>
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
4 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
PNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes % No ❑ NA ❑ NE
11.
is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
ElNA ElNE
ElExcessive Ponding ElHydraulic Overload ElFrozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
• ,
[--]PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑l Application Outsides of Area
12.
Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
f�(No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ YesANo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
5�No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
LANo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
[XNo
❑ NA ❑ NE
Ise drarrings of facilitygto better explainsituations (use `ad+
-
16ci com NGF7o per; '11�
i(ns- Ovc Pic? rum
Reviewer/Inspector Name 1A Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: 3 �j Date of Inspection U CS
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �fVo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �kNo ❑ NA ❑ NE
the appropirate box. 0 WUP 0 Checklists 0 Design
g 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis El taste Transfers ❑ A/nual Certification
0 Rainfall 0 Stocking ❑/op Yield 0 120 Minute Inspections El Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 14 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
['No
❑ NA
❑ NE
❑ Yes
bfNo
❑ NA
❑ NE
[]Yes JhNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No �NA ❑ NE
❑Yes
NNo
El NA
❑NE
❑ Yes
[XNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
0, No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
Page 3 of 3 12128104

W Division of Water Quality
Facility Number Q Division of Soil and Water Conservation `
Q Other Agency
Type of Visit aCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit P Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 Fs Arrival Time: Departure Time: County: �Q u /1 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: a Title: Phone No:
Onsite Representative: CAR 1 S U QWK-S I r �Yf I (W46 - f k" Integrator:
Certified Operator: P)1CAA6C_ S 4UA/T_QL Operator Certification Number:/ 90-4cS
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [—] c 0' =] Longitude: =] o =
Swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer I I �D
1 1 ❑ Non -La er
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Daja Calf
❑ Daia Heifei
EfDry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co t
i
Number of Structures: ED
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 Q�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ NA
[INE
ElYes
,0No
l,C} No
❑ NA
❑ NE
12128104 Continued

Facility Number:'3
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
D1 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: GO
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
V No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes qNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No [INA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,�] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) i
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
9No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
J� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
J�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[IYes
, No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
9Ec-p c LE l c� �o� coops 5 ,��a�E o�
Reviewer/inspector Name m.4iYQ� -7 Phone: 'T c76 _ 3d
Reviewer/Inspector Signature: Date: y 6
12128104 Continued

Facility Number: -- J`3 f Date of Inspection jl
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 OdNo ❑ NA ❑ NE
the appropriate box, ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ElNE
❑ Waste Application ElWeekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑\ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes D(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes .E'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 4�] No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes JRNo
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes qNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes KNo
❑ 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 �TNo
❑ 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
[INA
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 ElNo
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3
11
12128104

Division of Water Quality
Facility Number Q::Division of Soil andWater. Conservation
- O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit J6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I G Departure Time: LRCA�County: Gz Region: aj, Afi
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: / Phone No:
Onsite Representative:klIvf22 �2%� /7Integrator: rZ44&_,
Certified Operator: �J ti- f Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
Wean to Feeder
U Farrow to Wean
❑ Farrow to Feeder I
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other J _ J
Back-up Certification Number:
Latitude: 0 0 0 d Longitude: = ° =, =
Design Current Design Current Design t
Capacity -Population Wet Poultry Capacity;;Population CattleCapacity :PC
J❑ Layer
EI Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Pou Its
❑ 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number tof Structures:
b. Did the discharge reach waters of the State? (lf 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 l of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
El NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
A
❑NA
ElNE
ElYes
dNo
❑ NA
❑ NE
12128104 Continued

I
� - s
Facility Number: — 3 I I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
z9 O-1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes /PlNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P(No El 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 VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) deF_
13. Soil type(s) �pn) _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes (((PNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes A.No
No ❑ NA ❑ NE17. Does the facility lack adequate acreage for land application? ❑ Yes El El NE
I & Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary.)c
l� d e
'7)
Reviewer/Inspector Name Phone: p Z
Reviewer/Inspector Signature: Date: 3 Z
Page 2 of 3 12128104 Continued

. r i
Facility Number: Date of Inspection 2 d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )6No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ maps
p El other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,(No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
A 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
o
❑ 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?
El Yes
�(
p No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
El NA
El 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
[I NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
�No
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[P/No
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Comments and/or Drawings:
F
Page 3 of 3 12128104

Facility Number 3 l 13 !
I
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
Copliance 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: y 1! ou Arrival Time: ® Departure Time: County: DUP( 16T Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: r--xKAA I420101— Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: E__1 o =1 =1" Longitude: 0 0 0 d= .,
Design Current Design Current-, Design CuFrent� y
;..Swine - .Capacity Population Wet Poultry Capacity Population Cattle Capacity_ Population°
❑ Wean to Finish
❑ Wean to Feeder
© Feeder to Finish
DQ"
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
I
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
L
f;
Number of Structures: E:1I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes D/NNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes DINo ❑ NA ❑ NE
12128104 Continued

