310209_INSPECTIONS_20171231

NORTH CAROLIN '_
Department of Environmental Qual

r
Inspection
for Visit: QJRoutine
0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied
Date of Visit: '-1 t l' Arrival Time: ®j Departure Time: n � County: F� I (i� Region:
Farm Name: l.Cl/S 1`L U �ii �AiYi�{�1n.1 I" 1 (�i,(' Owner Email:
Cf
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative:y iiCt hall MAI k
Certified Operator: `3VA-,M
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 1 lY
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
11-ayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
lNon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D � P,oultr.
Layers
Design
Ca -a i
Current
P,o
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I jBeefBroodCow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes oNo
❑ Yes ni'IVo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412015 Continued

Facili Number:toe Date of inspection:
Waste Collection & Treatment — /
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes I 111 -110 ❑ 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
2
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes _L <o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑Yes ❑Ao
❑ NA
❑ NE
waste management or closure plan?
T
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?
❑ YesJD"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes Lallo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes V No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;EI"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 [3No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �ffNo
❑ 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 ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [�'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
,,�No
❑ Yes J21"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 En"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 21412015 Continued

Facili Number: Date of inspection:
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 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes � ❑ NA ❑ NE
❑ Yes ❑ No 'E2-MA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes ,,E21�o ❑ NA ❑ NE
❑ Yes,4EfNo ❑ NA ❑ NE
❑ Yes �<o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ YesNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes" glo ❑ NA ❑ NE
Reviewer/Inspector Signatur
21412015

(Type of Visit: Q Compliance
pliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: t I Arrival Time: . Departure Time: ® County: DAIIIJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
OnsiteRepresentative: `Jo►Ja, Ak� fft, (,k'u
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: f 9 6 R T
Certification Number:
Longitude:
Design Current
CapaciTy Pop.
Wet Poultry
er
Design
C•apaciTy
Current
Pop.
Design Current
Cattle CE INinish
Dai Cow
Feeder
JLa
6(;
Non -La er
Dai Calf
roGilts
Finish
Dai Heifer
Wean
Feeder
Finish
Dq P�oultr.
La ers
Design
Ca aci
Current
P.o .
D Cow
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
NJ
jBeef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
❑ Yes ❑ No
❑ Yes [—]No
[—]Yes
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued
f

[Facility Number: - Date of Ins ection: It
Waste Collection & Treatment
Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EdNo ❑ 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: C,}i pr ,�_)l LA&ooiJ ,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
i
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes n No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes CJ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ENo ❑ 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 7No ❑ 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 or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [;3"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
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3`No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E2 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
i
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists El Design ❑Maps ❑Lease Agreements
❑Other:
i
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo ❑ NA ❑ NE
Page 2 of 21412015 Continued

[Facility Number: - qbj
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dNo ❑ NA ❑ NE
2�. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
EdNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
- No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Ffj"No ❑ NA ❑ NE
Other Issues
No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
2 ❑ 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
E21�o ❑ 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
Q 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
E3 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
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ 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).--
0<<j ov',QER.$, NEB✓ C..0
Reviewer/Inspector Name: t- zj-/ ��6L U�
-�� Phod 9lo� �6 — / 3 0
Reviewer/Inspector Signature: ^ J / Date: t
Page 3 of 3 21412015

for Visit: dRoutine 0
Date of Visit: U
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Referral 0 Emergency 0 Other 0 Denied
Arrival Time: Departure Time: County:DUPC$ Region:
Title:
Owner Email:
Phone:
Onsite Representative: LblJ I4 Ao W-1L=k 1— Integrator:
Certification Number: I -I & al
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
R et Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
ot)
Non -La er
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr,+P,oul
I Layers
Design
Ga aci
Current
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
Beef Brood Cow
Other
Other
Turke s
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 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
❑ Yes N
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facili Number: - 17,119 jDate of inspection: Ki $ 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I Structure 2 Structure 3
Identifier: Lg &0V (. f � &-"fw A
Spillway?:
Designed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
Observed Freeboard (in): �Zz
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes RjeNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes O/No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public healtb or environmental hreat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [3/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 EfNo
❑ 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 or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
FNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
AIo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes N/q ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes b� "V ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: -/Affl Date of Ins ecrion: /
24. gid 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 [ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Io ❑ NA ❑ NE
❑ Yes Z/No ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
[—]Yes E No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
I_No ❑ NA ❑ NE
90
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #):rExplainany YES; answers and/or any additional recommendations or any other, comments..
Use drawings of facility to better explain situations (use additional pages as necessary).
S wpr, c- 0 !3 CIS", �,� �I [ PDX,
Reviewer/Inspector Name:
Phone: 1110 / ` 1 "1 L `
Reviewer/Inspector Signature:
Page 3 of 3
Date:

Reason for Visit: ID Routine O Complaint () Follow-up U Referral U Emergency U Other
Date of Visit: Arrival Time: Departure Time: County: Q)
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: y, Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone:
Assistance .
0 Denied Access
Integrator:
Certification Number: I
Certification Number:
Latitude: Longitude:
Region:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design C•ucrenI
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
11 .9 P,Onit
La ers
Design
Ga aci
Current
P,o P.
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
I Beef Brood Cow
Other
OtherI
Tmke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ❑ 0NA ❑ NE
❑ Yesrrz01"
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 21412011 Continued

Facili Number: - Date of Ins ection: lij
Waste Collection & Treatment
4 11 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 3 Structure 4
Structure jWO
Structure 5
Structure 6
�y
Identifier: L/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
4No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
WNo
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environme;Pl threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ,/No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes I �{ 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 I ytvo ❑ NA ❑ NE
maintenance or improvement? 777'
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 Phosphors ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ N
❑ 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
�
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CENNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I if No
T
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
JEJhj
❑ 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 WNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections - Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ILJ o
25. I3 the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes VNNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ ❑ ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes ZNo
❑ Yes '�No
[:]Yes ✓ No
31. Do subsurface the 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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
No ❑ NA ❑ NE
❑ Yes [EIgo ❑ NA ❑ NE
[:]Yes MA ❑ 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),
I -
't) M S/� V� 14 r J�lr/PlAd "jrm,C 1 oc� ��A"/
Reviewer/Inspector Name:
Phone: I I IU / M & —
Reviewer/Inspector Signature:
Page 3 of 3
Date:

(Type of Visit: tAtCompHance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine O Comulaint O Follow-on O Referral O Emereencv O Other O Denied Access
Date of Visit:
Arrival Time: Departure Time: County: CL� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
Onsite Representative: �orJW-r)AA*J A/I, z f-C,0_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: I C� %1e1I
Certification Number:
Latitude: Longitude:
Design & r _n
Swine Capacity Pop.
Wean to Finish
1111111111il Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Wq
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
1-1"
Non -La er I
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
I)r. P,o Itt. Ca aci $o ,
Layers
D Cow
on -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
I
lBeefBroodCow
Other
Other 11Other
Tor s
TurkeyPoults
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 WNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes CEl J ❑ NA ❑ NE
❑ Yes y ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 21412011 Continued

Facili Number: Date of Inspection: 4
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 l Structure 2 Structure 3
Identifier: UAc,,=A l L.AC,,mkJ-Z,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): s
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?
D-do ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes E2 No ❑ NA ❑ NE
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 o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffets, setbacks, or compliance alternatives that need ❑ Yes [;5No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [:3/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?
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 1 /I JN6 ❑ NA ❑ NE
❑ Yes U1 o ❑ NA ❑ NE
❑ Yes [J�No ❑ NA ❑ NE
❑ Yes Ind "o
❑ Yes No
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections/ ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L N ❑ 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

Facili Number: Date of Ins ection: 07� Z //
2#. Did the facility fail to calibrate waste application equipment as required by the permit? ❑�
Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes r;;r-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C3Xo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ZNo ❑ 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 [3 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 Oo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: /
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes F/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 ❑ NA ❑ NE
Reviewer/Inspector Signature: (}j�(y t�^� v/ Date: a%i
As
Page 3 of 3 21412011

Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: OL)P tZJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: j dNK}�. 'j i yuy -)(_
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
1962
Design Current
Swine Cacity Pop.
pa
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Cuen t
Cattle Capacity rrPop.
Da' Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, $oultr.
Layers
Design
Ca aci
C>urrent
Pao ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes ❑N ❑NA ❑NE
❑ Yes �9/ ❑ NA ❑ NE
❑ Yes ✓—Lj/No ❑ NA ❑ NE
Page I of 21412011 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
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: `lJ v -M (wlrvdN 7/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
J�jNo ❑ 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 environments hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Io ❑ NA ❑ NE
t t?
ma m enance or �mprovern /
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
dNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
L_l N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
LJ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[;Y<o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
� yivo
❑ NA
❑ NE
the appropriate box.
7
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 011 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Fr<o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection. $ 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Io ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [—]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
Otherlssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Nc ❑ 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
o ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
/
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
II N ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes
No. ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
Vo
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.4
Use drawines of facility to better exolain situations (use additional mares as necessarv).
^�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: !O (,3 CJ
Date:
21412011

RE
IType of Visit: gCom lance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emereencv 0 Other 0 Denied Access
Date of Visit It Arrival Time: Qz.o Departure Time: /a a 0 County: AWc_bNJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
I A�,, '^
Onsite Representative: QuWAT_ lAW 'v�< Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Latitude: /Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
017
S�
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oult . r
Layers
Design
C_a aci.
Current
P,o P.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
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 dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes [—]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes tNo ❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: - rDate of Inspection: t41
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Eallo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier: l%�t'S+rrr✓ JZ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
37No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑/No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Ea<o
❑ 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
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
o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
V No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
O/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Io
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�--I �
h A6
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑X
❑ 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 I3 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 Ko ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: I7 D4 Date of Inspection:
24. Dia the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA ❑ NE
Tto
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
['No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[TNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
_,�
Leo ❑ 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
LQ iio ❑ 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
6.d"K" ❑ 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
," o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ej_No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
QX ❑ NA ❑ NE
34. Does the facility require afollow-up visit by the same agency?
❑Yes
�� ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments's z x
Use drawings of facility to better explain situations (use additional pages as necessary)..
Reviewer/InspectorName: Jbija FA11►2ecL1.
Reviewer/Inspector Signature:
Page 3 of 3
Phone: nJ r)
Date: / t
1/4/1011

Division of Water Quality
✓
>�acility Number'
O Division of Soil and Water Conservation
r*»
='1
Type of Visit i rcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: rj ((7 Arrival Time: ® Departure Time: County: Du?LmJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: J4PA-r P&j mxl_L Yt,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
o =' = Longitude: =o
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
-� d.. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
El Yes. EJNo El NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
❑ NA
[INE
❑ YesI
No
❑ NA
❑ NE
Page 1 of 12128104 Continued

Facilit.,jNumber.',j� —Z
Date of Inspection ri lD
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:tA&00Tj I i.fi&Wyp Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33 3._L�
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 EZ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes EJ No ❑ NA ❑ NE
❑ Yes Zf 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 dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ICJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Kf No ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes LJ 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
❑ NA ❑ NE
❑N El NA El NE
�ElNA ❑ NE
" ❑ NA ❑ NE
No ❑ NA ❑ NE
,Comments (refer -'to question #): •.Explain any.YESaanswers and/or any,recommendaattionsoT any other comment""
Use drawings of facility to better explain situations. (use addttionaGpages as necessary,): = ,
t
r
Reviewer/Inspector Name t`!✓CJ c Phone:
Reviewer/Inspector Signature: Date:
r 7 12128104 Continued

Facility Number: 5 1 d Qq I Date of Inspection 9 D
Keauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �, NNoo ❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E o ❑ NA ❑ NE
the appropriate box. ❑ Wes, ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
1340
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
2-- NNo
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Er<o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
LQ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
NNoo
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
ElE Yes
�Z
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EYNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
Z
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,
EJ 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
``
EK o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

