310136_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

C
Type of Visit: 0 Com nce Inspection p Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Q outiae Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: O.-.cam'-1. Integrator: r f�
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Cattle
DairyCow
Design C►urreat
C•a acity Pop.
W to Feeder
e
ter
Non -Layer
Dairy Calf
eeder to Finish
(,? po
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P.oul
Layers
Design
Ca aci
Current
P,a .
Da Cow
Non -Da'
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Turkeys
Turkey Poults
Other
I
IBF-.t-.f Brood Cow
Other
Other
Discharges and -Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
[—]No
❑ NA
❑ NE
❑ Yes
D No
❑ NA
❑ NE
❑ Yes ❑ No A ❑ NE
❑ Yes NoNA ❑ NE
❑ Yesg�6E]No NA ❑ NE
Page I of 3 21412015 Continued

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

I
Facili Number: I - 13 jDate of Inspection: fq
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check [—]Yes E No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑ NE
[a NA ❑NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:.
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ N ❑ 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
dNo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ YesFNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes❑
NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes❑
NA
❑ NE
rya.
ReviewerlInspectorName: �IVtLIJA'
Phone:
Reviewer/Inspector Signature: "KA� Date:
Page 3 of 3 21412015

Type of Visit: (0 Co "Plianee Inspection V 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: IFQCounty: .%V t.ZW Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: b►� R��
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: I $ b
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry CaM.pacity Pop.
Cattle
DairyCow
DairyCalf
DairyHeifer
Design
Capacity
Current
Pop.
Non -La er
Wean to Feeder
BLayer
Feeder to Finish
a
rrow to Wean
rrow to Feeder
Design Current
D . P,oui_t_ry Ca aci P,o
D Cow
Non -Dairy
to Finish
La ers
Non -La ers
Beef Stocker
ts
Beef Feeder
!Farrow
ars
Pullets
Turke s
Turke Puultsher Other
Beef Brood Cow
her
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ o
❑ Yes o
❑ Yes No
D NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: JDate of inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):^
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
f
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[/J 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 environmen l threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No DNA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [�No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes M 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 E61140 ❑ NA ❑ NE
l5. Does the receiving crop and/or land application site need improvement? ❑ Yes o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes WNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements
❑ Yes eNo
❑ Yes [2/No
❑ Yes ENo
[:]Yes E(No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes YNo
�l ❑ NA D NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
[]NA ❑NE

Facili Number: 11 - I Date of Inspection: p
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
eNo
❑ NA ❑ NE
25! Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[�/No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
ErNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Ck<
❑ 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
[DNA ❑ 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
[j,<o'
[DNA ❑ 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 ❑ LagoonlStorage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [2<9 ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ;No ❑ NA 0 NE
Comments -(refer. to question #): Explain. any YES answers and/or any additional recommendations or. any other comments.
Uie-drawines of facility to better explain situations (use additional<pazes as.necessarv): "
Reviewer/Inspector Name:.
Reviewer/Inspector Signatui
Page 3 of 3
Phone
Date:
/4/2 S

(Type of Visit: 9 Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: l j Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: cl1/,JATA j,% K-LL ►I. rt_
Certified Operator -
Back -up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 1 1 b
Certification Number:
Longitude:
Design Current
Swine Capacity Pop. Wet Poultry
Wean to Finish Layer
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dair
y Calf
Wean to Feeder
Non -La er
I
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
=Wesign
D . P,oul
Layers
Current
Ca aci P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other Turkey Puults
Other Other
Discharges and Stream Impacts
i . is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[—]Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes ❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes II 1"
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes 1a 1`0
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: -15A I s ection: �1
Waste Collection & Treatment
4.,js storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
WN(o
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes � o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes WNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 21 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
WXo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
rNo'
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other-
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

[Eacility Numbe IJI - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesVNo
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes VNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
/No
NA
❑
X
❑ NA
❑ NA
No
NA
❑
o
❑ NA
No
❑ NA
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 Signatur
Page 3 of 3
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Phone( a
Date:
214 01 S

�Facility Nun
Type of Visit:
Reason for Visit:
Date of Visit: E
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Inspection O Operation Review O Structure Evaluation O Technical Assistance
0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Arrival Time: Departure Time: /® County: hLftW3 Region:
Owner Email:
Facility Contact: Title:
Onsite Representative: _ o N d I Y -n�g—
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone:
Integrator:
Certification Number: 17 10
Certification Number:
Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish I ILayer
Cattle
Dairy Cow
Desigu
Capacity
Current
Pop.
Wean to Feeder
I jNon-Layer I
EE]
Calf
Feeder to Finish
—Dairy
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►urgent
Dr, P.oultr. Ca aci P,p P.
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 Cl"No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes YJ N ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number:
Date of inspection: 111GIN
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier: �4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
Structure 2 Structure 3 Structure 4
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
Structure 5
dNo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes WNo [DNA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmgo
1 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [:]NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 0 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 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
n MA6❑
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�(No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
WN❑
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ 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 V Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
N
. ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facili Number: - Date of -inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [�o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EalNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes dNo
[:]Yes 2(No
[::]Yes No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
❑NA ❑NE
[:3 NA ❑NE
❑ NA ❑ NE
I_J No ❑ NA ❑ NE
2 o ❑ NA ❑ NE
[20% ❑ NA D NE
Reviewer/Inspector Name: LJ off N (, L Phone q i o j6
Reviewer/Inspector Signature: Date: (p
Page 3 of 3 2/4 0I4

