310172_INSPECTIONS_20171231

NORTH AROLIN
Department of Environmental Quai

for Visit: !b Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 15 / P /t I� Arrival Time: F Departure Time: F39 9 County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact:
Title::
Onsite Representative:
/n�
`�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Region:
Certification Number: 19 1 / 2.o
Certification Number:
Longitude:
Swine
We o Finish
Design
Capacity
Current
Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Guarent
Cattle Capacity Pop.
DairyCow
can to Feeder
4 vp
9
Non -La er
Da' Calf
Feeder to Finish
Farrow to Wean
Design
Current
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
D . P,ouI
Layers
Ca acit
P,o P.
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
jBeefBroodCow
Other
El Other
11 11
Turkeys
Turke Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [—]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Nu er: - jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0<0_�C_3 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): J I
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Io ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
O—No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4fi were answered yes, and the situation poses an immediate public health or environm 1 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
0 No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, 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?
0 Yes
Io ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NA
FN
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ffNo ❑ 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
[N ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EJ 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 E J NN ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: '3j - 4P IZA_Date of Inspection: o / 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes rTNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a PDA 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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
No ❑ NA ❑ NE
❑ No c2rNA ❑ NE
No ❑ NA ❑ NE
❑ Yes P-<0 ED NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes En No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑Yes No NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑Yes No ❑ NA ❑ NE
Reviewerlinspector Signature:
Date: D

Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t / Arrival Time: Departure Time: 1 13 O County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
to Finish
Design Current
Wet Poultry
Layer
Design
Capacity
Current
Pop.
MDesvgnau;rent
Cattlepacity Pop.
DairyCow
to Feeder
Non -La er
Da' Calf
FrFarrowtoWean
er to Finish
0
Dai Heifer
w to Feeder
w to Finish
D . Kann ,
La ers
Dign
Ca act
Current
P,o .
D Cow
Non -Dairy
Beef Stocker
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
101 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)?
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 [j'NO ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
❑INN/
❑ NA
❑ NE
Page I of 21412011 Continued

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

P�acitity Number: 'j - 2 Date of Inspection: Z O
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [6'No ❑❑NA ❑ NE
/
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? n Yes n No F /Y NA n NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ILI 110
❑ NA
❑ NE
❑ Yes
VrNo
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
ff No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
[—]Yes dNo ❑ NA ❑ NE
Reviewer/Inspector Name: 0 ✓ � /moo"-= 0 Phone: [phone]JA%�
Reviewer/Inspector Signature:
y �!1—" / Date:
Page 3 of 3 21412014

(Type of Visit: 0 CCopliance Inspection Q Operation Review p Structure Evaluation Q Technical Assistance v I
Reason for Visit:
R�_ouutine Q Complaint Q Follow-up Q Referral O Emergency O Other Q Denied Access
Date of Visit: akl yi 10 l Arrival Time: tl.l.cl� Departure Time: tl- County: 1 /pt�Lo Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 6(;'&prr valcw Ll ,
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
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?
Phone:
Integrator:
Certification Number: l 9 I 3 2.6
Certification Number:
b. Did the discharge reach waters of the State? (If yes, notify DW R)
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 D WR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
[—]Yes L/J 1Vo
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes VNo
o ❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

n
JI'acility Number: � - �1 �Date of Inspection:
Waste Collection & Treatment
4. Is Storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
U� Identifier: trn&v-o-vJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EZ"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
7(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
ENo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
I�'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
j`'
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are buffers,
❑ Yes
�-�(
❑ NA
❑ NE
there any required setbacks, or compliance alternatives that need
{LJ o
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ef No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[XNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
UeNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E4�No
❑ 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 ❑ 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? ❑ YesVNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes ❑ NA ❑ NE
Page 2 of 3 214120I5 Continued

!I.
JIFacility Number: $1 - ICI')_� I jDate of Inspection: J /a3p6 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 6Vo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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?
to
to better
any x rs answers anwor any
Reviewer/Inspector Name: �}. 3 �&eoa L/
❑ Yes dNo ❑ NA ❑ NE
[—]Yes 2/No ❑ NA ❑ NE
❑ Yes C3'No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
5 i
dations or any
as necessarv). I .
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
mments... -, r'. _
-TW9
Reviewer/Inspector Signature:
Page 3 of 3
Date:

Type of Visit: (0 C mpliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visi[: Routine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: J,S I Arrival Time: Departure Time: /® County: y/ViaL Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: (SQOg.1-[-
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: G
Certification Number: { 53 —/T
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oultm
Layers
Design
Ca aci
Current
P,o .
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPouets
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 DW R)
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
[—]Yes [—]No
❑ Yes [—]No
❑ Yes ❑ No
❑ Yes Io
❑ Yes u o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Vumber: - Date of Ins ection: IQ 115
Waste Collection & Treatment
jNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[—]Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: .l.jr'n ^�t�C6_IV'
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ZNo ❑ 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 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 IU "o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10%or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
[o
ii
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Yo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�rNo
❑ 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 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

jl�acilityNumber: 12,1- Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �VNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
UPOK0
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
❑NA ONE
o ❑ NA ❑ NE
No ❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phony 026 3 tJ
Date: L<i S
21412615

Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: E Arrival Time: Departure Time: County: 1 ,d, Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
OnsiteRepresentative: 1`�Q.���J-�(�j`, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I (jS `I
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Capacity Pop.
Dairy
Wean to Feeder
6d
Non -La er
Feeder to Finish
D , , P,oulh,
La ers
Design
Ca aci r
Current
$o ,
Dairy i
Farrow to Wean
Farrow to Feeder
Farrow to Finish
:Non-Dairy
:Cow
Gilts
Non -La ers
oars
Pullets
Other
Other
Turkeys
Turkey Poults
Other
Dischar¢es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No ❑ NA ❑ NE
[:]Yes
[]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ o
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Pagel of 21412011 Continued

facility Number: Date of Inspection,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
INo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[—]Yes
[:]No ❑ NA
❑ NE
StructureStructure 2 Structure 3 Structure 4
Structure 5
Structure 6
.I
Identifier: LA 6-"
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �j I
5. Are there any immediate threats totheintegrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes�>d ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes ❑ 'o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I Vivo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes V 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 [hose designated in the CAWMP?
❑Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�Io
❑ NA
❑ NE
acres determination?
N
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P<O
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate Coverage & Permit
Yes
N
NA
NE
of readily available?
❑
[I]
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
7 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections /❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ED]❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection,
�4. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ✓�No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E(No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 5No ❑ 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
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
No
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
dNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
U�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
EJ N
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VN
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
bio
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone
Reviewer/Inspector Signature:
Page 3 of 3
Date:

Ir ype or v isir: Ip comppance inspecuou ll uperanon review l.J mrucmre cvamapon v i ecunrcai assistance I
Reason for Visit: � Routine i) Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: W'1� Region: O Rtl
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: Qyevk/ d\ �'jGhrQJ\� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: Pye LS p)'
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D POaltr,
Layers
Design
Ca aci
Current
P,o -
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
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)?
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 [✓ENo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�No
[:]Yes
)!!�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21412011 Continued

Facili Number: - - In jDate of Ins ecfton:
Waste Collection& Treatment
4.11s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[!fNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
yStructure
Identifier: ftVnN
�— xP--
Spillway?:
Designed Freeboard (in): �--
Observed Freeboard (in)::7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3No
❑ 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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[7No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[/JNo
❑ 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
[ErNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Eno
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ErNo
❑ 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
C31No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q"No
❑ NA
❑ -NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ErNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2rPIo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[srNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[allo
❑ 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 EErno ❑ 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 2!rNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 1A I - In jDate of Ins ection: '3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [lr/-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [-]Yes [No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ErNo
❑ NA
❑ NE
❑ Yes
[ZrNo
❑ NA
❑ NE
❑ Yes
ZZ[No
❑ NA
❑ NE
❑ Yes 07No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes 2rNo ❑ NA ❑ NE
[:]Yes
ONo
❑ NA
❑ NE
❑ Yes
ICJ No
❑ NA
❑ NE
❑ Yes
OfNo
❑ NA
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facilitv:to better explain situations (use additional mtees as necessarv).
Reviewer/Inspector Name:
ReviewerQnspector Signature:
Page 3 of 3
Phone:
Date: (4/30

Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: d Departure Time: [IET? Zi County: 0tJ0CbJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: AR. Or Y11-TC04=L� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: to Z , Z/
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
l
Layers
Design
acia
Current
Dairy Heifer
Dry Cow
Non-Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
I 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)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
❑ Yes [-]No
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 21412011 Continued

Facility Number: I 1 L Date of Ins ection: $ Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure Structure 2
tllaCsys
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes 0NNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes _ ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ 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 M 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
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EXo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[-Io
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes E No ❑ 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes !� 1Vo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection,
�4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ff*�Nc/ ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [. 1 o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes dNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes JD"'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?
No
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[
❑ 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
0-No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[]-'No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O N
❑ NA
[3 NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phon(
Date: b L
21412011

YJ Division of Water Quality
F77
acthty:Nufnber —1 -0 Division,of soil and Water Conservation
Q O[her'A
t gency
Type of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / 1 Arrival Time: [70 Departure Time: / o ? County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �f'A �JoNLS
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o = ' = « Longitude: = o =. = «
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 /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 2 ❑ NA ❑ NE
❑ Yes U' No ❑ NA ❑ NE
12128104 Continued

Facility Number: — 7 Date of Inspection 7 n
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure_ 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?.
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes N
El 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_tt(�i�at,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes YJ N
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ yes y
❑ 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 E No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L2 N El NA [I NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ld No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
7,14o
El NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
!�I
[I NA
[I NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
I' N
ElNA
ElNE
18.
Is there a lack of properly operating waste application equipment?
ElYes
o❑
NA
❑ NE
Comments (refer to question ft Explain any YES answers.and/or any recommendations or any other comments
Use drawings of facility -to bitter explain situations. (use additional pages' as necessary): " ' B
w
Reviewer/Inspector Name Phone: )300
Reviewer/Inspector Signature: Date: S, b
J...... o ..o a 12128104 Continued

Facility Number: — Date of Inspection
6auired Records & Documents �,//_
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes Ld N El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other /X0
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections.,/P Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑Yes IjN ❑ NA [I NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ICI " ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ,,,�f; o El NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes LTI o ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No _
❑ NA
❑ NE
Other Issues
/
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
f
0 No
[I NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
u 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
N
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
es
�
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
o
❑ NA
❑ NE
jAddifional Comments and/or Drawings: _1
Page 3 of 3 12128104

^„ Phil on of
' Water Quality
fL—Jl 4 Rev t.
Facility Number ` 3� 11� - 0 Division of Sod and Water Conservation
0
Other Agency ,
Type of Visit orcompliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit a(Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: T)L>Pk. J Region:
Farm Name: _ _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: QR'F_',wJT MSTCNF,CL
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: o = 1 Longitude: = o = ,
�
D'estgn
t' .... a
'Current -' ""Design
y
Current
"Swore _Capacity
Population,' _ ,: Wet Poultry :Capacity
*_
Populahon `Cattle `. "Ca' actP.o ulahou
r-
❑ Wean to Finish
JEI Layer I
_
Dairy Cow
Wean to Feeder
Edo
.;_❑ Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
"� ❑ Dairy Heifer
❑ Farrow to Wean
Dry Po"oltry ❑ Dry Cow
❑ Farrow to Feeder
_; -
4 ❑ Non-Dairy
to Finish
❑ Layers❑Farrow
-- El Beef Stocker
❑Gilts
. ElNon-Layers
' El Beef Feeder
❑ Boars
-- El Pullets
H ❑ Beef Brood Co
�.,.
«.:
❑ Turke sthe
.,. _
a., .-�=":. ❑ TurkeyPoults
.,, IN
❑ Other
El Other
Number of Structures,
m
_�
777 ., M
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes El No El NA [I NE
❑ Yes PJ�No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
Page 1 of 3
11/18104 Continued