♦''Division of Water Quality
J Facility Number 31 = 2A9 Division of Soil and Water Conservation
Other Agency
Type of Visit QrCq(npliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit
---Q Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: �_)[j_y_[0_U Arrival Time: (tld Departure Time: County: CWtltw% Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
/ 11
Onsite Representative: ✓r+itJ N a<.i.02.- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [ o = =„ Longitude: [� o = ' = "
I
Design
Current
EN mi
Design Current7roo
Design Current
Swine Capacity
Population
Wet Poultry Capacity Population
Capacity Population
❑ Wean to Finish
❑ Laver
wWean
to Feeder
lujD
G
❑Non -La er
f
Feeder to Finish
fer
Farrow to WeanFarrow
to Feeder
ry
❑ Farrow to Finish
❑ La ers
❑ Non -Layers
❑ Pullets
❑Turke s
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Cowl
❑ Gilts
❑ Boars
Other
❑ Turkey Poults
Number, of Structures:
❑ Other
❑ 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?
Page I of 3
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
0
❑/Ny ❑ NA
❑ NE
❑ Yes
❑ Yes
N El NA
❑ NE
❑ Yes
.
No ❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: tty/ i ilk
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes
o
dZNo
❑ NA
❑ NE
6. Are there structures on -site which are not properly addressed and/or managed
❑Yes
❑ 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
Ld No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
I11 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
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?
Reviewer/Inspector Name
❑ Yes
Phone: / A
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature:
Anvn 2 of 2
Date:
12128104

1 Facility Number: — Date of Inspection
d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
❑ Yes �No ❑ NA ❑ NE
❑ Yes ld/
No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard [:1 Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections E]
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[I1� Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
Jr��-f/
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
V
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
N
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,ICJ
Id No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0<0
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
PNo
❑ 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
[j"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
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings: <r,.
Page 3 of 3 12128104

IType of Visit (Xcom ance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I e17;.rifd Arrival Time: 9i,5 Departure Time: County: /��/i�(77"tL Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: F70 F7, F7.. Longitude: Mo n
Design
Design C•unrent Design Current
Swineiiiiiiiiiiiiiiiiiiiiiilgffpggity Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer I ❑ Dairy Cow
Wean to F d
&J66
JLJ Non -Layer I ❑ Dairy Calf
LJ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
La El Beef Stocker
❑ Gilts
❑ Non -Layers ❑ Beef Feeder
❑ Boars
❑ Pullets
ElTurkeys El Beef Brood Co
Other
❑ Turkey Poults
❑ Other
❑ Other Number of Structures:
Discharges & Stream Imuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes CJ El ❑ NE
[I Yes No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — � Date of Inspection
i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes • No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 1A Ad&� 1AS�WV?i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31 3 d
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ N
8. Do any of the stucmres lack adequate markers as required by the permit? ❑ Yes dNo ❑ NA ❑ N
(Not applicable to roofed pits, dry stacks and/or wet stacks) �J/
9. Does any part of the waste management system other than the waste structures require El Yes E No ❑ NA ❑ N
maintenance or improvement?
Waste Application /
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 No ❑ NA ❑ N
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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. Soiltype(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 detertnination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E3'No
dNo
DjNo
Y
Ste'
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA El NE
El NA ❑NE
Comments (refer to'quesgon #) YEaplam anyYESan swnor ymn-ersaamnroeomments:
Use drawing of factLty to better explain sttuations�(use addttmnal pages asmecessary):
Reviewer/Inspector Name - Phone: S/0
Reviewer/Inspector Signature: Date: 6
Pape 2 of 3 12128104 Continued