Facility Number: 31—) 31 Date of Inspection G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA &awn)
Spillway?:
Designed Freeboard (in): I cr
Observed Freeboard (in): S4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E�No ❑ NA ❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes P4 ❑ 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 envir7yes
enta7No
eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E!(No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes L"J No ❑ NA ❑ NE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?
1 1. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types) t, -� L (—P) b
13. Soil type(s) tart �x�
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
�No
❑ NA
❑ NE
[//No
❑ NA
❑ NE
!d o
❑ NA
❑ NE
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES.answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
7,) coOT-JvE To w o"— v1► ozk-6 (AV UL,
Reviewer/Inspector Name .�vH +a t�i4 62 Ntcl.L. � Phone: (?id)) 7af.5
Reviewer/Inspector Signature: Date: <4 illlis fi
rage L o> s IZIZOIU4 "nrrnueu

'Facility Number: — �j Date of Inspection
• Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EdNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
C&
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[?(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EfNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ 4A
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
EYNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Q No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No LJONA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
lT No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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
Iltvo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
��,, ff
[1 o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
El Yes
�,/
E'J No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
i No
❑ NA
❑ NE
Additional Comments and/or Drawings:
i
7
Page 3 of 3 12128104

3�
r
ype of Visit 7Routine
Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance
eason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: hiioOT Arrivat Time: ' G Departure Time: County: 011PLMW Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: c� Title:
J
Onsite Representative: Gorr pi-'6k
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
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [=] o [= ' E::] Longitude: ❑ 0 0 = if
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Other
❑ Other - - T
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ 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
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
l
❑ Beef Feeder
❑ Beef Brood Co
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes CIA10 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes J ��N�o
�oo ❑ NA ElNE
ElYes ❑ NA ❑ NE
12128104 Continued

Date of Inspection
Facility Number:
♦'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E I No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
StructureI Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: LA&o9_&' I
Spillway?:
Designed Freeboard (in): d S.s
Observed Freeboard (in): 132
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EYNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
fffNo
❑ 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?
LZ Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ONo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
O No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
��
EJ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
LJ 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 Windo�w El Evidence of Wind Drift El Application
of Area
(Outside
12. Crop type(s) lM�u..ET �'C/ E S W E L f21M ✓aq J 6 O
Act, G A829'
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
U'1<4o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[:] yes
�Xo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
El NA [I NE
18. Is there a lack of properly operating waste application equipment?
El Yes
I No
❑ NA ❑ NE
`,) AI EF,;b �ow%,c A,-vA T9T6VAA1Z A/ LA6�P,91J 0.rj 6 AA/9 ASS Co✓,Gp
,2.1,) 1p"0 6 ,fav,-r.rAL AErE#_ 12AWr LL
Reviewer/Ins ectorName...`
Phone:IrQIQ).�� x ZZ7
p �U f ii Lam.
Reviewer/Inspector Signature: Date: S%178��__„_
12128104 Continued

Facility Number: Date of Inspection 17 oS
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the,CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
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 ❑ Crap Yield ❑ 120 Minute Inspections / Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
?No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El No
ZA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E?Ko
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ZNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ffNo ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
r] Yes
ONo ❑ 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
��
LI 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
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
No ❑ NA
❑ NE
12128104

Type of visit Ocompliance inspection Q Operation Review Q Lagoon Evaluation I
Reason for Visit 011outine Q Complaint 0 Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit:
Permitted 0 Certifi © Conditionally Certified 0 Registered
Farm Name:��
Owner Name:
Tune:
)Perational O Below Threshold
Date Last Opera r Above Threshold:
County: �AA4 ....� �� �,..... .
Phone No;
Mailing Address:..__
Facility Contact: __ ...... .. �/r1n,__�T�itfllee:�
Onsite Representativek Aw'e2
Certified Operator:
Location of Farm:
No:
Integrator.
Certification Number:
A6
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 4 " Longitude • 4
Swine
f on4wifv �ni��s�eAnr
o Feeder
--- --
- ---
O^Layer
- -
- - --
to Finish
Non -Layer
to Wean`:=
r
to Feeder
Other
to Finish
j
�k `a TutatDesk
Gilts,
BOaiSt'
x
Dischars eS 8 StreaZm 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?
Desagii r Csirreat.
tderCa—p�—=�PapWatzon
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
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes XNo
❑ Yes AO
Structure 6
Identifier:
Freeboard (inches):
12112103 Condmied