(Type of Visit: C) Ca fiance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:®County:td� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: )QhJA-TkA-j f MlCR— Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design
Capacity
C*urgent
Pap.
Wean to Feeder
I
lNon-Layer I EE
Dairy Calf
Feeder to Finish
Farrow to Wean
2
31M
Design Current
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
D . P,oult . Ca acity P,o P.
Layers
Non -Daily
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes C25 /No ❑ NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes � ❑ NA ❑ NE
[—]Yes 7No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - (o Date of Ins ection:
(Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes WNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2 Structure 3
L'I 6wvr,.
Structure 4
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
Structure 5 Structure 6
❑ Yes E6No ❑ 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 � ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ElYes 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 YNo ❑ 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�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
CI No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes�'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
d
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rNo
❑ NA
❑ NE
Required Records & Documents
N
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[f
❑ 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 El Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
[]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
.rNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Inspection: A72jtp
M. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes 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 fait to provide documentation of an actively certified operator in charge?
❑ Yes
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus toss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
/No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No [DNA ❑ 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
�o ❑ 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 21"No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes LLJ lv ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Reviewer/Inspector Signature: Date: 1"5
Page 3 of 3 /4/2011

Type of Visit: Co pliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: / "Z,p Departure Time: County: fJ T Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: S60"m4fo n;jr� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: is n
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr. l;oultr Ca aci P,o ,
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Boars
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Other Turkey Poults
Other:IBFTOth;r
Discharges, and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes FNo
❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
[—]Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Insection: Zi
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Lr
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): b
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [—]Yes D/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? ❑ YesNo ❑ 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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 4No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�J/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [] Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes R o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Yo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑.NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other: le
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes eNo ❑ 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 ❑ N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: r - Date of Inspection: -y/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes YNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[—]Yes [./ No ❑ NA ❑ NE
❑ Yes I__l �N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [5No ❑ NA ❑ NE
❑ Yes K
❑ Yes [v� �No
Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations; or auy, other. comments...
Use drawings of facility to better explain situations (use:additional pages.asnecessary) .;
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
V
Phone: C 10
Date: 12,524-111
4/20 1

Type of Visit: (.)'Comp "ance Inspection V Operation Review (_) Structure Evaluation O Technical Assistance
Reason for Visit: outtne O Complaint O Follow-up C) Referral O Emergency O Other O Denied Access
Date of Visit: 1L Arrival Time: O Departure Time: County: 6t_fL.W Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Onsite Representative: Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
-SMMMaIDesign
Swine
Wean to Finish
Current
Capacity Pop.
Design Current
Wet Poultry C►apacity Pop.
La er
Cattle
Dai Cow
Design C►urrent
Capacity Pop.
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
!0'7
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr, P,oult . C•_a aci_ P,o ,
ILayers
DryCow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non-Laye
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [3/No ❑ NA ❑ WE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [] Yes YNO ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �o DNA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

[6kility Number: st - I s jDate of inspection: it
Waste Collection & Treatment
4. Is'storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA &aurpj
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3'L
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 environment I 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 M"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 PNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [Z/No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus • ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[,2No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
�es
❑ No
❑ NA
❑ NE
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E3"No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
do
❑ 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 [3To
❑ 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 ONo
❑ 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 N
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes rNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F21No ❑ 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 L d l"o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Vo ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
lComments (refer to question #): Explain any YES answers and/or any additional recommendations or -any other comments, ,
usedrawingsof facility to better explain situations (use additional pages as necessary).„
15,) W CC.o Covr"U oEr-Oki)
Reviewer/Inspector Name: a6 ►.I t 4 FA It trll
Reviewer/Inspector Signature:
Phone: ( l)-ft
Date: if t1 11,
Page 3 of 3 21412011