Facility Number: — g Date of Inspection 2 D
ieguired Records & Documents
19. Did the facility fail to have Certificate of Coverage &Permit readily available? ❑���
Yes El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes No ❑ NA ❑ NE
the appropimte box. ❑ WUP ❑ Checklists ❑ Design
g El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
D"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
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,,dNo
eNNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
t O
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
B NNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ETNo
❑ NA
❑ NE
Other Issues
�,/
28.
Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
U/ N
❑ 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
O 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
LYNO
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
TTT
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
11 Facility Number 31 ZA`I 0 Division of Soil and Water Conservation /
0 Other Agency ✓
Type of Visit (2f C[q_mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C7 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ru Arrival Time: 27 u Departure Time: County: JvPI.U.I Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: 1 a N A-rkA. rv^ -r L_— Ctt­ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: =o =I = 11 Longitude: =o m' M
4ao b3ao
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
6❑Non -Layer
❑ Wean to Finish
0 Wean to Feeder
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
ElPullets
ElTurkeys
El Turkey Poults
ElOther
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure [IApplication Field ElOther
a. Was the conveyance man-made?
C Design U -urrent `ny
Cattle Capacity Population.
❑ Dairy Cow
El Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
ElBeef Stocker
ElBeef Feeder
❑ Beef Brood Co
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)?
Number of Structures:
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 PNo [INA ❑ NE
❑ Yes ElNo [INA ElNE
❑ Yes ElNo ElNA ElNE
0
❑ Yes ElNo ElNA ElNE
ElYes grjW4c ElNA [INE
ElYes No ElNA ❑ NE
12128104 Continued
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure [IApplication Field ElOther
a. Was the conveyance man-made?
C Design U -urrent `ny
Cattle Capacity Population.
❑ Dairy Cow
El Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
ElBeef Stocker
ElBeef Feeder
❑ Beef Brood Co
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)?
Number of Structures:
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 PNo [INA ❑ NE
❑ Yes ElNo [INA ElNE
❑ Yes ElNo ElNA ElNE
0
❑ Yes ElNo ElNA ElNE
ElYes grjW4c ElNA [INE
ElYes No ElNA ❑ NE
12128104 Continued
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)?
Number of Structures:
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 PNo [INA ❑ NE
❑ Yes ElNo [INA ElNE
❑ Yes ElNo ElNA ElNE
0
❑ Yes ElNo ElNA ElNE
ElYes grjW4c ElNA [INE
ElYes No ElNA ❑ NE
12128104 Continued
12128104 Continued

Facility Number: 31 — jo') Date of Inspection to aS of
9 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA Grmd A933 LAC�J AAJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ,dNo ElNA [INE
ElYes CJ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thFeat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Apulication /
10. Are there any required buffers, setbacks, or compliance alternatives that need ElYes W No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EYNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Q o
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
P/N;
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑Yes
o
El NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
�XNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
FAcu, fll ACt.WC- CLASH 'GAVC�E_ 4+LTH PNaiN 6tL-FHRM 1JA.VE 60C SNStgkt-ke .SEFEftACE�(
Reviewer/inspectorName JOHi✓ Nru- Phone: ( 1609C--)' Vq
Reviewer/Inspector Signature: Date: l0 5
12128104 Continued

�.� • Facility Number: 31 — 7,oy Date of Inspection
Y
Required Records &Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
El Yes PINo El NA ❑NE
ElYes ONo ElNA ElNE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
LiYes
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?
El Yes
1/ �o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
,❑
LI No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�[}</o
E No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
_J NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ElYes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes No [I NA [I 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?
ElYes
E3No
❑ NA
ElNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
�,//
L1 No
ElNA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
�
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
ElYes
ElNA
❑ NE
Comments and/or Drawings:
12128104

III. Fact Number - � Division of Waterand Quality (I
a� 0 Division of Soil and Water Conservation I /
-- - - 0 Other Agency (/
Type of Visit Otompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 9 ii /Arrival Time: Departure Time: County:
Farm Name: G<ii�I ! PY \ ✓ / (/(/%; iP��-,/ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region: Le�
Facility Contact: / Title: Phone No:
Onsite Representative: G' ek rl Integrator: _
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
can to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other ..
Back-up Certification Number:
Latitude: F-I o M. M Longitude: M o M
Current ° Design Current �r f
ty Population '' Wet Poultry Capacity Population Cattle C!
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Number of Structures-
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
M
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Numb er:.3 — Date of Inspection Lccy1Q�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: / Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): n
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [:]No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 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. Soiltype(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments r y
Use drawings of facility to better explain situations. (use additional pages as necessary):
6a8 6A; -'
3•FS' �y)
a A-3/a 6 21 r3�
Reviewer/Inspector Name F K Phone: Q —
Reviewer/Inspector Signature: e Date: y dL
Page 2 of 12128104 Continued
.S4- //Jc . 4e-I e//c i-r / nc