acility `Number• — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes VNo
seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ONo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes A No
elevation markings?
Waste ApOcation
10. Are there any buffers that need maintenancelimprovement? ❑ Yes )No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes No
❑ Excessive Ponding ❑ PAN ❑,Hydraulic Overload Q Frozen Ground ❑ Copper an4* Zinc
12. Crop type Y F(>WH % UDR
13. Do the receiving crops differ with tho designated in the Certified Waste Management Plan (CA )? ❑ Yes o
14. a) Does the facility lack adequate acreage for land application? ❑ YesNo
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? 2r'�es ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes XNo
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes PNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes '01190
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑NO
Air Quality representative immediately.
�s
- 41� 44
fi
�/519/w .Se zL
ReAewer/Inspector Name 1
Reviewerthmpector Signature:
❑ Feld Copy ❑ Final Notes
//
Date:
1Z/11N3 (:onunuea

Facility Number:
Reauired Records & Documents
Date of Inspection
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes)gNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, Wraps, etc.) ❑ Yes �gNo
23. Does record keeping need 'improvement? If yes, check the appropriate box below. ❑ Yes ONO
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ SoilSampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 'VNo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes YrNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes XNo
27. Did Reviewer/Inspector fail to discuss reviewlinVection with on -site representative? ❑ Yes No
28. Does facility require a follow-up visit by same agency? ❑ Yes XNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes �Vo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes/❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
3C Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms nerd improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted diming this visit. You wM receive no further correspondence about this visit.
60
ki
F� ��4 5."
� i
F,� ae�-Al)pus q �,�
�4�9 Q�
1211I2/03

Type of Visit t Compliance Inspection .0 Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint 10Follow up O Emergency Notification O Other
❑ Denied Access
Faciliri• Number Mate of Visit: L Time: L -2:E�E] I IQ �-"�J
Not OiDerational Q Below Threshold
Permitted ©Certified. 0 Conditionall Certified D Registered Date Last Operate Above Threshold:
Farm Name: /1�T_ ,I County
k
Owner Name: ��AF� Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
P one No:
Integrator: _ _ �! �J�2 ,lr n-I-
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� Longitude
- _Current " - Des' n _ _Current Des Current
Design" - ; : _w � � __e
W
.Swine ;w„ Ca acid -..Po ulahoII :=,Poultry._ Ca auto <-Po n1ah4II Cattle.__.=. _�Ca acaR_ 1'a"ulattan
_.
er Dairy
❑ Wean to Feeder =- ❑ La _,
r.
Feeder to Finish z_ ❑Non Layer , ❑ Non -Daily
Farrow to Wean
❑ Other
❑Farrow to Feeder _...._
jn
❑ Farrow to Finish ` Total DeSI n Ca RCi rx
❑ Gilts = I
Boars STotaI SS1,
t' - �'
-
Number of Lagoons m ❑Subsurface Drains Present ❑ L oon Area
e
❑ S ray Freld Area
trt ads 1 Solld Traps = ° [] No Liquid Waste Management System
Wm..
t
Discharges & Stream Imnacts
1. is any discharge observed from any part of the operation?
❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (inches):
05103101
Continued

Facility Number: — 4j Date of Inspection OL
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
El No
(If any of questions 4-6was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste -Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Pondin ❑ PAN ❑ Hydr ulic Overload
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Manage me t Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility tack 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.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑ No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
zzNo
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.
£omments (refer to`question #)•:`Exphun_sny YESattsirers and/or aay reconitnendattgns orsi�y other comments: - -
Use drawin of:faciltty to.beiter explain "sitnaZiotis' (use sdtrioitiail pages: as netessary) - ❑Field Copv ❑ Final Notes ^
�' DG ��u�/I /P ��L �G/'�.5� F �SCt�/I.ff�"'�_ �✓ //�� �i�/ n/,�_
�,�`•' ��'�i5� l /`�'}�-� /��a��- �T(s'{�p�1c�/+'1�'T �7id,4 LDS
Reviewer/Inspector Name -
ReviewertInspector Signature: Date: b Z
05103101 `-f Continued

Facility number: C> I —/ Date of Inspvction O�
Odar Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation? V
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads. building structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s). inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional Comments and/or Drawings: mm°
e.
AWF
kw
vl
�Gm �O�/��.�',D� � PRr� ✓�✓� �� ��P�f�c.� SPA-�iI/9r�-r-
,o _
-�- ,D��No2,�✓�. ,,,, G���✓ ors G'�,✓ � ���•✓
Cael
AFT � y
05103101