Facility Number: 'J — Date of Inspection 0 W
41 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i A(�rsa)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): aQ 4
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 ttlreat,
notify DWQ
7.
Do any of the structures need maintenance or improvement? El Yes
❑ NA ❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
,C1J/No
ICJ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9.
Does any part of the waste management system other than the waste structures require ❑ Yes
dNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need El Yes
_ (/
IJ No
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
EJ/No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,[._�,No
LB/No
ElNA
[INE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[IYes
C3//No
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
IQ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Comments (refer to question #)i Explain any YES answers and/or any recommeridations<or any other+comments
Use drawin s of facility to better explain situations. (use additional"Pa es as,necessir5) X =
�jUJp6E QG.�n,J6t7 w1 1�o1i faJ Z0a9,
oil•) ynt( SgrtPll UCCD ED rbc2- 10O5
otG.i ozc C,ae.o mzs-r P¢-f--swr
Reviewer/Inspector Name I - �a-pi's ;�j - `�""`- Phone% ip 96 �� i .5bii
Reviewer/Inspector Signature: ,,,,.Lty Date: 313 0
Page 2 of 3

Facility Number: 3� — )r1a Date of Inspection
'Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box elow. Yes [INo ❑ NA [INE
❑ Waste Application ❑ Weekly Freeboard ElW; Analysis Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspectionss El Weather Code
22. Did the facility fail to install and maintain a rain gauge? ElYes LCKNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L/J No ❑ NA ❑ NE
❑ Yes En No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[I No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
0 Yes
Vo
❑ NA
ElNE
26. Did the facility fail to have an actively certified operator in charge?
Eyes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[Xo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Q-�o ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
'No
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RI
❑ 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
L3�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
NNo
[I NA
[I NE
33.
Does facility require a follow-up visit by same agency?
El Yes
,Id
E'3No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

IType of visit 0 Co pliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit 7outine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: U , Arrival Time: TAT Departure Time: County: 01/10L70i Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: 'm Jr/ogs
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = = Longitude:
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle
Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
3Z66 jq17
JLJ Non -Layer I❑Dai
Calf
❑ Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
Laersow
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood CoyA
❑ Turkeys
Other
E]Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 2(No ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: 3 � — �% L 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 l Structure 2 Structure 3 Structure 4
Identifier: 1A6c6A)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 2-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes U No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental7eat, 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 LI 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 [I Yes UQ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 3"No ❑ NA ❑ NE
maintenance/improvement? ,,,{/
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes C No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of 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
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reviewer/Inspector Name
❑ Yes
❑ Yes
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA ❑NE
Reviewer/Inspector Signature:
0___ 7 -C 2
Date:

f
Facility No Date of Inspection 6
Reouired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes El No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW MP readily available? If yes, check ❑ Yes [ /No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Other
❑ Design El Maps
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
� No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections El
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2No
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2 o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CJ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ 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
b No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
E�
{Q 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
.{/_
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
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
O NNoo
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
E'No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

10 Division of Water Quality / II
Facility Number O Division of Soil and Water Conservation v
O Other Agency
Type of Visit 01compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 oQ Arrival Time: 9 O Departure Time: County: OUPGri) Region:
Farm Name:
Owner Name:
Owner Email:
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite RepresentativeIntegrator:
Certified Operator: Operator Certification Number: -
Back-up Operator: Back-up Certification Number: -
Location of Farm:
Latitude: =
o = ' = " Longitude: = o
Swine
Feeder
to
to
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
`3600,I - 6o ILINon-La et
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?
=. M
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
[INE
❑ Yes
❑l No
ElYes
El No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — I72 Date of Inspection 9 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: (.ai-MPJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1;2
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
[]Yes CT/No ❑ NA ❑ NE
[]Yes []No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �/NNo ❑ NA ❑ NE
❑ Yes �'J 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 L7 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U No ❑ NA ❑ NE
maintenance/improvement? .�!!
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E2' 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 Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O�����/'NNo
[I NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
io
❑ 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
Uf� o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
IGNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name .701a1`t fAr_0uCL U Phone: 91D l — r
Reviewer/Inspector Signature: Date: y Q 08
12128104 Continued

I
F#cility Number. 1 — 17 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,(._TNo El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes EJ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists g ❑ Design ❑ Maps
p ❑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
❑ 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?
ElYes
LEI N
❑ NA
[I NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ErNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LI No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EXo
❑ 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
NNoo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
B o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El,�,
Yes
/
o
❑ 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
u 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?
ElYes
Q<q
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit (YCompliance Inspection O Operation Review O Structur�Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral Emergency 0 Other ❑ Denied Access
Date of Visit: S 0 t{ Arrival Time: 7 3 b Departure Time: County: 0[/66ZA) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: / Title:
Onsite Representative- AV CJd Ated
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: F-1 0 0, 0 Longitude: n o n n
J
�ftibDesign
Swine
Capacity
Curren[
Populafion
Design
Wet Poultry Capacity
Current
Population Cattle
Design Current
Capacity Populaton
❑ Wean to Finish
10 Layer I
❑ Dairy Cow
Wean to Feeder
3 L00
/6 a6
JLJ Non -Layer I
Dairy Calf
❑ Feeder to Finish
'�,'� °
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
Dny Poultry
❑ La ers
❑Non -La ers
❑Pullets
❑ Turke s
❑ Dry Cow
❑ Non -Dairy
❑Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Boars
Other
❑ Other
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Yes ❑ No ❑ NA ❑ NE
❑ Yes FN ❑ NA ❑ NE
❑ Yes V ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: — 2 Date of Inspection
e
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?
r ,Stru m 1 Structure 2 Structure 3 Structure 4
Identifier: N1(yOtS�/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 36
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes CNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the smctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [:]No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10%or l0lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
/) 036 CXXC VAlk w 4ac Gpt tON ONTO 0500 A/JO G031 NAY VN %po/✓i - IF /lo r
Ni�rE [2, wAsrE .ZN 4--Mf �.qs O.fAuT wstH A RII'/AND 11n1O6X y NauR3 wAJ
/�QSWl�fp (n2avnld• 1✓otSP-P-0 As iWIIJ AS jorm/o Cv, $ �5 FAgmE oL bolt
MfASv2Ef to Appak3s eA06tkM Am No J.(aNl -XAT t6ff FIRM qpg.
SWsrN NAs n(Av p oFf 66M 2E,��oElalG. SE SW6 AIY't Tfmf U(,ck P4,1760k A/Frl)JG QAoc 0J,
Reviewer/inspector Name 1 o E Phone: Q/Q %
Reviewer/Inspector Signature: Date: S / O
Pnoo 2 of ? 12/2R/Od Cnndnned

