310207_INSPECTIONS_20171231

NUH I H CARULINA'AM
Department of Environmental Qual

Visit: QCompliance Inspection 0 Operation Review U Structure Evaluation O Technical A:
for Visit: 0Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0
Date of Visit: I 61 .�i 1 I' 1 I Arrival Time: Departure Time: County:
Farm Name: �Y i Owner Email:
Owner Name: /% S Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: � yV41 /AiYYAS'
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Region: 'l
Certification Number: M I t('"
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
_
Non -La er
IDai
Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I/ , P,oul_ ,
Layers
Design
Ga aci
Current
Pao ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
jBcefBroodCow
E.WOth—erjM
11 Other I
Turkeys
Turkey Poolts
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
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes WrNo
❑ Yes )z No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of
21412015 Continued

1 racility Number: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
1
❑ 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? ❑ Yes )Z"No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes'ZfNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? 'E� Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes P"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? Z
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance or improvement? /
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes I/I 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 Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[:]Yes
0 No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes ;YNo
❑ Yes JZ"No
❑ Yes No
❑ Yes gNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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 gNo
o ❑NA ❑NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3
21412015 Continued

>�acili Number.
Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
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 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
No ❑ NA ❑ NE
YNo ❑ NA ❑ NE
❑No DNA ❑NE
El No OJNA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ;2�No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
/&No
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
7777"`""
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes XNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 4No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 6 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
Cnts (refer toaquestio'n #j Explain any YES answers and/or any=additional recommendations oraoy other' comments r
UsedommeWmt3Fs of facility -to bettei exulain situations (use additional'ogees as necessarvl:
_
n
NwY jd tVA
4-7/1 — t� (e {�S fib k w-S W11 n )S dzViS , 6 ►6i. nuf 6�
�K a�� 1^
-- mow dj � w tli
Reviewer/Inspector Name: 77
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ILL l-Lte I�
Date: 3
21412015

(Type of Visit: Q Copipliance Inspection U Operation Review U Structure Evaluation U-Iechnical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: 1 tJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: L )ot.1g�r—IRA/J 'I t l"L;4Z Integrator:
Certification Number: 19 r7 I( -
Phone:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
I
Wet PoultryC•apacity
11-ayer
Design
I
Current
Pop.
Cattle
ow
Design
Capacity
Current
Pop.
Wean to Feeder
I
INon-Layer
I
alf
Feeder to Finish
I $c%7
j Oa
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D ,+ P,oultp+
Layers
Design
Ca acit +
Current
P,o
D Cow
airy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
I
Pullets
Beef Brood Cow
Other
El Other
IOther
Turke s
Turkey Pouets
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 R1 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: D Date of inspection:
Waste Collection & Treatment
4? Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3
Identifier: 1A C�f� �✓1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4 Structure 5
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?
dNo ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes MNo ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
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 I/I/No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes u7 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Agnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ 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 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
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ZNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspecti❑ 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? ❑ Yes29/o
No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 7A
24. Did the facility fat 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 [ZNoo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�Io
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[Z/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:
K,
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
,$) L E ►J�Eo6
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of
Phone: W ! 6 - 13 V
Date: q h 110
21412015

Type of Visit: (D Co lance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: V"ILtoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: DRegion:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: "Do"!aLwi 1 v I ±1j _C—.iL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: / U
Certification Number:
Longitude:
Design CLLGrent
Swine CIN
apacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da Cow
Wean to Feeder
Non -La er
D Calf
Feeder to Finish
1,Kk6 45M
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,oul
Layers
Design
Ca aci
Current
P,o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other —TurkeyPoults
El Other I
Turkeys
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
❑ Yes yo
❑ Yeso
❑ Yes gNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412014 Continued

Facility Number: - Date of Ins ection:
;Easte�Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2
Identifier: / ,/t►rinpN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4 Structure 5
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?
No
❑ NA
❑ No
❑ NA
Structure 6
❑ Yes No ❑ NA
❑ Yes No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments hrea[, 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 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 [Z 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 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [I No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Vo ❑ NA ❑ NE
❑ Yes 21 No
❑ Yes 6 No
❑ Yes [3/No
[—]Yes Ej'�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o/ ❑ NA ❑ NE
i
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Ins ection: ' /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
d
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes LA I o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes
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
[nNo ❑ NA ❑ NE
❑ Yes dNNo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes O NNo
❑ Yes � t-{"I�jti
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of -facility to better exulain situations (use additional paces as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatuc
Page 3 of 3
Date:
5

Reason for Visit:
Date of Visit: C
Farm Name:
—
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Referral
Technical Assistance
Other O Denied Access
Arrival Time: ® Departure Time: / Za County: Region:
Title:
Owner Email:
Phone:
Onsite Representative: (' W AIAAI ► / R14_r 1, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
I9 11t
Design Current
Swine Capacity P.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
]Non -Layer
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P,oult . Ca acity P,o ,
ILayers I
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
I lBeef Brood Cow
Other —TurkeyPoults
01 Other
Turkeys
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�j No ❑ NA ❑ NE
[:]Yes ❑ No
[—]Yes [—]No
❑ Yes ❑
❑ Yes rNo
❑Yes
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21417011 Continued

Facility Number: - Date of Ins ection:
\Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3/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): Ud_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes &No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environrnentt
fthreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ElYes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes VNo ❑ 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 [2fNo ❑ 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
rj{ o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FVo
❑ 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
�o
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 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �dNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