0
Type of Visit P Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit 4 Routine 0 Complaint 0 Follow up Q Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: Time:
Not Operational 0 Below Threshold
0 Permitted 0 Certifi d 0 Conditionally Certified 0 Registered Date Last Operate r Above Threshold:
Farm Name: County:
Owner Name: Phone No:
Mailing Address:
Facility Contact: Title: ne No:
T /,��'_
Onsite Representative: Q� Integrator: !Y -
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 u Longitude • 6 0~
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer ❑ Dairy
eeder to Finish JE1 No, -Layer ❑ Non -Dairy
Farrow to Wean
El Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ La oon Area 10 S rav Field Area
Holding Ponds 1 Solid Traps ❑ Na Liquid Waste Manage System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes /No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
X No
ElYes
No
❑ Yes
XNo
Structure b
Continued

Facility Number: — Date of Inspection
oF
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.) 16
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes FNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? Yes IVNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid levelTT,(
elevation markings? ❑ Yes J[J No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ZNo
11. Is there evidence of over applicatiop^ 4 Excessive Ponding El PAN ❑1 "ydraulic Overload ❑ YEs ANo
12. Crop type r `
13.
Do the receiving crops differ with those desi ated in the Certified Animal Waste Aanagement Plan AWMP)?
❑ Yes
�No
14.
a) Does the facility lack adequate acreage for land application?
El Yes
ONO
b) Does the facility need a wettable acre determination?
❑ Yes
VI' No
c) This facility is pended for a wettable acre determination?
❑ Yes
VNo
15.
Does the receiving crop need improvement?
Xyes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
I[J No
ir Reaued Records & Documents
//
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
/Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
VNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ZNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
WfNo
24.
Does facility require a follow-up visit by same agency?
Oyes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
IZNo
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments` refer to question:#) Expiau�rany YES4fiiwers and/or any recommendations or any" other comments
Use drawings of facility to bet ere%plain s�tiiahon s(use addrtional'pages as necessary}.AField Copy ❑ Frnal Notes
=
r
/%li��F �5� Spm� dam' �� � ��� �,4y �✓�4-��s � L � vf,C ,��5
(i�J/�i�i✓� F r .4
H,
Reviewerlinspector Name F Z�,r
Reviewer/Inspector Signature: Date:
05103101 f r Continued

Facility Number: _a Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ANo
❑ Yes XNO
❑ Yes xNo
❑ Yes o
El YeslkNo
El Yes /❑ No
Additional Comments and/or Drawings:
�feSCUC /`"ZF_ G pS /veep ->�m r�RDtJE�v► �n� �O f:50, F IV
0
P(l, / ,�Ilvc�zVz jC ,pop
/ /?�) eVC�, O)Z7-1'f
eA1eAQ411-C-- 4AM,7-AJ6A4�'
P�Sf/fr�� ANp dC �f�iJ�4L ��i2�,,✓a� Zs
40
)0 PVC69 1_:atqx�o
� nJ �XC ��t✓ �� S�A��,
O5103101

of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit oRoutine O Complaint O Follow up O Emergency Notification O Other 1 ❑ Denied Access
Facility Number
Bate of visit:
r31 13 i
Permitted 13 Certified U Conditionally Certified 0 Registered
Farm Name: U h B { �0. r'
Owner Name:..... G.'`.ae�.....rl n f..........I.........I............
El Time: 11347
Not Operational O Below Threshold
Date Last Operated or Above Threshold: .........................
County: . V�....*.............................
PhoneNo: ............................................................... . . ..... . . ..... . _-,
FacilityContact: ..................... .................................... I.................... Title:................................................................ Phone No:............................................. .
MailingAddress: ..................................................................................................................... ..... ...................... ........... ......................................... - ..... ..............
_
Onsite Representative: 1 i , ,.
p i.�..Lr!1 f.%...... 'L � SC�--- �:'-----I ....... Integrator:..... r'�rk� vr� cf.cei�/ G!Y
Certified Operator:
Location of Farm:
...................... ............... I ...... I................ Operator Certification Number:..................... .
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° " Longitude • 6 46
Design . Current
Sw_ 1m : :Capacity Po elation,
Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
r ; ❑ Boars
Number of Lagoons
Haldug 06iidi I Solid Traps.; C
Design Current Design : „_
J❑ Subsurface Drains Present JJ0 Lagoon Area J❑ Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes')2j'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes )
❑N
O
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes EI'No
c. If discharge is observed, what is the estimated flow in gailmin? 4 f a
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ,ErNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Q-No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes '=No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes _J'No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:..............1.......................................................................................................................................................................................................
Freeboard (inches): Lf 2-
5100 Continued on hock