Facility Number. 3 % — Date of Inspection r S o
11
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 appropirate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps [3 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 rainbreakets on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ 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: s
a
Page 3 of 3 12128104

I I z
Type of Visit &CCoompliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit CD Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S 10 b
Arrival Time: 8� t A
Departure Time: County:
DVpL A. Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator:
Location of Farm:
.J Ay Jo
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: o = ' [� Longitude: [� o
Design - Current
Design Current Design Current
Swine
❑ Wean to Finish
Capxact Population
�
W,,et Poultry - Capactty Population C the Capacity Population
..._ _ ,
I ❑ Layer ❑ DairyCow
® Wean to Feeder
360,E oz70
�. ❑ Non-Layet
—��'�:. ❑ DairyCalf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
-, .
..>u''>
D_ry Poultry
❑ La ers
❑ Non -Layers
El Pullers
❑ Turkeys
❑Turke Points
❑Other
❑ Dry Cow
❑ Non -Dairy
El Beef Stocker
-- El Beef Feeder
❑ Beef Brood Co
.' � -
:.= Number,of Structures:-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [?'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
f�No
❑ NA
❑ NE
12128104 Continued

Facility NumDate of Inspection i a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: (A(,- IV
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): A 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2 NN/o El NA El NE
El Yes D<o ❑ 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? El Yes u No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [,a o El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ElYes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LEI No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CfNo ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
u No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
C—f No
El NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
9 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
El NA
El NE
18.
Is there a lack of properly operating waste application equipment?
El Yes
�YNo
E 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):
Reviewer/Inspector Name c J"NN A&,tL Phone: 41
Reviewer/Inspector Signature: Date: )o O
12128104 Continued

• Facility Number: — L Date of Inspection
'Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L/I No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E(No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ 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
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
ElNA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El NA
[I NE
qNo
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�U/
El o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
dNo
❑ NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ElNo
E 1V/A
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L7 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
�/
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
L� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
(/_
IJ 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
{/
L NNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E3 No
❑ NA
❑ NE
Comments and/or
12128104

Division of Water Quality
Facility Number O Division of Soil and Water Conservation
- -- Q Other Agency
Type of Visit 0 Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C� Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 7 0(o Arrival Time: Departure Time: County: AX40 XK/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
OnsiteRepresentative: `JAM%s ✓anlES Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = ° Longitude: °
w
Design Current Design , Current Design Current -'
Swine Capacity Population Wet Poultry Capacity Population Cattle, Capacity Population--
❑ Wean to Finish I 1 ❑ Layer
® Wean to Feeder I UiDo I t7o ❑ Non -Layer
❑ Feeder to Finish
❑ Farrow to Wean D Poultry
rY -
Other
❑ 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?
rfifer
ker
er
❑ Beef Brood Co
Number of Stn
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 2No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ,dN El NA ❑ NE
El Yes L20 ❑ NA ❑ NE
12128104 Continued

Facility NumbDate of Inspection QG
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
'Structure 1 Structure 2 Structure 3 Structure 4
Identifier: W ociA)
Spillway?:
Designed Freeboard (in): d. S
Observed Freeboard (in): ,4 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [/ No ❑ NA ❑ NE
❑ Yes 2fNo ❑ 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 VNo ❑ NA ❑ NE
8. Do any of the stuctures 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 ff No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L/1 No ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes u 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) &Ir'0004 CG) s o
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes l_7 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes LJ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes Ell"No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L1 No
❑ NA
❑ NE
❑ Yes
1;4
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or anyother comments..
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name __J Phone. l45—
Reviewer/Inspector Signature: Date: aid :JZ7
Page 2 aJ J 12128104 Continued

FacffltyNu Date of Inspection ? ob
Roauired
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
NNo
ElNA
ElNE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
ElYes
2 No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
V4o
❑ 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 InspectionVNo
Weather
Code
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
R No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NoA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
❑ No
NA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[2 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
3 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
��
E"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
E 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?
ElYes
L� N
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

0
Type of Visit ,Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
' �s�
Date of Visit: � nA�r�riwalTime: —, J`�Q Departure Time: County
Farm Name: ( Azls n?�'< Cl0/jr� Owner Email:
Owner Name: ��'✓c�t/v t�i��5 Phone: —
Mailing Address:
Physical Address:
Facility Contact: �Tiitle:
��/ O�t1fi5 iC/G�F✓i �J1�7
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean b
Wean t
Feeder
Farrow
Farrow
Farrow
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: F�n = [� Longitude: =o=, =„
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer I Ji
Q1 ❑Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes JKNo ❑ NA ❑ NE
❑ Yes
[--]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
ElNA
❑ NE
❑ Yes
❑No
❑ Yes
J,/No
❑ NA
❑ NE
❑ Yes
A No
❑ Nil
❑ NE
12128104 Continued