Fac�llty;Number,
31
l36
�Dlvision of Water..Quahty, ..
:O,Dtvtsion of Soil and Water Conservation s>
Other�Agency,:,
Type of Visit of Com Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: b4 Departure Time: County: :� Region:
Farm Name: Owner Entail:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 = s = i! Longitude: = o = ,
a Design Current Design .Current
Sw the Capaci Po utation Wet Poultry Capaci Po ulahon Cattle
a: Wean to Finish ❑ Layer ❑ Dairy
Cow
❑ Wean to Feeder 10 Non -Layer ❑ Dairy Calf
Feeder to Finish OCS ❑ Dairy Heifer
❑ Farrow to Wean = ❑ D Cow
• DryPoultry� m,
❑ Farrow to Feeder ❑ Non -Dairy
r ❑Farrow to Finish ❑ Layers
.3 ❑ B f S k
" El Gilts ❑ Non -Layers
❑ Boars ❑ Pullets
t.
K ❑ Turkeys
th" r.
nother
urke PoultsElOther
ee toe er
• ❑ Beef Feeder
❑ Beef Brood Co,
Number o Sty
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 1 of 3
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
VNo
El NA
❑ NE
❑ Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — 1 Date of Inspection t1 l o
Waste Collection & Treatment ,�(
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ErJ 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: k..iaCyt 0
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3C.)
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) 1
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes E No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t cat, 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 2f 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 Ef No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes UNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
eNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYes
U(No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2/No
❑ NA
❑ NE
Comments (refer to question, #): Explain any YES,.answers and/or anyrecommendations or any other comments ,Y
Use drawings of facility to better explain situations. {use additional °pages ,as necessa
Reviewer/Inspector Name 'Ijbu;°,: " Phone: td
Reviewer/Inspector Signature: Date: lIA Lu
Page 2 of 3 1 12128104 ` Continued

1
r
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ETNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ElYes ETNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
LI Flo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
� o
El NA
El 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
❑ NA
ElNE
UNo
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
I No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LI No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concem?
❑ 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
E305o
❑ 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
oo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
Elj Yes
,�,�
!3 L /o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

acility Nu
Type of Visit
Reason for Visit
Date of Visit: 1I a
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Arrival Time: '�U ] Departure Time: County: Il/PiIRegion:
Owner Email:
Facility Contact: Title:
Onsite Representative:��►4:T�16a►—�l
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 n = 6 0 « Longitude: = ° = ` = «
Design Current
Design Current
Design Current
Swine iiiI Capacity Population
Wet Poultry Cap, amity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
can to Feeder
on -Layer
❑ Dairy Calf
Feeder to Finish
Gad
❑ Daia Heifer
❑ Farrow to Wean
Dry Paultty
El Layers
❑ Dry Cow
ElNon-Dairy
❑ Farrow to Feeder
El Farrow to Finish
El Non-Layers
❑Pulle
❑ Turke s
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood CoN.
❑ Gilts
❑ Boars
Other
❑ Turkey Poults
JE1 Other INumber
of Structures: E]
❑ Other
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there an adverse impacts or potential adverse impacts to the Waters of the State
Y P P P
El
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: 3 — Date of Inspection t5
.
Waste Collection & Treatment
VNo
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 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: Lip — r��
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
dNo ❑ NA ❑ NE
8. Doany of the stuctures lack adequate markers as required by the permit?
❑ Yes
C 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
M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance ahernatives that need
❑ Yes
❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ es
ENo [INA
ElNE
15. Does the receiving crop and/or land application site need improvement?
L Yes
❑ No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
QI No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
NN El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,[��,
hdNo ❑ NA
❑ NE
I;Comments (refer' to quest�ori'#} r Explain eny,YES,answers and/or any: recommendatlons or any other -comments
'Us­e"drawings4f facility to better egplaun sttua(zgns (use additional page`s as necessary) g Y
_ 3
wjIQ
14 - ti &T FZ40 AiC0116K .
Reviewer/Inspector Name "; j Phone:
Reviewer/InspectorSignature: L. Date: la 2
I

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

Type of Visit 6Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 2 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 6 Q 6 Arrival Time: ��b6 Departure Time: County: JOAN W Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Oimicn-tJ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = 6 = fl Longitude: = ° 0 6 = i,
Design Current Design Current Mesign Current
Swine Capacity Population Wet Poultry Eapacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dairy Cow
❑ Wean to Feeder
❑ Non -La er I
airy Calf
® Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Layers
El Beef Stocker
Non -Layers
El Pullets ❑Beef Feeder
❑ Beef Brood Co
El Farrow to Finish
El Gilts
❑ Boars
❑ Turkeys
OtherEIFI
Turkev Poults
❑ Other
❑ Other Number of Structures:
Dischar 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 0NNo ❑ NA ❑ NE
El Yes
❑No El NA
❑NE
❑ Yes
❑ No ❑ NA
❑ NE
El NA
❑ NE
❑ Yes
El Yes
[o
m- ❑ NA
[INE
ElYes
IJ No ❑ NA
❑ NE
Page l of 3 12128104 Continued

Facility Number: — �, Date of Inspection D D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [(No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: JA OP A)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y3 ,�(
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes LI 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 eNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
Ell
7. Do any of the structures need maintenance or improvement? Yes El No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Z 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 El Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,,�__,,�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I�1"No ❑ NA ❑ NE
maintenance/improvement? �
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes O No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
[2'N'o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
r/*No
❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
❑ NA
❑ NE
7� SASS WO94< S XU­ FP J / flIrk- WALL , lJ#cwKErvj �SN�1 i/f MFM"S AL
Reviewer/Inspector Name
. Phone 0 f 7 0
Reviewer/Inspector Signature: Date:
: use i, vJ �... ..... ..T r...'.�...