Facility Number: 31 — 33 ! Date of Inspection Z o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes'ONo
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes ZNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes j No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes Q"No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes .[TNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes _eNo
12. Crop type re- s('V'-19ae 9011v"0drt t"t.5-VIC SX � G/ra
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? Yes ❑ No
14, a) Does the facility lack adequate acreage for land application? ❑ Yes ,,UNo
b) Does the facility need a wettable acre determination? ❑ Yes PNo
c) This facility is pended for a wettable acre determination? ❑ Yes _Q�No
15. Does the receiving crop need improvement? ❑ Yes .fNo
16. Is there a lack of adequate waste application equipment? ❑ Yes ONo
Required Records _& Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ,Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes _,ONo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ,f Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes--ffNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes j'No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes EfNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Z No
24. Does facility require a follow-up visit by same agency? ❑ Yes dNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes/3�fNo
- ' �•vioial� 40S'or-dgfieien. wire ngfet%. Onng Oissit; Yoh �viil �ec�iye titi u;-t�gr . .
..•�orresnondei�ce:aXwut�thisvisit:-:-:-....::-: :.:.:.:.:.:.:':...........':':-:-:-:-:-:-.
Comments (refer to gaestsoa #) ;;Ea�plain any YES answers and/or any recommendattoias'or aay other corrwaents.
W , Y
Use drawgs; of_facility to tietter explain situations. {use additional pages as necessary},
#3. rlva) ywS been Ict*led 4YtGi �t ed ah A.
b 4 r4 is qP1 ►h WgS4e
spo ke 1,� i-K 4eChl e, I �Pe r- to f f� ` ho^ � 12 ¢ �q,`d 4 4 �'^-e rvtk,
he G r1c0ftel"' � �IIA zeor�G�s. £ae sv� nPw��t 1G
f7e c,o,-ds .
�l. /Deed fd k.ve lie,^,z f'C, cue ZV�' co„e,-a j v4114 ble .
! -1 . 8e .5 L, re -lo vse a ra s•i e Gnat � �6_r Aa4e- e tr✓.�; ba dqy5
e_�eAjf -Co'- Ge►i�vja ;.-y - �Q n;-��L�re� apJo1;'M o1r� ��!�-�Zr �� l,'Ate,-�� 4a
bexe-t.ud4 -j L� oc&ve,41 %n 1,4e 1 ��� �P A.1.id 0-r& ✓r�nP�,,a1 - 4..Wl s,'S 40 r}) —
Reviewer/Inspector Name
- 2ut til _ �M-�t .lt.. r s _ �. - _ . _ti
Reviewer/Impector Signature: Date: R Z al 5100

[Facility Number. 131 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 'TerN0
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, [:]Yes ONo
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 /jEfNa
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 .fNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes A!fNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Yes ❑ No
Additional Comments and/or Drawings:_.: -
1 col � +"gahef 4L-,-,� F,-gbrrtva' Be 5yrl To [J<G of revrc.{ (;e-j;l.ni
)°An/ rude r �- -gr�9
a�( ,,z n � p
A -o4es: Tljeee if q 5,,>od 4,1r& be--e,-v } 4 be,-,#-w rarl.
Fesvve J-�;- 4v bPi1)n4-- - i ti Sefest-be,; Amy o pra 11 eAjm S
jGoa r,
y Ci Lt c
Si.wu� ( 5r� d nr s; )4- ed or if �,; e4 ( C'0+ i►�+ c�,•�� �.'.. e.
d!U„,�v-e,
1
Vl ! �O tT Qnl�s �'r�0 �✓l k do- (do ' `, -�+ ,�2G o / Lf✓ Svw � �e
j r.a Z . '2- �`ee (c.b o w4 2--4[i ; .�1� ;) f 41s,'f , s {a�J a f GL�, "cat°
rv1.;h �s s�-a�-6 r vy►,,� eleva-�,bn "
5/00

- DIvIsion of Water t2uaLty `F r `
.?
Q Dtnston of Soil and -Water Couservahon
Q er Agency
Ottt s
4 s
3
Type of Visit
Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Q Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: 30 Printed on. 7/2112000
Q Not Operational O Below Threshold
Permitted © Certified [j Conditionally Certified [3Registered Date Last Operated or i bove Threshold
Farm Name: ......�!��"�. :................................... Counh'.
1t--�
Owner Name:
Facility Contact: .......................
Phone No:
.......................... Title:................................................................ Phone No:..........:...........................
MailingAddress: ...................................................................
Onsite Representative: C.W� .........................
Certified Operator:.... ............................................... .
Location "of Farm:
........................................................................... .... ................... ..... I ......... ........... ..... ......... I...........
................................... Integrator:.....D.6 09 W GU ........... .................
....................................... Operator Certification Number: ..........................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° i° Longitude • ° «
Design Current Design Current Design Current
Swine Ca aci Population. Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
Feeder to Finish (gqq E 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 JE1 Subsurface Drains Present Area 10 Spray Fietd 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. II -discharge is observed. what is the estimated flow in gal/min?
d. Dees discharge bypass a lagoon system:' (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
�<No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
D<No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
t<No
StMCLUre I Structure; 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .............................................................-.---.................................... ....................................
....................................
Freeboard (inches):
5100
Continued on back