31
(Type of Visit of Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit (d Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
3 d oS
Arrival Time: 6 O 6
Departure Time: County:
O✓17LIMd
Farm Name:
t-ANSbrt- oJiJtL,$'Ltit.SES
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: &� o k-'etJ or. o {
Certified Operator: AW L Eru2_
Back-up Operator:
Location of Farm:
Swine
Wean
Other
❑ Other
Title:
Latitude:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
0 F-3
[ ---- I" Longitude: F--] 0 F-7 F-1"
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
G -Lao I 12LOQE]Non-Laver
Dry Poultry
❑ Layers
_
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity . Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ 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 KNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes �Co ❑ NA ❑ NE
12128104 Continued

Facility Number. 3 — Date of Inspection 3 05
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: (.A6aOtJ I ('A600iJ RL
Spillway?:
Designed Freeboard (in): �t
Observed Freeboard (in): 3 I
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 ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes JNo ❑ 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 Uo [INA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [.I No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) (/
9. Does any part of the waste management system other than the waste structures require El Yes LI No ❑ 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 CNo ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) LI 1 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?
Z,1.) (LEGorasa Q.AJ>41FAI.I. "AND toSi>EGT,S,,O irr I2-A-rd,
�06TAa-t- (LR=0 GAOGE.
kcc— a GoPY `'F CC--n-Ts.FrCATrc •f' cauert,P+G.E Ante
❑ Yes
ANo ❑NA
Wo ❑ NA
o El NA
VNo
uVEl NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
�l_fa-wiT li� ICtrCoRO$,
Reviewer/Inspector Name -f��QL- (L Phope. ytd j^tS 3ipJ x Zo3
Reviewer/Inspector Signature: Date: 3lybj

Facility Number: ( — Date of Inspection
l6guired Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 2 Yes ❑ No ❑ NA ❑ NE
d
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
f/
2 t' es
❑ No
❑ NA
❑ NE
❑ W ste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Sod nalysis ❑ Waste Transfers
❑ Annual Certification
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections Monthly and I"
Rain Inspections
❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
RYes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
0(i A
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
N�o
Ll NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,❑,
LYNo
[] NA
❑ NE
27.
Did the facility fail to secure a phosphors loss assessment (PLAT) certification?
❑ Yes
❑ No
LJ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ZNo
❑ 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
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Facility Number Date of Visit: Time: �n
0 Not Operational C Below Threshold
E3 Permitted 0 Certified 0 Conditionally Certified 0 Registered
Farm Name: ....._._..L.G.K.L.t' 4�.._._.! (�✓.`� 21..--.................... _..............
Owner Name:
Mailing Address:
Date Last Operated or Above Threshold:..
County: ........ /a/.11.�L......... _........... _
Phone No:
Facility Contact: .._._ ................ .............................. __._......._... Title: ... ....... ._.... .... Phone No:
Onsite Representative: .._,.l7YILV.__4__ 0 .eJX _ Integrator-
Certified Operator: .._....... .................. ..._......._._..__...._.........._.._—_................ _............ Operator Certification Number: .............................. _._._....
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =11 Longitude =• =' =«
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z
Freeboard (inches):
12112103 Continued

Facility Number: 3( — 2 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 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
❑ Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
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.
7�'1CCy �i✓t'C� ��M�bK �OD�
403
Reviewer/Inspector Name 3:
Reviewer/inspector Signature:
Field
Date:
Final Notes
12112103 Continued

Facility Number: 2 Date of Inspection
Required Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ 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?
(iel 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 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Division of Water Quality,
Division of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit (Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: Time: � Printed on: 7/21/2000
�— �� I
Q Not Operational Q Below Threshold
Permitted E3 Certified 0 Conditionally Certified E3 Registered
I _ Al
Farm Name:
Operated or Above Threshold: .........................
tv:..........3...11. . 1A...................... .... �...t.......
............................_...._........----- t 1
Owner Name:....,�,-Ilw
A..................................1...��..irl �yy..��///...........................................Y
Phone No:......................................................................................
Ke�N .... .. .._""'. f�. .- ._ Y�CI-4 Phone No:Facility Contact: .. .................... .......... Title:....
Mailing Address: ...................................�............... Inte/................................
►�ty�0........
. �e.l ....._...Onsite Representative:.......�rl. .._1my�d.1gr.......Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Date Last
Court
swine []Poultry ❑ Cattle []Horse Latitude Longitude =• =° ="
Design Current
Swine Capacity Population
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current
Poultry Capacity Po ulation
❑ Layer
❑ Non -Layer
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
Waste
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
Lagoon Area I❑ Spray Field Area
b. If discharge is observed. did it reach Water of the State'? (If yes, notifv 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 St re 2 Structure 3 Structure 4 Structure 5
Identifier: ........... .0..
............ ........ .......................... ................................... .................................... .............................
❑ Yes x No
❑ Yes []No
[]Yes ❑ No
_Aq_
❑ Yes []No
❑ Yes [ANo
❑ Yes O�No
❑ Yes (LNo
Structure 6
Freehoard (inches):
5/00
Continued on back