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

Facility Number 3 L
QYDivision of Water Quality
O Division of Soil and Water Conservation
Q Other Agency
Type of Visit Ooompliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit V hfoutine 0 Complaint 0 Follow up O Referral ()Emergency ()Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: J N�14N /- Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Region:
Latitude: = 0 0 & Longitude: = ° 0 ` 0
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La ei
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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Neifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
111
111
❑ Yes Dof o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[]No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[:]Yes
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is'storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LA I�aaIJ
Spillway?:
Designed Freeboard (in): I
dF
El Yes No El NA El NE
El Yes El No El NA El NE
Structure 5 Structure 6
Observe reeboard (in).
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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 environm tal 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 dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes�001
�NXoNA
❑ NE
16. Did the facilityfail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
P P g lm
❑. NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
U4 ❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
7.) Svwl.l- EK45Xd on/ SDIt4{ 144
tS� JVA �— Lt-dS4 ESIAS�S 0 "$5 (WEA—,
mil.) S6rc-PATE, -TAX 7- Y 2.onit< Ppwot J(-1
Reviewer/Inspector Name . I I Phone:
Reviewer/Inspector Signature: Date: 1 u
12128104 Continued

Facility Number: — 3 Date of Inspection
Requited Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
,..�
21. Does rec keeping need improvement? if yes, check the appropriate box below.
LI Yes
El No
❑ NA
[I NE
aste 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
dJ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L'(N
El NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
��0�103
NA
�A
VN
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification
ElYes
❑ No
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
d1q.1[I
NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El 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
ffNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�No
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L2/No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

y _'jlivision of Water Quality
Facility Number �' Q Division of Soil and Water Conservation
-- - - - C) Other Agency
Type of Visit Q'Eompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: I i J V_0_ ArrivalTime: Departure Time: County: I Region: C
Farm Name: `�`7�l/�,—loll /!/�G _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 0 Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design
Swine ­.Capacit
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish (,
❑ Farrow to Wean
El Farrow to Feel
deer
to Finish
ElGilts
❑ Boars
Other
❑ Other - - - - -
Phone:
Phone No: _�Z_
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = 6 Longitude: 0 ° = ` [� "
ntDesignCurrent Design
ion Wet Poultry _ Capacity Population' Cattle Capacity
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: 31-1361 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Strut re 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift El Application Outside of Area
12. Crop type(s)xexl_;��C
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): 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):"
e c- Co/ U G �'� / r� L�✓� - ee� s e
Reviewer/Inspector Name I"Ope Phone:
Reviewer/Inspector Signature: Date: L6_
Page 2 of 12h8104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24. id the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/,or>Drawings:
AL
Page 3 of 3 12,2&04

31 H 13G
Type of Visit CC pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ( Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Z- Qs
Arrival Time: a
Departure Time: County: bUPLZ>/ Region:
Farm Name:
Owner Email:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: r'Ejd
Certified Operator: { LAIII M c.9C A-:e
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 a [= . [= « Longitude: [= ° = 6 = is
Design Current
Design Current Design Current
Swine
Ca ac! 0puladon et Po Itry�
Capacity Pop�lahon .:.Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La ei
❑ Dairy Calf
Feeder to Finish
3�0� Z
❑Dai Heifer
❑ Farrow to Wean
Dry Poultry
ElD Cow
El Farrow to Feeder
❑ Non-Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other NO
am
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
ko
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Yt,o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

I' acility Number: 31 Date of Inspection Z 2 D $
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes El 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: L8 6�_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
S. Are there any immediate threats to the integrity of any of the structures observed? El Yes
23 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
4No ❑ 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? E(Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes
�
DNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
!J No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
0No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 63 eaLm voA S Cro
13. Soil type(s) M 0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ILI No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[]
yes
L2 No
❑ NA
❑ NE
17. Does the facility lack adequate'acreage for land application?
❑ Yes
6o
[I NA
❑ NE
18. is there a lack of properly operating waste application equipment?
El Yes
�`No
❑ NA
❑ NE
C XAss Go'fER- 0C LA4, 0 DU C WALA S,
21,) tj&c4 cey vF ANNUAL. C 2"[z F c AT Aa J 0
Reviewer/Inspector Name ly "T Phone: �9ra) 3cis-_39a� x 2p3
Reviewer/Inspector Signature:, Date: 4� v
12128104 Continued