F,2cility Number: I - Z o''I Date of Ins ection:
2�. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes KNo ❑ 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 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 to provide documentation of an actively certified operator in charge? [:]Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes F2 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
%(No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
dNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
No
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[;
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[� .
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
rNoo
❑ 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: UGHN P (I,U� Phone:UIU/ J7 6 —
Reviewer/Inspector Signature: ` Date: O
Page 3 of 3 214 14

W
Type of Visit: O Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: U Routine Q Complaint O Follow-up Q Referral 0 Emergency O Other Q Denied Access
Date of Visit: Q Arrival Time:® Departure Time: County:DLNO(Z►) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: J0rJgT4IgrJ V11t,lf'-'_
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone:
Integrator:
Certification Number: ICll l 6
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Desigu
Capacity
Current
Pop.
Desigtt Current
Cattle Capacity Pop.
Da Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
I$73b jIm
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,oultr.
Layers
Design
Ca aci
CujP—n,,
P
D Cow
Non-Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
NJ Other
Turkeys
Turkey Poults
Other
Discharees 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 ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
ElYes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Oaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure` I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA Y
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Lt 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 environmenta
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
I 1110 ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
eNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
24
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ENo
❑ 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
ENo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: Date of Inspection: q gNo
1124. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesIto ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
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)
❑ Yes
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes E j No ❑ NA ❑ NE
❑ Yes Ef'No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
! No ❑ NA ❑ NE
[�/No ❑ NA ❑ NE
❑ Yes [al%'o ❑ NA ❑ NE
[—]Yes �No ❑ NA ❑ NE
I-omments (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
Phone: OiOM— %3 0 D
Date: 9R c I
21412011

Reason for Visit(!} Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �9/Zp �l �, Arrival Time:® Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: b"ATkAti i r 6LU,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: I I � 1 b
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da Cow
Wean to Feeder
IB
Non -La er
DairyCalf
Feeder to Finish
p
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oulti.
Layers
Design
Ga aci_
Current
P,o .
D Cow
Non-Daity
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
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 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [—]No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [—]No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facili Number: 107
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E41X0
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2
Identifier: u%GV62
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (4 Ll_
❑ 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 r2rNo ❑ 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
I 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) T
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes ONo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [�lo ❑ 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
[D N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
AIo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
F/o
❑ NA
❑ NE
acres determination?
/
17. Does the facility lack adequate acreage for land application?
❑ Yes
—
I ;1
7
❑ 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
F3/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
PKNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: Date of Ins ection:
24. Did the -facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 21�0 ❑ 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 NNo/o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes F o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes V No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
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
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of
any
additional
s as necessarvl.
Yes
�No
❑
❑ Yes
No
❑ Yes
ZKo
❑ Yes
W
No
❑ Yes
V
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: l4IU M
Date: Z/
21412011

I'ype of Visit: Q9 Co pliance Inspection V Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit�J�outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: C� /9 /,, Arrival Time: Departure Time: /pp County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: A J VVII 4,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator•
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Desigrt Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Da' Calf
eeder to Finish
g
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oulfi.
Layers
Design
Ca aci
C•ucrent
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
11 Other
—TurkeyPoults
Turkeys
Other
Discharges and Stream Impacts
ZNo
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
r/M
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yeso
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 21412011 Continued

Facility Number: 'LO Date of Inspection:
Waste C61lection & Treatment
4:Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No
Structure 1 Structure 2
Identifier: LA 4;ozi.i
Spillway?:
Designed Freeboard (in):
❑ NA ❑ NE
❑NA ❑NE
Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): W
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EITNO
❑ 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
Ej No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
—[D"No
I YNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 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 Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes Noo
❑ NA
❑ NE
15 Does the receiving crop and/or land application site need improvement?
—
❑ Yes I I NO
777�"'
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes o
❑ NA
❑ NE
acres determination?
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 Y
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ET/No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes [D, o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ETNo ❑ 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 Inspecties�Wl
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 ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 2 1 - 9.07 Date of Inspection. a 9
24.,Did'the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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?
❑ Yes ❑'<'
❑ Yes ENo
❑ Yes EJ io
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30.-Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
] No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ONo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
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
❑ Yes
�zo
❑ NA
❑ NA
❑ NE
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:

Type of Visit Qf Co�ppliance 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
J
Date of Visit: j6 jf7 Arrival Time: '® Departure Time: County: DLQLc�Region:
Farm Name: Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: cVAT Pd9 ✓ Alta Lj-(-- fl— Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification'Number:
Location of Farm: Latitude: 0 o m= Longitude: mom.
oQ. Q
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 n No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
0
❑ N ❑ NA
El NE
❑ Yes
❑ Yes
❑ NA
ElNE
❑ Yes
No ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: ) —2,41 Date of Inspection
Waste Collection & Treatment
z 14. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
ppStructur I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes CNo ❑ 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 thr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes N ❑ NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 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 lZ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,_,(/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �I No ❑ NA ❑ NE
maintenance/improvement? ,._//
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes L�J No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Wo ❑NA ONE
o El NA [3 NE
'o ❑ NA ❑ NE
❑ No [I NA ❑ NE
U No ❑ NA ❑ NE
Comments (refer to question #)r Explain any YES answers and/or auy recommendations or anv othet.,eomm�entst
Use,drawings of faciH[y3o,better explain situations (use additional pages as necessary)
Reviewer/Inspector Name
664.) ' ( Phone:
Reviewer/Inspector Signature:
Date: /6 d
Page 2 of 3 V 12128104 Continued