Facility Plumber. ? — Date of htspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obs rued. (ie/ trees, severe erosion,
❑ Yes
4No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
Po(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
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
[XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
O No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
*1 0
11_ Is there evidence of over aappli n? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
[(No
12. Crop type (/f J�6
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
5CNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
XN0
b) Does the facility need a wettable acre determination?
❑ Yes
Po
c) This facility is pended for a wettable acre determination?
❑ Yes
9(No
15. Does the receiving crop need improvement'?
❑ Yes
XNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
*o
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes X 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 *o
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes VNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes WI- No
21. Did the facility fail to have a actively certified operator in charge'? ❑ Yes �KNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
fie/ discharge, freeboard problems, over application) ❑ Yes ANo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes O(No
24. Does facility require a follow-up visit by same agency? ❑ Yes XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes O�No
IJ d•violatitjris:oi• ileficiencieS were p6fe, iluritig this:visit: Yoit w5t1 receive tiq further
curies otidence: about this
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):
14,�ivv�S><ca�
Reviewer/Inspector Names j�zfeoe/— 11,111,T1
Reviewer/InspectorSignature:,,-� ,�%JQ®� %%/1/j,��t%1 //� Date:

,Facilil)1 Number. — Date of Inspection
Odor Issues #PO
'
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?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes 9No
❑ Yes �No
❑ Yes [)(No
❑ Yes KNo
❑ Yes �<No
❑ Yes (1Vo

Facility Number 3 Date of Visit: Time:
Not Operational 0 Below Threshold
® Permitted .Ce tified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: Z4 tt"e ✓ S Ay.) Pam/ County: AAA
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative:—Adi:/l�Bt0 znnsef�_
Certified Operator:
Phone No:
rr/!Phoon�ne�nfNo:
Integrator: Lr(�
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =o =' =« Longitude 0' =' ='
Farrow to Wean
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 7i
Freeboard (inches):
05103101
❑ Yes K] No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
R jNo
❑ Yes
1A No
❑ Yes
In No
Structure 6
Continued

Facility Number: ( — Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
❑ Yes
ZENo
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
XNo
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
Wo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
® No
9.
Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
��55
93 No
Waste Aoolication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
IN No
11.
Is there evidence of over application? ❑ Excessive Funding [I PAN ❑ Hydraulic Overload
❑ Yes
KLNo
12.
Crop type �A Gr/4B4 7Dy
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
E[No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
PSNo
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
ZqNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
1�i No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
gNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
;�LNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
E,No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
M No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
ONO
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
tsNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
RjNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
EKNo
Im No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ttt . U .•.w
" Omments.(refe[ t0 gne3tinn t{). EapIdn any YES answers and/or any �&ommCndations O[ any Othe[ COmment6
fL.^� ".." - + 4 1 :-� any,"
xz-,L•
Use�dr'awmgs of facdrtyg[b betteriexplam situations (use additionabphges as accessary) s ❑ Field Copy ❑Final Notes
r
y«/mode Ata4 v--'fveef` '^ )sf1E✓ `"7eon Gem//s,
t 0�--4"-M 'POQeaI-W4 6.4 �B�r
Reviewer/Inspector Name �� - '
Reviewer/Inspector Signature: Date: 6�
05103101 1 NIL Continued

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes J�INo
❑ Yes Wo
❑ Yes PNo
❑ Yes P![No
❑ Yes Flo
❑ Yes FLNo
❑ Yes k9:No
Additional Comments and/or Drawings: 'i" 01
05103101
05103101