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

Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Z Routine 0 Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: 1 Time:
rO Not O erational 0 Below Threshold
} Permitted ® Certified DyCyjonditionally Certified [] Registered Date Last Operated or Above Threshold:
Farm Name: ill !/! A County: !010 rfl10
Owner Name:
Mailing Address:
Facility Contact: /jTitle:
Onsite Representative: �n D z4a
r, e4v
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator ✓
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 & " Longitude ` 6
_ Design' Current Design Current Design Current
Swine Ca aci P,o ulation Poultry Ga aci P,o ulation Cattle Ca aci P,o ulation
❑ Wean to Feeder ❑ La er ❑ Dai
❑ Feeder to Finish 3 ❑ Non -La er _� ❑ NonDairy
❑ Farrow to Wean
El Farrow to Feeder ❑ Other
El Farrow to Finish Iota_ 1 Design Capacity
ElGilts
El Boars Total SSL.W
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ y S ra Field Area
......... ............
Holdon ing Pds / SoGd Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the 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): 3
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number: 31 — �, Date of Inspection / 1 1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gained markers with required maximum and minimum liquid level
elevation markines?
Waste ARplication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hvdraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVI`MP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
I & Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WitiP, checklists, design. maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie' discharge, freeboard problems. over application)
23. Did Reviewerlinspector fail to discuss reviewAnspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [--]No
Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspo©dence about this viiit.
Commeflts (refer to question . Eiplauistiy YES answers aadlor atry_.monuii dsitions'orianV.other_oomm'e
Use drawtnl s of fac7tty to better ezplam siRuahons. (nse addttionil pages is necessary) - `: ❑ Field Covv ❑ Final Notes _::•
�/aS�� c� ->Q •� Cut om.t ,'s ✓�'y h.� h --- S�, Goo,? yto * a��,r
_. A4 fi, 1,t 4ti'01i, f lu fDoh G>''v 0,1 � d7�' �v�' �`� e I.A el, 0
�!
GQ w P�r`h 11%' Xt v>p"� OA-4 /0 rvvG [. X 44- L.c h 1 -t
PCe C 0 r VoLe f o s v�. 5 a�!
.-� ;.
r
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: /
05103101 r Conifnuad

Facility Number: 3 / - G I Date of Inspection 1 ZI
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30_ Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Cl No
❑ Yes ❑ No
Additional Comments•and/orDrawings:
;:*:E A
T
05103101

of Visit OO Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 136 Date of Visit: 4R512002 Time: f lam
F ----- ---------------- . ........... 10 Not Operational O Below Threshold
Permitted M Certified E3 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: .............•
Farm Name: bill.MdCay..FAral..................................... .............................. County: 1.upUA............................................... W1<)F U.........
Owner Name: William .................................. McKay........................................................ Phone No: 9.10.-.296039.6...........................................................
Mailing Address: I,5IC...GUmaU.kaWell.Raad...............................................................KenanNYWCAC .................................................. Z83.49 .............
Facility Contact:.............................................................................. Title: .. Phone No:
.................................................................................................................
Onsite Representative: Geno.Kcmigdy............................................................................ Integrator: Mux.phy..Funily-Earms...... .......................... I......
Certified Operator: Wifflam.J&............................ McKay.................................. Operator Certification Number:.IB��$.....................
............ ........
Location of Farm:
East of Kenansville. On North side of SR 1729 approx. 1.7 miles North of Hwy 24. 1&
T
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 s- 53 u Longitude 77 • 54]4 F-22­1 G[
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes N 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 galfmin? .
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:.................1..........................................
Freeboard(inches): ...............3.a.................................................. ... :.................. ................................................. ...................................
❑ Yes ❑ No
❑ Yes No
❑ Yes 0 No
❑ Yes 0 No
Structure 6
............................

k -
Facility Number: 31-136 Date of Inspection 4/25/2002
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improveinent?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancefimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed
❑ Yes Z No
❑ Yes 10 No
D Yes 0 No
❑ Yes % No
❑ Yes M No
❑ Yes R No
❑ Yes Z No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes X No
14. a) Does the facility lack adequate acreage for Iand application? ❑ Yes 0 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?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W1]P, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Peru -lit?
(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?
Yes [)No
❑ Yes X No
❑ Yes N No
❑ Yes Z No
❑ Yes X No
❑ Yes N No
❑ Yes C9 No
❑ Yes 19 No
❑ Yes Z No
❑ Yes 0 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 0 No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
❑ Field Copy ❑ Final Notes
15 Field # 1,2 & 5b needs work to get improvement to insure adequate cover.
Rest of farm and records look good.
Reviewedins ector Nam
e
Reviewer/Inspector Signature: Date:

iDtvtsion of:Water atity .
- a Q Dtvtsion of.Soil and -Water Conservation t F
-Q'.Other.:Agency: `r
of Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit Routine Q Complaint O Follow up Q Emergency Notification Q Other _ ❑ Denied Access
Facility Number Date of Visit: '�rG Time: 3 G Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Permitted © Certified ❑ Conditionally Certified © Registered Date bast Operated or Above Threshold:
FarmName: .1�1......1•,\.............................................................................. County: ....t.� t................................................
Owner Name:
Phone No:
FacilityContact: ..............................................................................Title:................................................ Phone No:
M1lailingAddress: .......................................................................................................................
....... Integrator: Representative* �� .. Q ............. ....,..........................
. .....................
Certified Operator .......... Operator Certification Number:...,___,,,,,.,
Location 'of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 • & « Longitude • 6 44
Design Current
:"'Capacity Population
Wean to Feeder
Feeder to Finish
a
Farrow to Wean
Farrow to Feeder
-
Farrow to Finish
Gilts
Boars
Design Current Design_ Current
Poultry Capacity Population Cattle. Ca a Po iiilation
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Subsurface Drains Present ❑ Lag-mm Area ❑ Spray Field Area
No Liquid Waste Management System
Discharees & Stream Im act5
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 -nude? ❑ 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/ruin`?
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 W No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes O No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes M No
Structure I Structure 2 Structure ; Structure 4 Structure 5 Structure b
Identifier. ............................................ ........---
Freeboard (inches):
5/00 Continued on back

Facility Number: — Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes )<No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes A 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 XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNo
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONo
Waste Application
10_ Are there any buffers that need maintenance/improvement? ❑ Yes X No
l L Is there evidence of over application? ❑ Excessive Ponding❑ PAN ❑ Hydraulic Overload ❑ Yes 0 No
12. Crop type ,pt��lr`-� p1 S 6Vg
13. Do the receiving crops differ with those designated n the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
:: Vu yiolhG66s:oc- deficiencies were potted- d&ifig fhis.visit'. - Yoix Will-i-eeeiye iio futtho - : •. -
scorrespondence abanit this visit. ..... . ... ...
toscjuestian #) :Explain any YES ansys
❑ Yes XNo
❑ Yes WNo
❑ Yes kfNo
❑ Yes 9—
❑ Yes EYNo
❑ Yes X No
❑ Yes ❑ No
[]Yes )<No
❑ Yes U No
❑ Yes V No
❑ Yes DjrNo
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes V'No
A.
ly
�� o�--� . S, j�R co a�—•,-,1 +-fit �—j .
wll�\A r w kt i,,-w t__,o X, cLr r-ri rt
Reviewer/Inspector Name L�2C1�►--� k --.
Reviewer/Inspector Signature: 7�11_ (q )t_"
Date: 5/pp

'
Date of Inspection V Printed
on: 7/21/2000
Facility Number: -- 391
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
XYes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28_
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ YesNo
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.)
❑ YesNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
gNO
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
XNo
Additional-Cornruents an or Drawings:.--
J
5/00

F- Facility Number Date of Inspection Q'*
Time of inspection a G 124 hr. (hh:mm)
,Permitted © Certified [3 Conditionally Certified 13Registered JE3 Not Operational Date Last Operated:
C '
Farm Name: ......�`............ County:---...........1.�`',............ ......................•...•
Owner Name:.........................................................
Facility Contact: ....Title:
MaiiingAddress: ............................................ .. ...........................
Onsite Representative:. , . 2 `^o„ e .._.... .......
Certified Operator;.......
Location of Farm:
Phone No:
Phone No:
..................................................................................... ......... I................
Integrator:...... .......... .................................................
Operator Certification Number: ..........................................
Latitude �� �� ��� Longitude
-Design Curirent . Design - Current. Design Cuiirent
swine- ` ,Ca ac�ty_Po`pnlation Poultry Ca acity.,.Popnlation- Cattle Ca ci _.;Po` ulatioii
LL ❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish -Layer = ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ; ❑ Other
❑ Farrow to Finish Total Deli Ca a .
ci va
❑ Gilts P
El Boars Total'Sk
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (Il'yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Rf No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JyNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes toNo
Structure 1 Structure 2 Structure 3 - Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): I .............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes O<No
seepage, etc.)
3/23199 - Continued on back

Facility Number:' — Date of inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
9No
0
❑ Yes
❑ Yes
[YNo
❑ Yes
[�(No
❑ Yes
b`No
❑ Yes
eNo
❑ Yes
ONO
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there'a lack of adequate waste application equipment?
Required Records & Documents
I7.• Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20: Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
yioiatians;or ddi:cieacies *&o pbfed• 00fift this,visit: Yoix wiil-reeeiye do fut t f
:. rorresnondence: A;aut this :visit_ .........:...::.................... .
❑ Yes R( No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
<Yes ❑ No
❑ Yes gNo
❑ Yes XNo
❑ Yes DgNo
❑ Yes Wo
❑ Yes &No
❑ Yes D�No
❑ Yes JXNo
❑ Yes &No
❑ Yes CirNo
❑ Yes [YNo