Facility Number: ` — Date of inspection 7/21/2000
Printed on:
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑YesNa
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ,�'No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes KNo
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 6rNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes X No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes t<No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type kT��1 _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ YesNo
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 1KNo .
16. Is there a lack of adequate waste application equipment? ❑ Yes q'No
Required Records& Documents
17. Fail to have Certificate of Coverage & General Permit readily available? XYes ❑ 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 WNo
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports) D41yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes P�(No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes )4No
22. Fail to notify regional DWQ of emergency situations as required by General Permit`?
Oe/ discharge, freeboard problems, over application) El Yes �No
23. Did Reviewer/lnspector fail to discuss review/inspection with on -site representative'? ❑ Yes 4 No
24. Does facility require a follow-up visit by same agency? ❑ Yes kNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes allo
0: q yiolatiQtis:ot- deficiencies were poled during phis:visit: • Yoe>E will receive Rio: #'urthetr.
':•corres• aridei�ce:ahout�this:visit:-::•:-:-::•::-:-:•:-:-:-:-:•:•:-:•:•:•::-:-:•:-:-:-:-:•:':•:-:•:-:-:
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
WZOC)C��-Iz
C)�
os
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Lq GU 5100

Facility Number. �j —�`3 Date of Inspection 6 2 OG Printed on. 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge AJor ho-low ,gYes ❑ 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 T(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes W 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 e6 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? x'Yes ❑ No
-Additional : Comments'and/orDrawings: - -
r
5100

Facility Number Date of Inspection
I --- - j Time of Inspection � 24 hr. (hh:mm)
p Permitted p Certified ■ Conditionally Certified p Registered in Not Operationa Date Last Operated:
Farm Name: Huntrt:.Farms.................. County: Duplin WIRO
OwnerName: 1.!' khael................................. Hunter........................................................ Phone No: 298-.347.1 ....................................................................
FacilityContact: ...............................................................................Title:............................................................... Phone No:....................................................
Mailing Address:.1.5.7.fi..NC.Hwy.11.1.S........................................................................... Chanquap tx..NC.................................................. 2852.1 ..............
Onsite Representative: .......................................................................................................... Integrator: DogwAotlXarms....................................................
Certified Operator: Bhchad.L............................ Hunta .............................................. Operator Certification Number: l$Q.7.b.............................
Location of Farm:
Latitude ®0®4 ©L° Longitude ©• ®4 C.
Discliarye%&Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes []No
Discharge originated at: p Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? 17 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) p Yes []No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes []No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure ] Structure G
Identifier:
Freeboard(inches):...............24............... ................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes []No
seepage, etc.)
3/23/99 Continued on back

Facility- umber: 31-131 Date of Inspection
6- Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
[]Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11, is there evidence of over application? []Excessive Ponding ❑ PAN
[]Yes
[]No
l2. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
p No
14. a) Does the facility lack adequate acreage for land application?
p 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 readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
© Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
p 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
CY : No• viulations.or. cll�fi�ieitcres•wei e.nnted :during. this•visit..'S�ou_;vill :rereivr no-. further.:.:.
........ ....... ... ... ... ... .. .. ...........
:: • corxes�adde[1ce. abou# this:visit:: ::: :::
Assessment w
freeboard available. No problems detected.
Reviewer/Inspector Name -
Alan Johnson_ C: Koontz,(DLQ)
Reviewer/inspector Signature: Date:

0 Division`of Soil and Water Conservation'.-'Ope�rahon ReAew
w .13 Division of Soil and Water Conservation r Cotnpliancelnspection
Division of Water Qualityry- Compliance Inspection
b Other-Ageney - Operation'Review:
JJD Routine 0 Complaint 0 Follow -tee of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 1 Date of I nspection 'L
Time of Inspection t-so 124 hr. (hh:mm)
© Permitted -(Certified © Conditionally Certified [] Registered [3 Not Operational I Date Last Operated:
i
FarmName: I-f�dlYv`5................•.---..............................----............... County:.........t1y►..................................... ... .......-........
�....``.........r
Owner Name:. ............. !. G.4 f.......-..-..j(1j-k%.J Y. ................. Phone No:... �.Il �.Z� .�..-. �......................
Facility Contact: ............................ Title:.............. ..... Phone No:
Mailinn Address: [ (t.3.li.....NG.........i.� �.. S !!.. $5
`` j...........................................t..........
Onsite Representative: ..............R��q 1��. Integrator :.
ii. L .. i. ....... j{ j a be., ...............
Certified Operator:.............t Ck�f�l?.`.....x........1.?]lYsl'...................................... Operator Certification Number:..........................................
Location of Farm:
1
r.......................................................................................................................................................................................................................................................................... E
Latitude Longitude
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity. Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
ENon-Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
2q qX
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ID Spray Field Area
Holding Ponds / Solid Traps F 10 No Liquid Waste Management System
Discharg,es & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance nean-madel
b. If' discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in galhnin'?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
❑ Yes [P No
❑ Yes 0 No
❑ Yes P No
N IN
[:]Yes ® No
❑ Yes N] No
❑ Yes ® No
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes M No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): Z-5
I/6199 Continued on back