+ Facility Number: —1 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V1 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: 111)z_
Spillway?: ado
Designed Freeboard (in):
Observed Freeboard (in):%
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ;Z No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes /No ElNA [INE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;XNo ❑ NA ❑ NE
maintenance/improvement? 1
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes X No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ANo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes 10No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes �No
El NA
[I NE
18. Is there a lack of properly operating waste application equipment?
El Yes JZNo
❑ NA
❑ NE
/Vo I , 5 Gn .
IReviewer/Inspector Name I ` Phone: Ql0'�%%w—��� I
Reviewer/Inspector Signature: rL� �� Date: .7 /
12128104 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes oNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
J?fNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R�(
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,_No
L�J No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
xl
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
YfNA
❑ 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
[Z 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
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
�f
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
I/J No
/
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comruentssand/or Drawings:
20 Gf��i� /�EEoS �o F %��ft-10F_p F2 r/1fs o2 F-•Q4/A-y
SyS�.Eir,,,
A%KVf<r five'QWI /�� Loofrfq (�-000.
12128104

(Type of Visit OCompliance Inspection O Operation Review O lagoon Evaluation
for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: % 6 Time: �i
3 /
Not Operational 0 Bel
#Permitted E3 Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:..
Farm Name: ��r-27 j----...___._._.__...._._ County: ».v.L92111_'L ___.....__..__—_
Owner Name: ... .slfa.n.e s..
Mailing Address: ................. _................... _....
Phone No:
FacilityContact:.._...._......._._.........._..._.................._...._......._._ Title: .......... _...... _._...................................... Phone No: ...................... - 1 I / J
Onsite Representative::i.,y-,�i,Szn.t5,—�1CertI �:1.TC.CId)_....._..._..... Integrator: _.(Zl3.�kfwS_ %L�........._..................
Certified Operator:
Location of Farm:
Operator Certification Number:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =" Longitude =• =' =11
to Feeder
rto Finish
v to Wean
v to Feeder
v to Finish
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
Struct%e l Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ...... ._...._.................................... _.___ .................... ...... :.. __._......_ .----
�7 _ _ ........... ._........... ...... .......
Freeboard (inches): q 16
❑ Yes 0"No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
ZrNo
❑ Yes
O'Itlo
❑ Yes
ETNo
Structure 6
12112103 Continued

�Factlitsy Number: 3 / — �� Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes m No
closure plan? f
(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 Z No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes VfNo
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? If yes, check the appropriate box below.
❑ Excessive Pondidiing ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper�or Zinc
12. Crop type ,AMUTAA irKA L�� 5MALL a44-;;r) / Udfi�%��
❑ Yes Q) No
/
❑ Yes No
❑ Yes No
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA )?
❑ Yes No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes 9No
16.
Is there a lack of adequate waste application equipment?
❑ Yes XNo
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes No
liquid level of lagoon or storage pond with no agitation?
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes ZNo
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes XNo
20.
roads, building structure, and/or public property)
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes No
X
Air Quality representative immediately.
Comments (refer W gaesbon #) Z kphtm any'_YFS attsweis and/oi;`any rernmu%mdahons or anp otherNcomments e '
Use drawings _of facdtty to better ezjtlatn sttua6a s (»seaddtboml pages as neeesrary),(❑Field Copy Final Notes
w v x _
Z 3 sum Aec AvIc44o RoP4llc-}!
•
/L)0a ; �v�aA� >�r�-1 �.✓o SSE ��e�os �✓,�T
/
Reviewer/Inspector Name
Reviewer/Inspector Signature: /� Date: /
12112103 yr — Continued

Facility Number: 3 — Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes �'No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes VNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling /
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
P(No
27.
Did Reviewer/Inspector fail to discuss reviewlmspection with on -site representative?
❑ Yes
P No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
VI No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
VNo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Fort
12112103

Type of Visit /" Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit koutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facilk_v Number
Date of Visit: I Time: I � J "—J
O Not O erational O Below Threshold
[3Permitted ® Certified n©Conditti"on�ally Certified,.t�❑ Registered Date Last Operat or Above Threshold: ._...�...._..._._.
Farm Name: ....'T..._4rI�t7!!.......rr`�_...................... County: �..
_o .. ........_..... r........... ...................................
OwnerName: ............. ...�._.� ..'0L�............ .............. ---....... _...._...... Phone No: ..... _............... _............ .......
-- ._.._....._...._......_.
Mailing Address:
FacilityContact: ............................... _._................................ _..... Title: ...... ._.......................................... _.......... Phone No:........
OnsiteRepresentative: •e,7„/fly/ Yf , ../*egrator.....
Certified Operator...................................._................................................._........................ Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle []Horse Latitude "0 "' 1 Longitude =• =` ="
Wean to Feeder ;❑ Layer ❑ Dairy
Feeder to Finish f ❑ Non -Layer ❑Non -Dairy
❑Farrow to Wean
❑ Farrow to Feeder ❑Other
O Farrow to FinishWPM�. ..
Lagoon Area
No Liquid Waste
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 DW Q)
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 anyy adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes VNo
❑ Yes ❑ No
❑ Yes ❑ No
. ❑ Yes ❑ No
❑ Yes 0,No
❑ Yes VNo '
❑ Yes XNo
Structure 6
Identifier: __ .._..... .
Freeboard(inches): ...............��............................................ .................................... ...................................................... ................ ................. .................