Facility Number: — Date of Inspection Qe
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 V No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes] No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes KNo
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.permanendtemporary cover? ❑ Yes ,�j No
AdditionalComments`and/or-Dr
rw
3/23/99

Facility Number: — Bate of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes (4No
(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
9No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
CErNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
IN No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
R No
12. Crop type t sy
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
9.Yes
❑ No
c) This facility is pended for a wettable acre determination?
Yes
❑ No
15_ Does the receiving crop need improvement?
ZYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
gNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
9No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(ie/ WUP, checklists, design, maps, etc.)
❑
D�No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
PdNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
X No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
YNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
tTNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
9No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�No
�'�T J•yiolafions:or deficiencies #4, 'rp' jnot;ed- diWihd this;visit: • Y:oii ;wiil•Teceiye iris futther
icorres�ondence. abnu this visit.... .. . ... . .. ..
Comments (refer to question #): Explain any YES answers and/or any recommendations or any_ oilier comments:"
Use drawiings of facility to better ezplain:sttualtcins (use:additional pages as necessary)
E
n If
3/23/99

Facility Number: 1 Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor 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
N No
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
j 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
P�No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
VNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
XNo
3/23/99

Division of Soil and Water Conservation [3Other Agency. �x
Division of Water Quality f #`
Routine Q Com laint O Follow-u ' of DNVQ ins action O Follow-u of DSWC review O Other
Date of Inspection +�
Facility Number 3 3
Time of Inspection 24 hr. (hh:mm)
0 Registered _Q Certified © Applied for Permit © Permitted JE3 Not Operational I Date Last Operated: -
Farm Name: ................................
$ill.......-..11l��. ....-rr±.•................................................................ County:....�i��ft^................................
Ommer Name: ................
1��1.� 1x�........................................................................ Phone No:..CIa�. Lq!�..`.Q`l�r...................
Facility Contact: ..........................:.-....,
! .
....... Title:
Mailing Address:.... 1-�..... G.t2+�t1AY� .... 4.G�.t ��...V...................... . ....................
.......
Onsite Representative: ..... (1tii.iA i It.-...........�1?t-c.1t ...............
Certified Operator:....-... ......................
Location of Farm:
Phone No:
Integrator: .... mvf................................. ............. ...............
].`ti Operator Certification Number; .......,uq.�..............
...... ,AxelS-...i.5....P&...A0Y.- --.-$, $ ...� ....SK..I�z.. �....I.A s!kt .5... ��....�fe. YYi...t!IP� ....w . `x-i Irm.. � r................. �
...................................... ..... .... _ ... ... ... ... .... ......................................... 1
Latitude • ���� Longitude �• �' Z`l� "
-Designi Current •Design Current.
: Capacrty Population.
❑ Wean to Feeder
Feeder to Finish
3 6'17-
A
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ GiltsI
LEE]
❑ $oars
Di -sign -Curt
Capacrty Popuh
M
Numberyof Lagoons . Holding
Ponds ❑ Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area
w
R
y ❑ No Liquid Waste Management System
m
General
L Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
I IN
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ® No
3. Is thereevidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than IagoonslhoIding ponds) require ❑ Yes l�` No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes j No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97 Continued on back

Facility Number: 31 _ t36
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures (l.agoons,llolding PondsLFlush Pits, etc`,)
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier:
Freeboard(ft}:..................................................
............ .... .........................
10. Is seepage observed from any of the structures'?
Structure 4
11. is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes M No
❑ Yes M No
Structure 5 Structure 6
.......................................
❑ Yes [4 No
❑ Yes )0 No
12. Do any of the structures need mairrtcnance/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 P No
Waste Application
14. Is there physical evidence of over application? ❑ Yes Wo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .............-6aYt'141Ao .................................................. .....................
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 land application? ❑ Yes No
18. Does the receiving crop need improvement? CQ Yes ❑ NO
19. Is there a lack of available waste application equipment? ❑ Yes M No
20. Does facility require a follow-up visit by same agency? ❑ Yes N No
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes ® No
22. Does record keeping need improvement? Yes ❑ No
For Certified ,or,•Pentlitt•ed,Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes No
24. Were any additional problems noted which cause noncompliance of the Certified•AWMP.1 ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Permit' ❑ Yes ,(� No
0 No.violations or deficiencies were- noted during this.visit..You.will receive no further
correspondence about this.visit.
Cornments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawin s of facility to better ex lain'situations. (use additioriM. ' ii esmas necessary .. t
P P fi }. .
ze
1�.. Smat� �v'uit. s�na��� �Oe ftWwvt.� �� •(•o c.l(ov o�-roW`� o� i)errt�Vc}a.
AL
22 • �-S4C- tvyti�� S i 5 ShDt?� sae � t} b�
SkotA 6e ncor)J or\ f lZR-Z c4A(r- ct,c
7/25/97
Reviewer/Inspector Name iG ifl
Reviewer/Inspector Signature: Date:ZI�9$

Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
LFacility Number Date of Inspection EQZT4E
Time of Inspection r g! � 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status- 0 Registered 0 Applied for Permit (ex-1.25 for I hr 15 min)) Spent on Review
A Certified El Permitted or Inspection (includes travel and processing)
0 Not Operational Date Last Operated: .. . ....
_K 7.L
Farm Name:._. Af._jL r4r . ..... ... . ..... County: . .....
Phone No: Land Owner ---- — ----- . ......
Facility Conctact: Title: . . ..... . ....... . . .... Phone No: .... . .......
Mailing Address: .. . .... . ..... . ...... 2.1-141 . .....
Onsite Representative: .. . .... Integrator: ..........
.....
Certified Operator . ..... L 0- V Operator Certification Number: _12-yo-S ---- — ----
Location of Farm:
+ 2 75:
11Z ;�7i
Latitude 0 4 Longitude
Type of Operation and Design Capacity
W-�; � lis
Current
Wk esilo
. . ...... . .
-
a on.K.1 CaDacitv KijillationR»Ca act Po ulahon
.i 0 Wean to Feeder Layer 101 Da'y 1 1
% Feeder to
❑ IQ Non -Dairy Non -Layer
Finish 362L
q
-row to Wean
.�g
rl F D�
. . ...... ago
Far
ME
w to Feeder fit a
W;o e -a"' ac 1 3,672-
T ffid D SIEW
JE.
P, Farrow t Finish
4
4
. .. . ..... . . . ..... .. --FJ'ot!1F'SSL' -77 OD r. ae
0 Other
"s
Je"":IAW
�...... . . ............... . .
x Drains Present
Number0 Subsurface
Lagoon A Irl Spray Field nick--
General
I . Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at. E] Lagoon [] Spray field 0 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?
❑ Yes No
❑ Yes No
[I Yes P9 No
[:1 Yes I;gNo
El Yes No
[I Yes � No
D Yes O-No
E]Yes XLNo
Continued on back

Facility Number: -.&......
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures ¢moons and/or I#olding Poaft
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
t ,
15. Crop type ......xu&........ ........ ................... _..... u.... gnn
❑ Yes R'No
❑ Yes Q No
❑ Yes RNo
❑ Yes gL No
Structure 5 Structure 6
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Ce ifiedFacilities �n1X
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes ES�No
❑ Yes gNo
19 Yes ❑ No
❑ Yes bj�No
❑ Yes E9 No
❑ Yes &No
❑ Yes Cq No
faYes ❑ No
❑ Yes R No
❑ Yes PSNo
❑ Yes E'No
❑ Yes E'No
Yes ❑ No
® Yes ❑ No
Comments ,(refer to question'#I) Explain any YES answers andlor'.any_recommendatFons'or '"any comments
Usc drawrngs,of facility to better explain stuatxoris (use additional pages as necessary) . ''
.
lL- Lr_56m walls skodd �oe jnvAA I-oW aim, amj4 Mcydi- � s`�eS stw O be. 4W.W
4
y 4. c(ay arJ rescued -
is. Cm5io' l Croy iv, -A-fid I g S601i 6e improver).
z� . Gmeo\5 or, svba(( Y&ZK S61d be- i ncovporaw in
z u. S %_fCods 51'J be, Kc � 4ef J nu,a-� alJ #'� Sev- nvrn,6ev- 0ai�td
o`� arl� Alas a" s i5 Shr�(r� b e-
5 k y
a
Reviewer/Inspector Name:
c
Reviewer/Inspector Signature: Date: :141 111`7
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

•
Site Requires Immediate Attention:
Facility No. 31
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Own(
Mailing Address:
y3y
County:. Oti IJ '� !_
Integrator. (41n-14 _ Phone:.
On Site Representative: i=k re /��P � _ Phone:
Physical- Address/Location: 4 t 4 r'r Ch 4 Ad a Ae e_ S 12 12 ?- 9�
le �_ �v U �,4�m- em�A LET
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity:, 7 L Number of Animals on Site: v
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 30 _" Longitude: Elevation: Feet
Circle Yes or No
Does`the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No Actual Freeboard: Ft_ ^� Inches
Was any seepage observed from the la oon(s}? Yes or Was any emsion obse d? Yes or
Is adequate land available for spray? Yor No Is the cover crop adequate Ye or No
Crop(s) being utilized:
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 a state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 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: _ ria2�ft 01j.
Inspector Name
Si tore
cc: Facility Assessment Unit Use Attachments if Needed_