Facility Number: 3 -- b Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage &Permit readily available?
El Yes
Nq-
❑ NA
El
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
NNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
BIN o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZINo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E?<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
U3 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NNo
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
,3
I'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
B 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
Voo
❑ 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
B-<.
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes Pfgo ❑ NA ❑ NE
' dditioua[ Comments and/or Di aH ings: " 77
_w
Page 3 of 3 12128104

Type of Visit(36 pliance Inspection Operation Review 0 Structure Evaluation Technical Assistance
Reason for Visit rRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: p Arrival Time: Departure Time: County: lf)VPL=;%% Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact Title:
Onsite Representative: Awn-r1gA tJ y\"1 —Liu— E' R Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [ o = [� Longitude: [� O
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Poff-pulation
❑ Wean to Finish
IEJ Layer I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
❑ Dairy Calf
Feeder to Finish
'O
I
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
El La ers
❑ Non -Layers
❑Beef Stocker
❑ Beef Feeder
❑ Gilts
❑ Boars
❑ Pullets
❑ Turkeys
❑Beef Brood Co
Other
❑ 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 dNNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
P4�o
❑ NA
❑ NE
Page I of 3
12128104 Continued

'Rcifty Number: Date of Inspection G
Vaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes DJ 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
Identifier: I la<rwy
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3b
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes No ❑ NA
❑ NE
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ONo ❑ 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 environmentalat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ N
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes U<0 ❑ NA ❑ N
(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 ❑ N
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA [IN
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CfNo ❑ NA ❑ N
❑ 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
E
E
E
E
E
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Y "o
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[3<o
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]Yes
EXo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
PKN
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
5No
❑ NA
❑ NE
IReviewer/Inspector Name ' `fp 14 tJ ApP--{.)(_" Phone:
Reviewer/Inspector Signature: t✓yq �, Date: $ 6
Page 2 of 3 11/18104 Continued

11�
Facility Number: 3 — Date of Inspection o
eouired 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 ❑ Desi gn ❑Maps [I Other
❑ Yes Ld N ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
U/ N
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
[I Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L�X�No
[I NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3 /No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
I No
❑ NA
❑ NE
Other Issues
/�
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
0 o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
C I No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
04o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Io
❑ NA
❑ NE
12128104

IType of Visit Qf Co Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit _ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: YI oQ Arrival Time: I % 3a Departure Time: County:'\-ir Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact:
/,� )� �, / yt/l Title:
Onsite Representative: `' - mq-rk 'tr" ' ' `m Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = = = „ Longitude: F71 ° M I F71 u
r
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Csapacity Population
❑ Wean to Finish
10 Layer
❑Dai Cow
❑ Wean to Feeder
ILI Non -Layer
I❑Dai
Calf
Feeder to Finish ( o
❑Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
on- airy
❑ Farrow to Finish
❑ Laers
❑ Non -Layers
❑Beef Stocker
❑ Beef Feeder
Brood Co
❑ Gilts
❑ Pullets
❑ Boars
❑❑Beef
Turke s
Other
❑Turke Pouets
❑ Other
Number of Structures:
❑ 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 0/ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: Date of Inspection
W e Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ENo ❑ 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: LACs�j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): qL
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
ILI 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
VNo
❑ 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
L'J'No
❑ NA FINE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
U<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
[;Ko
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
dNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ONo
❑ 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)
aui
18. Is there a lack of operating waste application
properly P g PP q P
FL-Su/E f2CLD CC-CA0 ro (36 .� 8EAA--✓OA, j4A(fE 000JTY AGrt,,t ao^-Tsr eaw�E 0r
WO ASSES T86 P.tblbj, LfeTtER-- [5 i0�s7 0( ru5U --T), iT7 13Crt--....voA WUP
1iec- i f% BE UPOAtE'D,
1 .� ) i5c-n t1VA -FSr ,L-0 N6ErifN (i �✓E.E 12 CoNTgot--
Reviewer/Inspector Name I 614 i ASIZNELC Phone: C jjo279 3 �d
Reviewer/Inspector Signature: 4 Date: YJVo'9
P. 7 , r t 72128104 Continued

FaLcidty Number: 3 — U Date of Inspection �l 6
t.
ReSired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes LJ
❑ Yes LJ No
❑ NA ❑ NE
❑ NA ❑ NE
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 V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑Yes
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LEI I�0
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El es
L_�,I o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
��l/N9
i� N
❑ 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?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
(Additional Comment&and/or Drawings:
❑ Yes ro ❑ NA ❑NE
ElYes ❑ NA ❑ NE
❑ Yes IQ No ❑ NA [I NE
El Yes No ❑ NA ❑ NE
❑ Yes r ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 3 of 3 12128104

i1
i
p Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
11
0 Other Agency's
Type of Visit Q5 Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (p Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q Gti o"1 Arrival Time: f Departure Time: County: bUPt,'Tjj Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: J614 A114AA Mal [ CtLL
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude: = o = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
f8jo
L6o
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Design Current
Cattle Capacity Poptilaiion
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
-1
❑ Yes U4 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑/No
❑ Yes
U N
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 ( — 1.� 7 Date of Inspection
„J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes LeNo
❑ 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
, A
Identifier: C66-t#-)
Spillway?:
Designed Freeboard (in): r' C • Sr
Observed Freeboard (in): 4 J�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No �
❑ NA
[INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes [l 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 environmentalat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes N�o ❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? El^ 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 LyNo ❑ 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 2No ❑ 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 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[f]f
El NA
El NE
�No
E2 Noo
❑ NA
❑ NE
o
❑NA
El NE
L o
❑ NA
❑ NE
AIo ❑ NA ❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
IReviewerQnspectorName ,J614t✓ FA(41 L, Phone: 210%'73'73 I
Reviewer/Inspector Signature: 9 Date: 9 4-% 07