Faciiity Number. —, Date of Inspection
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/nnprovement?
8. Does any part of the waste management system other than waste structures require maintenancelrrnprovement?
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?
I I - Is there evidence of over applications? ❑ Excessive Ponding ❑ PAN ❑ Hydrac Overload
12. Crop type Az:em unfit- l it PAta 1 . t �/�7!>lU_ 1"'e' ✓ /�Ji�FI<Fs
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 amenable 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?
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/uvspection 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 ✓�I No
❑ Yes�No
❑ Yes �No
❑ Yes frNo
❑ Yes �No
❑ Yes XNo
❑ Yes V.No
ElYes No
❑ Yes o
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes �No
❑ Yes XNo
❑ Yes VNo
❑ Yes �No
❑ Yes No
❑ Yes�//No
❑Yes tdNo
❑ Yes YNo
J❑ No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit i
Field Copy [] Final Notes -
Reviewer/inspector Name _
Reviewer/InspectorSignature: /Aj/�q JK /OAIOCi Date:

Facility Number: — Date of Inspection I
Odor hmlLs
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 y1No
❑ Yes / No
❑ Yes 0No
❑ Yes ONo
❑ Yes $N:
ElYes
❑ Yes ❑ No
Additional Comments and/or Drawings:
05103101

Facility Number 31 172 (late of Visit: 2/8/2001 Time: I5:00
0 Not Operational 0 Below Threshold
Permitted 0 Certified Q Conditionally Certified E3 Registered Date Last Operated or Above Threshold: .........................
FarmName: ........................... _...................................................... County: llu ft................................................. Y.IRD........
OwnerName: Blandw................................. dunes ................................. _........................ Phone No: 910-291.1,309 ..........................................................
Mailing Address: 9I(.E.xa,Iames.Rd............................................................................... Warsaw ..NC.......................................................... .28,19.8..............
Facility Contact: day..douea..........................................................Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Integrator:.Geldabom HQg.1Arms.......................................
.Iona .................................................. Operator Certification Number: 202JI ............................
Vorth of Warsaw. On East side of SR 1305 approx. 1.5 miles North of SR 1307. A
M Swine []Poultry ❑ Cattle ❑ Horse Latitude 35 • 03 27 Longitude 78 • 02 11 F 25
Subsurface Drains Present
Discharees & 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?
❑ Yes M No
❑ Yes ❑ No
❑ Yes ❑ No

Facility Number, 31-172 Date of Inspection 2/8/2001
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes N No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...................................................................................................................................................................................................................
Freeboard(inches): ............... 42................ ............. _..................... ................................... .................................... .................................... ....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes N 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 N No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/mrprovement?
❑ Yes
N No
9.
Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
N No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
N No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
N No
12.
Crop type Coastal Bermuda (Graze) Small Grain Overseed
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
N No
b) Does the facility need a wettable acre determination?
❑ Yes
N No
c) This facility is pended for a wettable acre determination?
❑ Yes
N No
15.
Does the receiving crop need improvement?
❑ Yes
N No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
N No
17.
Are rock outcrops present?
❑ Yes
❑ No
18.
Is there a water supply well within 250 feet of the sprayfield boundary? ❑ Unknown
❑ Yes
❑ No
❑ On -site ❑ Off -site
Required Records & Documents
19.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
N No
20.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
N No
21.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
N No
22.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N No
23.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
N No
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
N No
25.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N No
26.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
N No
Odor Issues
28.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
N No
liquid level of lagoon or storage pond with no agitation?
29.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
N No

J.Facility wber: 31-172 Date of Inspection r 2/8/20017
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon?
32. 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.)
33 Do the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover?
Printed on: 3/7/2001
❑ Yes 14 No
❑ Yes No
❑ Yes No
❑ Yes 10 No
❑ Yes [K No
No ions or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Reviewer/Inspector Name Geer Wore ............
Reviewer/Inspector Signature: Date:

Division of Water Quality
0
- � Division of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit iQ outine O Complaint O Follow up O Emergency Notification O Other
❑ Denied Access
Facility Number Date of Visit: --/=- rime: ® Printed on: 7/21/2000
Q Not O erational Q Below Threshold
0 Permitted kcertified [3 Conditionally Certified 17 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ....... ..tRa,nnLl!'1i4—.....J� .... (cA,.......................... County:............D.„ui�._......................
OwnerName:.... ( .._ va*h......................................................... Phone No:.........................................................................................
Facility Contact: `� �LMs�t.�5. �.......................... Title:..... e..:!CkUtlr............................... Phone No:......................................................................................
Mailing Address: ..............................
............. .. . .. .. . .. .. . .. ... . .. . .. .. .. .. . .. .. . . ........................................ ..........................
Onsite Representativr..._:�.A�✓i _ ba/.u:S..........................,irar„... Integrator. .......... ,777-#,-tH.S.6,t7,.....,Atti.Y.J.t�.
Certified Operator: ................................................... ............................................................. Operator Certification Number:......................
................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0• =1 0^ Longitude =• 01 =..
to Feeder
-to Finish
v to Wean
v to Feedet
v to Finish
Boars
Design Current
Design Current Design Current
Poultry _ Capacity Population Cattle Ca aci Po ulation
❑ Layer ❑ Dairy
❑ Non -Layer I 1 1[:] Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
I Number of Lagoons I❑ Subsurface Drains Present 110 Lag,-tm Area ❑ Spray Field Area
Holding Ponds / Solid Traps E:= ❑ No Liquid Waste Management System
Discharges & Stream Imuactc
1. Is any discharge observed from any part of the operation? []Yes A(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. Ir discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier.......3..11.....................................................................................................................................................
Freeboard (inches):
5100
❑ Yes ❑ No
❑ Yes ❑ No
_Al
- —
Yes
❑ No
❑ Yes
(ZNo
❑ Yes
N�o
[]Yes .4No
Structure 6
Continued on back