Facility Number: ��— t� Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑Yes Ph
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 00 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'? Ej Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ,Yes ® No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes .9 No
Waste AnDlication
10_ Are there any buffers that need maintenance/irprovement? ❑ Yes 0 No
11. Is there evidence of over application'? ❑y Ponding ElNitrogen ❑ Yes 14 No
12. Crop type bP iSIA ..............Si{!^!7�11.....gY Lr....... ................. C.Prr......(4 ...........�{-100- ................................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes f3No
14. 'Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment'?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
0. N-o.V10)atIOnS .or. deficiencies .were noted durink i iis.visit:. Y.otti Wvill.rerelve ne further .:.
.. eorr&biHidehee: abbot, this visit,', .: .................. . .:.:......... :...:.:..... . • : • _ .. . .
......................_................................ .
❑ Yes [$No
❑ Yes 19 No
El[ Yes ,&tNo
❑ Yes V No
❑ Yes '® No
❑ Yes 0 No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes A No
Comments (refer to question#): Explain any YES answers and/or any: recommendations or any other comments rv_,
Use drawings d facility'to better explain situations. (use additional pages as necessary)
VppT 6 i
8• Cce�ctti,,�w�.�tri"� �� t,. s ��.Id s���� � �► Gt�As� ��s si�at�� �e.
u►�,�n�tiu.� � ��.� �e�•� t� Yvtntl�
Reviewer/Inspector Name ' '
Reviewer/Inspector Signature: -&& I Ir 6 LDate: �lZrt�� _ 1 1/6/99

[] Division of Soil and Water Conservation (3Other Agency
Division of Water Quality
[%Routine 0 Complaint O Follow-uR of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection $
Facility Number
Time of Inspection 24 hr. (hh:mm)
© Registered [Certified © Applied for Permit [3 Permitted JE3 Not Operational Date Last Operated:
Farm Name: L�...............................................
C.lv``'� ...�`.r.....'.:.!".:.�............................................................... County ��..��'�,..
g5o
OwnerName:.......! 4.�1 1................................................................................ Phone No:...................... .......................
FacilityContact:.............................................................................. Title:........................ I ....................................... Phone No:
...... .........................................................
Mailing Address: .....e.4...... `�— �1 �, S �.......- l.! h .... `\� l ..... .. fir ............... ....I.........-...... - r......-.......... S2-
Onsite Representative:.... �- ..... +- 1.0.!'�S-riv Integrator:...... . .......................
1.
Certified Operator:............................................................................................................... Operator Certification Number:........................
[.ovation of Farm:
-........ M
.s...... InrT. ........ .... ... +'........................................... .� ! ... 1� ..1.5� ... !ica ..Y�k�.
...........................
Latitude �' 0' 0" Longitude
Des rgn Current `:a Design_ Current Design , Cvri=ent
" E,
Swine CapacrtyVPapulaliori` Poultry ' Capacity Population Cattle ; Capacity :'Populahon;
❑ Wean to Feeder
Weeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Ip Non -Dairy) I I
Y
❑ Other
Z't)tal Design`
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
mai ntenanceli mpro vement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design?
7• Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes t,No
❑ Yes F1 No
❑ Yes
0 No
❑ Yes
It No
❑ Yes
1XNo
❑ Yes
P(No
❑ Yes
0 No
❑ Yes
9No
❑ Yes W No
❑ Yes ONo

.' Facility Number: 3 —
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
( No
Structures (LaEoons,Holding Ponds, plush Pits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
�No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: i
Freeboard(ft):......... r1��......................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
(4No
It.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
(XNo
12.
Do any of the structures need maintenance/improvement?
CdYes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type .... 5 ............51� ......................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for Iand application?
❑ Yes
No
18.
Does the receiving crop need improvement?
❑ Yes
allo
19.
Is there a lack of available waste application equipment?
❑ Yes
(4 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
DI No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
D(No
22.
Does record keeping need improvement?
aYes
❑ 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
kNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
9No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
NfNo
0, No.vio'lations-vr. deficieneies. were-notidduring this;visit.- Y_ ou.wifl receive-no,ftirther : -
:•correspondeitreatioulrthis:visa.-.., :�::":•�•. �-.:....... . •:; "_,.....� ....... ........•:
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rpj� t_CQ�,-.\�1��`,se
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aN
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P c
7/25/97
U' ca�'T� i..ctiT}�. �C��SS � v'f-� 5 l�l� Cl�-►'��--.'� � �i t -i0 4�, �

6,
X.
Feedlot Operation
'� z ; � DWQ -Animal Feedlot Operation Site Inspection
10 Routine 0 Complaint—O-Follow-up of DWQ inspection 0 Follow-u2 of DSWC review 0 Other
Date of Inspection
Facility NumberE3ZD—E= Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
0 Registered 0 Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
Farm Status: MCertified 0 Permitted or Inspection (includes travel and processing)
0 Not Operational Date Last Operated: . ..... . .....
Farm ..................... ... . ..... --'*"--"'*"—'* .. . . ..... County: . .....
Land Owner Name: AA-diad__.- . ..... . ..... Phone No: &22L:..
Facility Conctact: .. . ...... Title: . ...... Phone No: .. . . ......
Mailing Address: . ..... ..... . .....
Onsite Representative. ..&'C�-a ......�l.L . ..... Integrator:
Certified Operator: ......... _... . .... . . ..... . ..... . . .... — Operator Certification Number:
Location of Farm:
lkg.-L -4- , 'JD , , kzqh± - k . .... j zi h&.- nq
_.Via W_ -.SA- 1. _A ... tcisljv.ae .... 11
Latitude Longitude
Type of Operation and Design Capacity
..........
W
Design
.... ...... !
Design Current
e ti Current
j6ijillation .. apa
6
C ent-
'S
,,X "no -Catd
5K 'm c1tVQP0"Vu at'­­�'...'__�_. -ODu a on.
Wean to Feeder pagi L-ayer Dairy
Dairv]
Feeder to Finish QJEI Nonj2yer I E❑I Non-
Farrow to Wean
VIN
171 Farrow to Feeder RTotal Design C
Farrow t Finish.
...........
NumberSubsurface .of.."Ek' HdIdifigT6 10 Drains Present
_goons
un
...... ...... I . . ii I 10 Lagoon Area�=pray Field Area t
I
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: C1 Lagoon [I Spray field El Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenancetimprovement?
D Yes RNo
El Yes ETNO
[I Yes E[No
[I Yes JgNo
TI Yes
C9 No
0 Yes
KNo
[I Yes
CKNo
0 Yes
ONo
Continued on back

Facility Number: _. 31....—...�..._
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
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Structures (Lagoons and/or Holding Ponds)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
KNo
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
10.
Is seepage observed from any of the structures?
❑ Yes
RNo
11.
is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
ER -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
RNo
Waste _Application
14.
Is there physical evidence of over application?
❑ Yes
allo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ...._...........1vA0.S.......... �JLv& .........................._...... .. Y.t3�t['i.......................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
S4 No
17..
Does the facility have a lack of adequate acreage for land application?
❑ Yes
NrNo
18.
Does the receiving crop need improvement?
K Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
K No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ISNo
For
Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
ERNo
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
RNo
24.
Does record keeping need improvement?
0 Yes
❑ No
Comments {refer to'questton f!) Explain any YES`answeis and/or any recommendations;or any other cdmments
-
Use drawings of faeihty,tb better ezpIam situations (use Ad do{nal pages as necessary) Val F
5Skaulo '_6e
I 11��w;F
IZ. emSipn o,-rMS c_rour4 tn\xi ?7Tes fiflt, 6Ji A - c..r� tl� i rMeded. LAB-.
�4s S64 4C fc seecka. 7
4
l Coo s C OC i n �J c13 AUYA6-r I 7) lOUJa be. OK y red .
a
Reviewer/Inspector Name t::•t^e�
3:E
Reviewer/inspector Signature:
,�_L ��,u,
_. _
Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No. ?/ -/.?/
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERA.TIO `S�SITE VISITATION RECORD
7
DATE: .1995
Time:
Farm Name/Owner: t ey ( Wuly-r60-
Mailing Address:
County:
Integrator. _-/(i��J2i Phone:
On Site Representative:Phone: jqR
Physical Address/Location: A9 11 A �Np
Type of Operation: Swine Poultry Cattle
Design Capacity: _,. Number of Animals on Site: r&P/A/b
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° _,�O ' IZ'�" Longitude: —17 _" —V?, ` " Elevation: Feet
Rol 2 (P 17 R-- _ Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard-_a_Ft- Inches
• Was any seepage observed from the lagoon(s)? Yes o
as any erosion observed? Yes r NToH d,,�
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: / ? 4e ez .� (ZgAs`%t_
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain -
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: !J / -
Inspector Name S' ature
_'�
cc: Facility Assessment Unit Use Attachments if Needed.