Facility Number: 31 — Date of Inspection 5 YI 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes UNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
IQ 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?
ElYes
2/No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ETNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
�P'No
I�J�No
[I NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
u No
El NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ElNo
ONANA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RKo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ej`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?
ElEr 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
Q'No
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality
Facility Number O Division of Soil and Water Conservation
Agency
Type of Visit pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 7Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: IS OS Arrival Time: jZDl7 Departure Time: OO County: oV % Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 96NJ 4NN E n LZ
Certified Operator: JLMMT (,1Sl,t�`plYlS
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = . = Longitude: = o = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
p
1 iOv
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P No ❑ NA FINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
ElNE
❑ Yes
❑l No
❑ Yes
E No
❑ NA
❑ NE
❑ Yes �o ❑ NA FINE
12128104 Continued

Facility Number: 31 — T,{f'7 Date of Inspection OS
Y
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 Structure 2 Structure 3 Structure 4
Identifier: (A "p pl) 1
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): 3-7
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 2 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmQntal threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Y/es ❑ No❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes 2 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 ❑ ICJ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�
2 No
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
]o
❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I 0 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12.
/ .
Croptype(s) f3ca muw LG'5 FESc of U6) S io CSkJ
'
13.
Soiltype(s) A,tt)�
fpi
14.
Do the receiving crops differ from those designated in the CAWMP? ❑/Yes
ZNo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? Edyes
RAo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'! El Yes
E
❑ NA ONE 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
-7.) QLk-4i t„mL4,- ►xcbs Woa is aoL) Gp-Ass C4=,t/Ef2-.
iS�) Fawir- �iuAs rjeco,� Vj00.1c ntJh wE�� marr�>_.
(ZE.c.oaC of
Reviewer/InspectorName r Phone:Cq�O
Reviewer/Inspector Signature: Date: (tS pS
12128104 Continued

Facility Number. 3� —20y Date of Inspection 3 iSu�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes v ❑ NA El NE
20. Does the facility fail to have all components of the CA WMP 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
E2 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 InspectionsJ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
R No
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LJ No
❑ NE
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
Ely
r❑NA
ETNA
El24. NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
❑ No
I� NA
❑ NE
— 26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ej*'No
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
,❑_,/NA
1.d NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LYNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
E'N'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?
❑ Yes
,�/7
[3 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
ElYes
LJ 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
LJ N
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
12128104

(Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit j& Routine O Complaint O Follow up O Emergency Notffieation O Other ❑ Denied Access
Facility Number Date of Visit: Time: E,
Q Not Operational Q Below Threshold
® Permitted ® Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: ..... .....
.
Farm Name: ............ 4 -F5 .17-1__._._.--------.---------....-...--.---•----..-... County: ..........
!S/ cyt9f�ft.................__.
Owner Name:
Mailing Address:
Phone No:
FacilityContact: ... ............ _................ ..... ............ -_.-._._.-_ Title: ............. ------ ----- _.__ .... Phone No: ....... _.......................... _......
Onsite Representative:..[ W Integrator: ... �fe�,!,�, ,.
Certified Operator: .-........................ ....... __. .. Operator Certification Number: ......... _.... .
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =11 Longitude =• =1 =14
Destgn
Current - Destgo Current Design Current
_
Swtne Ca Poultry,-_ Ca'act
- .;
s .
ulation i%Istion
act ...Pii
elation-
.P,6 s.Cattle _Ca acit ,'Po
Wean to Feeder
m ❑ Layer
❑ Dairy
Feeder to Finish
❑Non -Layer
❑Non -Dairy
-
Farrow to Wean
- -
Other
Farrow to Feeder
�s€ -
Total Dcst Ca act
Farrow to Finish
Gilts
f r y
Total SSLW.:
❑Boars
.,
r, r
Ntrtnbe-r of Lagoons
-
-
- •s "'i sg:T
-
Tr
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Freeboard (inches): Z`2i
12112103 Continued

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

Facility Number: 3) — 2t>7 1 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
❑ No
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenancelimprovement?
❑ Yes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑ No
elevation markings?
Waste Application
10.
Are there any buffers that need maintenancelimprovement?
❑ Yes
❑ No
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
20.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately.
Comments (refer toflqueshon #) Expbun any YES answers andtor any recommendations ur any'othc� c T
�rnmments
Use;drawtrtgs of facdtty,to better a rphtm srbnatioas (ase addthonal pages as necessary) ', ❑ Fteld COPY ❑Final Notes
Reviewer/Inspector Name .. "-- "'
Reviewer/Inspector Signature: Date: Z
12112103 11� d Continued