Facility Number: 3; — / 7 Zj Date of Inspection y0 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obs ved? (ie/ trees, severe erosion, ❑ Yes [INo
seepage, etc.) vA
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes E:No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes �No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 5�rNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes V No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes1Vo
12. Crop type g a. 5 G WA, SR
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
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?
.. f.. yi...... of .... ...mere holed ....tg this:visit: Yoit witl i eoeiye Iio: further: :
ctirresporidence: about this :visit... .
❑ Yes o
❑ Yes o
❑ Yes XNo
❑ Yes of No
❑ Yes 5(No
❑ Yes UNo
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):
Tents has AL- wu1
k)uP Aa-4 kaN rC—tfj elk — h
k✓ w,t fi�,t
pd/5.
❑ Yes XIo
❑ Yes tgNo
❑ Yes 5ZNo
❑ Yes I(No
El Yes W-No
❑ Yes (.No
❑ Yes &ZNo
❑ Yes o
❑ Yes o
re-W�� Cg-a� ro,, ,
'►�► C,c_ �att� yy.q,P ivy Yt GdvyCs S llDvtlt�t
Reviewer/Inspector Name
X.
Reviewer/Inspector Signature: 5__7 AmL� I - jVw -//,"A /A Date: 7_Zj9 " 5100

Facility Number: 2,,— /? Date of Inspection 40D
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 4No
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 [4.
❑ Yes VNo
❑ Yes 060
❑ Yes VNo
❑ Yes 0
❑ Yes *0
.4e6.o.,�t_t_neut_s:°a:.n or_ ra....wmgs a$ _ ._..'_.e _M,1' 1_'�+='e-..:-

v
Division of Soil and Water Conservation -Operation Review -
Q Division of Soil and Water Conservation - Compliance Inspection
OLDivision of Water QualityOCompliance Inspection -
OtheeAgency-peration Review "
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 0 2.4 hr. (hh:mm)
Q Permitted *ertifiedf [3 Conditionally/Certified ❑ Registered JE3 Not Operational I Date ILast Operated:
Farm Name- V�1�....:.f......L.LLa✓��.4.Y._� ............................... County: .......
..... ('ll....... ........................ .........................
OwnerName:.......\.....:.Y.�Q.S............................................._...................... PhoneNo: ........................... ................................................. ...........
rt�
Facility Contact: .....�J...�L..-��....._...._...............Title:....1�'" `�.......................... Phone No:I'✓.p.��_.��..�.A..:_.�-l..N'/
Mailing Address: ..................................................................................................................... . `� ��6'- �aSr7
Onsite Representative: �1v„�-....................................................... Integrator: .......
Certified Operator: ................................................... .................................... ........................ Operator Certification Number:
Location of Farm:
Latitude =•=' 0•' Longitude =• =' 0"
awme
to I
to
v to
v to
v to
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
Holding Ponds / Solid Traps E:= ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/min''
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection &'treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
[]Yes VNo
❑ Yes KNo
❑ Yes P(No
❑ Yes K�No
❑ Yes 1�fNo
❑ Yes XNo
❑ Yes jx No
Structure 6
Freeboard (inches): ........�..................
1 /6/99
Continued on back

Facility Number.3 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ((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 14 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes NIQo
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes XNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
11. Is there evidence of over applicatioln''?, ❑ Ponding ❑ Nitrogen El Yes JdNo
12. Crop type ......7� �1.•t^G r....bp..I...1�.........................................................................................................................................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes j9fNo
14.
Does the facility lack wettable acreage for land application? (footprint)
❑ Yes MNo
15.
Does the receiving crop need improvement?
❑ Yes LKNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes XNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes (VNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
�(
❑ Yes tgNO
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes hNo '
20.
Is facility not in compliance with any applicable*setback criteria in effect at the time of design?
❑ Yes 0No
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes D(No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
N(No
(ie/ discharge, freeboard problems, over application)
❑ Yes
23.
Did Reviewer/Inspector fail'to discuss review/inspection with on -site representative?
❑ Yes ONo
24.
Does facility require a follow-up visit by same agency?
❑ Yes [XNo
No.vitilations-or.de$ciendes.werenotedduring.. iis'.. i .......retA ' no further.'.'
correspbridehee:abotifthis:visit.......::..'.'.'.'.'.'.'.'.'.'.'.'.'.'•'•'•'.'•'....'.'.'.'.'.'.'..'
Comments (refer to question.#): Explain any YES answers and/or any.recommendations or any _other comments
Use -drawings of facility to better explain situations. (use additional pages as necessary):.
Reviewer/Inspector Name
11/6/99
Reviewer/InspectorSignature:_e_ �� O Date: o��
C(q 1

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Date of Inspection KUVR_$J
Facility Number
Time of Inspection 24 hr. (hh:mm)
C1 Registered QCertifled E3 Applied for Permit 0 Permitted JE3 Not Operational Date Last Operated:
..........................
Farm Name:....... L 1..........................................................
..........................._ Q -RS...._.L... Vt«.................................. County:................... 11
Owner Name: ......... 10 �GPhone No:.,_.
....... R3.. 0�...........................
Facility Contact:.... ..................... Title:................................................................ Phone No:
T, ......................
Mailing Address:.... ....... '— � O .. ` (� ja� $
Onsite Representative: ..... ��` .._ � r.......................................................... integrator: ... C c�aT�yr4....... .........................
Certified Operator:..._.......................................................................................................... Operator Certification Number:.........................................
Locati n of F
_ "^ ...�1.. ._ J..............:....... .......:
�1'].....f_......................................................................................................................................................0...................... .
Latitude O'0'=11 Longitude =•0°=11
Design,'- Current Design Current Design Current
Capacity Population Poultry Capacity Population Cattle _ Capacity Population
Wean to Feeder GG ❑Layer ❑Dairy
"-' ❑ Feeder to Finish 10 Non -Layer 1 10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
m
❑ Farrow to Finish Total Design Capacity-
0 Gilts
❑ Boars Total SSLW
Drains Present
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes gNo
2. Is any discharge observed from any part of the operation? ❑ Yes G(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes KNo
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?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes UfNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ONo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 9 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 0 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Od No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes la No
7/25/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.Holdine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1
Identifier:
..............
Freeboard (ft): ......... `.a..�..........
Structure 2 Structure 3
10. Is seepage observed from any of the structures?
❑ Yes XNo
❑Yes t4No
Structure 4 Structure 5 Structure 6
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 enterin waters of the State, notify DWQ)
15. Crop type ._......../.....5.... Sri
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 Reviewedlnspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
u• lvo.viotaaonsor aertciencies were notea aunng tnis.vistt..r_oumin receive no rurtner.
: corTespQtidt:nce tibout this:visit::: :: � :: :::::::::::: • ::: " :::::
❑ Yes IgN0
❑ Yes 19 No
❑ Yes C�No
❑ Yes M No
❑ Yes F1 No
❑ Yes RrNo
❑ Yes V No
V Yes ❑ No
❑ Yes (BrNo
❑ Yes Q9 No
❑ Yes WNo
Yes ❑ No
❑ Yes 0 No
❑ Yes No
❑ Yes No
ve c� �.+c ��eS. t�ee� �ssJl ve e�q
7/25/97
Reviewer/Ins for Name"� Y"' NO
IReviewer/Inspector Signature: o 0�_ Date: �j g