Type of Visit IS Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit CI -Routine O Complaint Q Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: Z _�Z Time: di'f
( 2
Not Operational 0 Below Threshold
® Permitted ® Certified 0�� ��C///onditionallyy Certified 0 Registered Date Last Operated orr�//JAbove Threshold:
Farm Name: J�al/nit Wi(("dMf Td✓A County: .Gtal_kn
I — I
Owner Name:
Mailing Address:
Facility Contact: /� % Title:
Onsite Representative: ///yRe✓ /&C40 4.jAeA
Certified Operator:
Phone No:
Phone No:
Integrator:_ _
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =' =` 0 u Longitude =' =` 0
Design Gu—�rren
-' D gn Current ;, ki. Demos-ig`n Current
-
e Ca achy -' Papule
_P,dultry, ' _ ` Capacity ' P,o ulation - Cattle Ga aci a Po ulation
Wean to Feeder
arrow to Weanarrow
r
to Feederarrow
to Finishilts
oars
Total SSLW
Number of Lagoons
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds /Solid Traps -
❑ No Li uid Waste Mana ement System
Discharges & Stream lm acts
1. Is any discharge observed from any part of the operation? ❑ Yes [KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ®,No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection R&, Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: [ 2
Freeboard (inches):
05103101
❑ Yes D�No
❑ Yes ® No
Structure 6
Continued

Facility Number: 31 —
Date of Inspection �f
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type U'.J ew."q/ft ( F] --jwwi 6'rx s, clowwof . [ * t self rr—>
❑ Yes EANo
❑ Yes ® No
❑ Yes �5No
❑ Yes W No
❑Yes (UNo
❑Yes [&No
❑ Yes ® No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 54No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
®No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
® Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
NJ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
®.No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
F,No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
RNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ESNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
®.No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
In No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
25No
E3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
Comments refer to uestibri A. lam an YES answers and/or an`` re'`ticommendations or an_ other' rn s:' =
(� 4. P y Y 4 y
IIJse drawings of faciht .461betfer ei:plarns fuati nix (use Sh"additional pages as necessary) ❑Field Copy ❑Final Notes
�0F, �c,;
.; ....... A� -i , �'`` . A . V"' ; ...,,.. , rti
/S Fe Ill1 Al2 Awe *vtia1 A/vor Wif Aetll 1140/v �i7�Asl�.r1° U A/C
/
�Ti Af1/ gted -JO M- /iL � /" ke r tP 1 p •C��Al -iD 1L6/e 7'6w
//4'.r%r�
�A
/��
d3 , Fie" .S �C7'u�� Z �/�O!/Lj�Y 'FiFs�>dfi �/1�" eof4eG7`�:C,
✓e/ ""M 0 Z svom,/k o�/a 'i A I.
Aevy-olt Agm
i 404119 o e
�
Reviewer/InspectorName — / ) _ - *'• ' '` " ' "%�
Reviewer/Inspector Signature: Date: 4`L
05103101 Y Continued

Facility Number: ?j/ — Z071 Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
'Pr No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
V,No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
R No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
®No
32.
Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
MNo
Additional Comments and/or Drawings: "T4
E
05103101

(Type of Vieft Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit F(Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Dale of Visit: Time:
`�0`�
o Not Operational Q Below Threshold
Permitted E3 Certified 17 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ......
FarmName: ................................................................. County:...._ ........................... ......... .......... _.
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
MailingAddress: .......................................J.............................................._....(............................................................................._............ ..... _........ --
Onsite Representative: �,��I ".-^0=................................... Integrator:....: ......... .............................................. _..........._..
Certified Operator................................................................................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =, =" Longitude =• =° =I.
Design . : Current
Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
Farrow to Feede
Farrow to Finist
Design --
Cattle t anacity 'I
❑ Other
Total Design Capacity
Number of Lagoons a _ 1❑ Subsurface Drains Present Jj❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps,; ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
❑ Yes
ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
M No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
Wo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
t9 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ......................................................................................................................................................
Freeboard (inches):
5/00
Continued
on back

Facility umber: '31 —/4T? _ Date of Inspection O
-
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
D'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
ONo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
0 No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
EjNo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
9No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
tKNo
11.
Is there evide a of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
i�,No
\
12.
Crop tYPeSe l o qt e<z P
13.
�_2
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
b�No "
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
W,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?
XYes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
W No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
t�No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
MNo
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) id Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes
WNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes
2rNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
O No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes
8 No
24. Does facility require a follow-up visit by same agency? ❑ Yes
14 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes
No
IQ Yibla{igtls;oi• d. fciencie$ •ire itgCe\]• ilWift tbis:vjslt; • Y;ojt will•Sec¢iye tjo fptth • ; • ;
:: cori es .. deuce: abotii this visit :::::::::::::::::::::::::::::: • : • :.:: :
_ q :t- — i. r r _..., '
CommeNs_ (refer to question #): Explain any YFS'answers and/or any recommendations or any.otlter cottmienLa
" y '
of faci i to better e - lain;sitttatiorts. (use additiomd' as n _
wings ty: _ ?iP _ P� eccssary).`.
Use dra •
Reviewer/Inspector Name - - _
Reviewer/Inspector Signature: Date: — r3^ c k 5/00

41 Facility NuDate of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
XYes
❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
4 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
C�rNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
����,,,,II!I
�No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
O No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
ftNo
Additionalomments an or, ravnngs:
/.
ipl�cb�e�--�e.�'
-��s�2 5��\�. � � gyp\ �`►Jc,1.,,e-�_ t„r�
5/00

` I Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency '
of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
(Reason for Visit xoutine O Complaint O Follow up O Emergency Notification O Other �fj "❑ Denied Access
Facility Number ZO �Date ofVisit: t0-It�UOTime: L�V�.Jpntedon: 7/21/2000
,,�� ^^ O Not O erational Q Below Threshold
�rermitted Certified �. Conditionally Certified 0 Registered Date Last Operated r Above Threshold: .......... .....
`` ..........
�7, I �� J
Farm Name: ....... ....l.l.�.i\f, yiti.S.........-�.rr.,.. County^ ....................Gt,!!_:................................
OwnerName: ................................................................................................................ Phone No:.......................................................................................
FacilitvContact: ..............................................................................'fitle:................................................................ Phone No:
MailingAddress: .............................................................._................... ........................
. (� Onsite Representative:.. `��lIntegrator:.............. (l1
.........
Certified Operator: ................................................... ............. ............................................... Operator Certification Number:...........................................
Location of Farm:
' IT
❑ Swine []Poultry ❑ Cattle ❑ Horse Latitude Longitude �•°'
Design Current
ow.ue t-apacity ro mauon
❑ Wean to Feeder
Feeder to Finish 697
❑ Farrow to Wean
❑ Farrow to Feeder
fl Farrow to Finish
Number of Lagoons
Holding Ponds / Solid Traps
Design Current
Poultry Capacity Po uI t1i
❑ Layer
❑ Non -Layer
❑ Othc
Design Current
Catfle Capacity Population
❑ Dairy
❑ Non -Dairy
16GD Total Design Capacity
r333d�� Total SSLW
DischarLes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Waste
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
Lag.on Area I❑ Spray Field Area
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharec is observed. what is the estimated flow in gal/tnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes RNo
❑ Yes ❑ No
❑ Yes ❑ No
N%I
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes WO
Stro fuk I Struc r LY Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. .%._�!...........................3.._t.t.................................... ........ ............................ .................................... ....................................
Freeboard (inches):
5100 Continued on back

Facility Number: S — 01 Date of Inspection ID 1 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes P!wo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level -
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? /1 ❑ Excessivee Poonnding ❑ PAN ❑ Hydraulic Overload
12. Crop type 5 G�� I' ik
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
i�No
((No
9No
MO
ONo
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
KNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
qNo
b) Does the facility need a wettable acre determination?
❑ Yes
9No
c) This facility is pended for a wettable acre determination?
❑ Yes
Z[No
15.
Does the receiving crop need improvement?
❑ Yes
®No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
9No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
(KNo
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
0No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
R(No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
o
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
[KNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
DC1vo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
t%No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[RlVo
/`
d4,6 yiolatiotis:oi• &hic,Wncies t er8 noted d,&, ing this:visit; Ybtt will teec, ive do further:::
:. coriespoticleiltie: about this .visit_ ::":::............................. .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
J, � u��c ecr-l—
�i® C/ V
�ftS� lL.ea�- p� e�r`t�' �[ SCE- �S� ii►-- �%h.vy
Reviewef/Inspector Name
ReviewerfInspector Signature: &: j y / r%tq,Q Date: 10 —/ 1 — 0-0 5100

Facility Number. Date of Inspection ' G / ,CYl� Printed on: 7/21/2000
Odor Issues 1 01
26 0Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge M/or below
❑ Yes
j3kNo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
CO
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
E)No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
QrNo
l_
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
QjeNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
E;1No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
;rNo
5100

E3 Division of Soil and Water :Conservation'- Operation -Review,
t_ E3 Division of Soil and WaterConservation -Compliance Inspection
;.
Division of Water. -Comp-CdmPI lance Inspeetion
;= Other Agency -Operation Revtew - -, _
0 Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
I Facility Number / I
Date of Inspection
Time of Inspection
® Permitted 0 Certified Q Conditionatly Certified, E3 Registered C
Farm Name: ............._v��..!.:M.M'....._t`-�/.!_°.'_V.`..`..5....1....^.. r:...........................
Owner Name: ................(/..f.m.:...... ..........................................
Facility Contact:
Flailing Address: .................................
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
Not Operal
County:
Phone No:
24 hr. (hh:mm)
Date Last Operated:
t -IN
Phone No:
.(............................................................................................................................................... ..........................
`�s7C�C
..t.} ....................kIntegrator: rrtor. .._ .......
............................................................ Operator Certification Number:..........................................
Latitude =•=' =11 Longitude =• =` ="
-- :_ Design Current ' _ Design Current _ Design- Current
Swine . Capacity Population Poultry Ca achy Population `Cattle Capacity Population
[IWean to Feeder ! ❑Layer - ❑ Dairy
Feeder to Finish 1746 10Non-Layer I 1 10Non-Dairy
❑ Farrow to Wean-
❑ ❑ Other Farrow to Feeder _ -
❑ Farrow to Finish 'Total Design,'Capacity
- ❑Gilts,
❑ Boars Total SSLW
Nu[uber of Lagoons ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holdirig:Ponds / Solid Traps ❑ No Liquid Waste Management System m
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure
Identifier: WE 7 _...Wr7 2
39 ............................3 /
Freeboard (inches): ......................................................................................................... ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes UNc,
❑ Yes LgNo
❑ Yes M No
Structure 6
❑ Yes J15No
Continued on back