❑ DSWC Animal Feedlot Operation Review a '
DWQ Animal Feedlot Operation Site Inspection
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DS%VC review O Other
Facility Number
Date of Inspection
Time of Inspection 0 24 hr. (hh:mm)
13 Registered Certified [3 Applied for Permit E3 Permitted 1E3 Not Operational I Date Last Operated:
Farm Name: .......... ................
County; ........ P a.......................nG� C ......�..........�....................................
Owner Name: ............. iL L......14a.............................................................
Phone No:..L`t(9....2.53-..�i1Q�.............................................
Facility Contact: ...... .`.J(4ntS........S S................................... Title: ...... 1.111 0,W..............I......................... Phone No:.. 1Q.� 94:.7dg�A..............
Mailing Address: ....._7,.(t.......�Vi.....x�Ityn.4,S....lSrt_.................................................. .... ...! kf..%......r/..'rJ.G........................................ ..z�4.�.........
Onsite Representative:...... �p.w,,i.S......40.4............................................_..._...__...._. Integrator: .... C7..4.1.6-0.........
Certified Operator ............. 4JL*1 S..... . I�r........ ltus..................... -............................. . Operator Certification Number:....2 2.2-.L....................
Location of Farm:
Latitude Longitude ®• =, 2E
Current
owme
Cattle
W Wean to Feeder
30
"Layer
LJ Dairy
El Feeder to Finish
II❑ —Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
JE1 Other I_
❑ Farrow to Finish
Total Design Capacity
3,00
❑ Gilts
❑ Boars
- Total SSLW
103ox
Number of Lagoons / Holding Ponds
ID Subsurface Drains Present ❑ Lagoon Area
IDSpray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
2. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made'.
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
EA No
c. If discharge is observed, what is the estimated flow in eaUmin?
N
11
d. Does discharge bypass a lagoon system? (If yes, notifv DWQ)
❑ Yes
V No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
Ji No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
I4 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes Wo
❑ Yes IQ No
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes FM No
Continued on back

Facility Number. 3 — 17L
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons holding, Ponds Flush Pits, etc. I
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Identifier:
...................................
Freeboard (f ):............. I.....................
Structure 2 Structure 3
10. Is seepage observed from any of the structures?
❑ Yes Ig No
10 Yes ❑ No
Structure 4 Structure 5 Structure 6
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 Anolication
❑ Yes 54 No
r■EMRr_M
® Yes ❑ No
14. Is there physical evidence of over application? ❑ Yes allo
(If in excess of WLMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............ llWKUJA........ lYA-7C......................................................... ....... 5"1..... 5raLn................................................................ ...............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes J,9 No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 Noviolations or deficiencies were noted during this.visit..You.will receive no further
correspondence about this visit
❑Yes 1ANo
9) Yes ❑ No
❑ Yes WO
❑ Yes A No
❑ Yes CO No
® Yes ❑ No
® Yes ❑ No
❑ Yes No
❑ Yes )K No
IQomments (refer to question q): Explain any YES answers and/or any'recommendattons or other comments I
Use drawings of facility to better explain situations. (use additional pages as necessiry):
ck. ��6r, d wwS Lss fit, adcr�ua� c .
12. Ere.sian etr� W r4t(, �t,. s�tcu!(] (Oe FII�d Wi� Cat vt-seedej.
i�. Ctxi�fr,l 6�rmut�a �� �tou� � trtt�aved nr aael�eetk� Lt)►� su+a[l 9�in. /I
. N i�Vo�cN �al lLv tR i b *t,4 a cork sttal�
loe U�JM Ut�e'Wk, FleO utua`ber sh6uO 6e l�lor��d 'in 4J. S weovd� aid a (VP off
sptv.V rests Iset keluIi,t w, N h (e v t er PIw. , �n�-y OJT , p S6u� be ; r, Flan.
7,3, Pe cecWicfiSiovt I-afy. 6vt sjk. 7/25/97 j
Reviewer/Inspector Name i�. ;1
Reviewer/Inspector Signature: l�h _ A jn . Date:

Site Requires Immediate Attention: �'�
Facility No. ,
�1,
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �� �a 1995
Time- / 0. / b.
Farm Name/Owner: R
Mailing Address:
County: � L
Integrator.
On Site Representative:
Physical Address/Locat
�r
Type of Operation: S
Design Capacity:'_�Q p 0 Number of Animals on Site: 3 _). o c7
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3:5L_' OZ' Longitude: -75�— ` 1)Q' '3 Z)" Elevation Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) &or No Actual Freeboard: Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes ot250) Was any erosion observed? Yes of N�`�g
Is adequate land available for spray? j S or No Is the cover crop adequate?dDor No
•
Crop(s) being
Does the facility meet SCS minimum setback criteria? 1200 Feet from Dwellings .� or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or6�
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes oro
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o6� - 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 ?'G,-t ova S- -ec
o5
cc: Facility Assessment Unit . Use Attachments if Needed.