Facility Number: 3 -ZQ Date of Inspection
tt. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any pan of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? []Excessive ,Pponding�El PAN
12. Crop type Im r�r G i J p t r�i�
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?
.. J.. yiblatitit....... e. dte -.W. r.b h6ted• during this:visit: - You will-rebeipe fio: fufther •' •'
corresporideitce: ahotiti this visit:
❑ Yes 0 No
❑ Yes P9 No
❑ Yes k No
❑ Yes J91 No
❑ Yes 9 No
❑ Yes ;9 No
❑ Yes t9 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
J� Yes ❑ No
❑ Yes No
❑ Yes J9 No
❑ Yes H No
❑ Yes )4 No
❑ Yes 0 No
❑ Yes 1XNo
❑ Yes �O No
❑ Yes ® No
❑ Yes 10 No
,0 Yes ❑ No
JS. 'Er, rmvdA -PA 6 SWZ ylee,a4f iw)fraVZMenf . M. ke C-6corlf
4,o be41iv GS0A6/Ijk cdA!ga f . A ffl y 1;me, o1S neet 4 4,e"r J-1
-k' Yoi I fell.
25. TobAC&D iS f1AV74ed in C,W �Q 6;el,4 en -TW3 • Wrt4e /ah
10 i✓),-h4e All erojas 4Aa+ w'•l) be opl.1046j in F;elds wh;l e
ensurmn 44.4 -iheie ;S - def).64
Reviewer/Inspector Name
,jr
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Number. �— Date ofInspection
060r Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
® Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
JR No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
O No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
CK No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
A No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
% No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
P9 Yes
❑ No
. "_tirdona_. Comments an, or. rawtngs:".
• NqY bales Gan fe&XAJ4 ovl �a✓»1. for- :1. yeao- 6U+ Meed -/v
be. eea ovlof e,^ vli)TZ& l Ae'r g/f1e%
c
• Farv>1tr stlok�d RrG2e o� GU� �il7Q)e r cDg5}a) t-r S(r4yed or'.
• J-AVIOA ✓1o� rn 11 ACGofa(� 4o ��/` QUal;} l,.
F i-mer S41d 6he ad bvl�rte4 s5k%1LO .!a / I
. L Ac,OOhs grre Well %er y .
• F;elefs oyl cend;4;on .
3/23/99

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
Routine O Com laint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection ?j
Facility� Number 3 '�-U'�
Time of Inspection 03G 24 hr. (hh:tnm)
E3 Registered E3 Certified (3 Applied for Permit btPermitted JE3 Not Operational Date Last Operated:
Farm Name:.._ '_� ^ ..1 i .`\1\�t F:...rw�............................................... County:...�...y....a 1q4��......t..,.I.........................................
Owner Name:.......3A"�:.^...\.. ll\\�.!:^. ............................................................... Phone No: .....l.�G..: a `9 � 1�iO
.................................................................
FacilityContact:....�.......................................................................... Tiittle:.................................................................. Phone No:...................................................
Mailing Address: ..o.....5/��.._��1 .V �.h(.1 .........._ ...i�`Q.,IA�......._................... .................... ..........................
OnsiteRepresentative:V..^`K ._/."..... why ................................ Integrator:.. ...................................
Certified Operator..........................._i.......,......................................................................... Operator Certification Number:.........................................
Latitude Longitude
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
"No
2. Is any discharge observed from any part of the operation?
❑ Yes
ONO
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
C�No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
qNo
c. If discharge is observed, what is the estimated Flow in gaUmin?
"A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
Xj No
3. Is there evidence of past discharge from any pan of the operation?
❑ Yes
i(No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
)4No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
IgNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
RNo
7/25/97

acihty Numberr -3
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes KNo
Structures (Laeoons.Ifoldine Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes IgNo
tincture I 2 Structure 3 Structure 4 Structure 5
Structure 6
1Structure
Identifier: .1...............LT�.................................................................................................................................
Freeboard(n):........ 3.:5............... ..... :.9z..1...................................................................................................................................................
.�...f........
10.
Is seepage observed from any of the structures?
❑ Yes
t,ti No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
tr{ No
12.
Do any of the structures need maintenance/improvement?
E(Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
C9 No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
CO No
(If in excess off WNW, or runoff enterin waters of tlhe1 State, notify DWQ)
15.
/
Crop type ?.1%�:_�......p.{..F�f1{.g.}._C 131s4F.............. ._.a...._.i.}..Ffj.f._.1.'uJSS.�r..................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
O No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
O(No
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
P No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
IgNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O No
22.
Does record keeping need improvement?
❑ Yes
O No
For Certified or Permitted Facilities Only.
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
yhm" No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
24 No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
P No
E3-
No.vi6iationsor deficiencies: were noted duritig this:visit. You:will receive ito ftirtfier .
cO&&PQtldeitce about this:visit.'.:.:.:. :
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:�I Date: 1 G (23 r18

0 DSWC Animal Feedlot Operation ReviewEN
3
MC3,DWQ Animal Feedlot Operation Site Inspection �;.w11
lW Routine: O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
(� Date of Inspection
I .Facility Number y,2 O' ( Time of Inspection I Z' Zr 24 hr. (hh:mm)
Registered ® Certified 0 Applied for Permit 0 Permitted [3 Not Operational Date Last Operated: ..................
Farm Name:._.w�..t................_.................._........... County':tt.c.r.�.....................................
.�.1..�i...�%
Owner Name:.....�.t.�.rxG. .......&.......e.1.ls.r...S....................................- Phone No:....1.1..0..i....--.i..Q..........................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address:.... ..... VA ..... U..Lva. tl.a..p.a_!^.....R,n.n_L...................�t..tt.tid.�-9.V-t..L�.f'..t....�J..�./.................. ..�..�_rJ..l.�..
Onsite
I
Certified Operator:.wT �t_.rv,.r.,,.xt......_w.l.
Location of Farm: r
Integrator:...Q..Y.. e..S..O-.q.,,.............
..................................
Operator. Certification Number,.....1. 91.1..6................
Latitude F-3—T]•©`0" Longitude E J-11 • H(, `®"
Swine
Population
❑ Wean to Feeder
CK Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons / Holding Ponds
General
Poultry Capacity Population Cattle Capacity Population
❑ Layer 1 ❑ Dairy
❑ Non -Layer I Non -Dairy
❑ Other
Total Design Capacity 333 0
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Total SSLW I L4
Subsurface Drains Present jJU Lagoon Area Ip Spray Field Area
No Liquid Waste Management System
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b_ If discharge is observed. did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a laggon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes
KNo
❑ Yes
9[No
❑ Yes
KNo
❑ Yes
RNO
❑ Yes
® No
❑ Yes
® No
❑ Yes
®,No
❑ Yes
RNo
❑ Yes
KNo
❑ Yes
QNo
Continued on back

FaciGtyNumber.31 -ZO _
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons Holding Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier: ._........
Freeboard(ft):................... ................ ....................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
Structure 5
15. Crop type ..lass�rx�.v.t%x.................._. 4�94.w£....._.... .........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified.AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
Ef No violations or deficiencies were noted during this.visit. You.will receive no further
....... . ...... . ...... . .... . . ...... . ...... . ...
correspondence ahout this visit.
YES answers and/or
❑ Yes ®No
❑ Yes KLNo
Structure 6
❑ Yes &No
❑ Yes .
® Yes ❑ No
❑ Yes KNo
❑ Yes ® No
❑ Yes ®,No
❑ Yes �No
IK Yes ❑ No
El Yes ERNo
❑ Yes ELNo
❑ Yes 1KNo
❑ Yes JLNo
❑ Yes KNo
❑ Yes 91No
❑ Yes IRNo
ents ,
r
IZ • P141 tti-t'C. M� S p I fL O n. t'O.n p0 w W d tt t W wMr-C Nxx41aQ-
t8.t�.�JJekaLe La a 11Tafi 'ET--j(-°—LXf,wh"ne�If"�'�. gisu,wo.I o cer zc{i q
w kL-,e ttie.e. jq. / J
0tvv.- S'k Iook-c J00c1.
7/25/97
Reviewer/Inspector Name
Reviewer/InspectorSignature: n I„ , ,M_ AgL,,,,,,,,,,.,,,trk, Date:

Site Requires Immediate Atten n:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERA7ev—
Time: VISITATION RECORD
DATE: I , 1995
Farm Name/Owner: % 'Z. 7j
Mailing Address:/aL/' r✓ .I/ht %� �Z/C 1/L LQ�
County: L. /Aj
y
Integrator. j (i Phone:
On Site Representative: �22 �h/6 Phone:
Physical Address/Location: J / 41 • dA
Type of Operation: Swine _V Po ltry _ Cattle
Design Capacity: 1p �l� / / O%�� Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 Longitude: 7 7 ° ran ' 0/)�" 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�r No Actual Freeboard^�Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes o6was any erosion obnYe
? Yes r No
Is adequate land available fors ray? Yes or o Is the cover crop adequatr No
Crop(s) being utilized: ��N
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?, es r No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Ye r No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yeas or No
Additional Comments: ___;_ A7 Q/YL �-ZYV Af S &76e? t_�>
Inspector Name
cc: Facility Assessment Unit Use Attachments if Needed.

!1
31- V�7/n
~ Site Requires Immediate Attention: /. W
Facility Noar-�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION SITE VISITATION RECORD
DATE: —3? .1995
Time: I J� ""
Farm Name/Owner: L ty krr g f49-44 J�(O
Mailing Addresss� Y'/1 (7L1 �/r G� aGC-Qi
County: /J[/f>Ll
Integrator. Phone:
On Site Representative: /I1/e Phonee-
Physical Address/Locadon: % 90 r lU� L) /�
Type of Operation: Swine Poultry Cattle
Design Capacity: OV Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° Longitude:° Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have tcient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches Yes r No Actual Freeboards Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o&Was any erosion observed? Yes r No
Is adequate land available for ray? Yes or No Is the cover crop adequat Yes No
Crop(s) being utilized: I
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings. es r No
100 Feet from Wells? Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters oemanagement
a state by man-made ditch, flushing system, or other
similar man-made devices? Ye or If Yes, Please Explain.
Does the facility maintain adequate w records (volumes of manure, land applied,
. spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: %bb�-1 L�q
14K-M
cc: Facility Assessment Unit
Use Attachments if Needed.