Lagoon Dike Inspection Report
Name ofFafm/Facility Aso,
Location of Farm/Facility .5,2 { ^
Owner's Name, Address �YL V\ k'vd�OC6 1"/
and Telephone Number
Nt,&bers�J , l �C. Z c7
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:1V
Embankment Sliding?
(Cbeck.One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
,12, q Names of Inspectors 2 I�i 1tuL��
S Freeboard, Feet 3
Top Width, Feet
IDownstream Slope, xH:I V A
Yes -' No
Yes �No
Erosion? Yes ,-, No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Treesy
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes /No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes / No
Other Comments

Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Lagoon Dike Inspection Report
&0— Su-1
P g,�-t5al , I\LL
aNames of Inspectors
Structural Height, Feet
Freeboard, Feet
Lagoon Surface Area, Acres
Z Top Width, Feet 1 ��
Upstream Slope,xH:I V
3_ I Downstream Slope, xH:I V I
EM%onkment Sliding?
Yes No
(Ch�'t�'i, c,One, Describe if Yes)
Seepage?
Yes No
(Check One, Describe if Yes)
Erosion?
Yes / No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(brass, Trees)
Did Dike Overtop?
Yes �No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes /No
t
No
Engineering Study Needed?
Yes
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes -No
Other Comments

Lagoon Dike Inspection Report
Name of Farm/Facility
Location ofFarm/Facility
SQ 1 �541
Owner's Name, Address
and Telephone Number
�I,JSrILZS'Oi.1 FiC Zf�c7
Date of Inspection
Ci ` Names of Inspectors
Structural Height, Feet
S Freeboard, Feet
3
Lagoon Surface Area, Acres
�/ Z Top Width, Feet
j D
Upstream Slope,xH:IV
Downstream Slope, xH:IV
3.
Embankment Sliding?
Yes No
(Check One, Describe if Yes)
Seepage?
Yes —No
(Check One, Describe if Yes)
Erosion?
Yes /,�_ No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees) -
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes / No
Engineering Study Needed? Yes /No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes /No
Other Comments

Lagoon Dike Inspection Report
Name of Farm/Facility
Location of Farm/Facility
-z OR
Owner's Name, Address
and Telephone Number
�y�zsnal,
Date of Inspection � "1 Names of Inspectors K _ jZ9Slk
Structural Height, Feet 4-' Freeboard, Feet
Lagoon Surface Area, Acres Z Top Width, Feet i (�
Upstream S1ope,xH:I V 3 _ Downstream Slope, xH:I V I
F tibankment Sliding? Yes �No
1:1,A­
(00,,4 One, Describe if Yes)
Seepage? Yes No
(Check One, Describe if Yes)
Erosion? Yes / No
(Check One, Describe if Yes)
ICondition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes -,'�No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes -'—No
i
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes --'No
Other Comments

13 urvtsion m aou an water a,onservanon vperanon tteview
p Drvrsion of SmLand Water Conservation Compliance Inspection - _
s� Division of Watei Quality -Compliance Inspection
v p Other Agency `Operation Review
p t-ompiamt p
Facility Number Date of Inspection ® .
Time of Inspection 24 hr. (hh:mm)
0 Permitted M Certified 13 Conditionally Certified 13 Registered l7 of perationa Date Last Operated:
Farm Name: Lanicr.s.Nursery.......................................................................................... County: Duplin WHtO
OwnerName: Auu.H.................................... Herring ...................................................... Phone No: 252-50-39.89 ..........................................................
FacilityContact: ...............................................................................Title:............................................................... Phone No:....................................................
Mailing Address: 292.Bill.Sulton.Road......................................................................... Alberlsoit.-NE ....................................................... 28508 ..............
Onsite Representative: ....................... .................................................................................. Integrator: Goldsbium.Hog.Farms .......................................
Certified Operator:Marshall.S.......................... Britt................................................... Operator Certification Number: 19.629.............................
Location of Farm:
Latitude ©• ®° ®" Longitude ©' ®' ®"
Design: Current
SwineCapacity -Population
® can to Feeder
6400
❑ ee er to 7 uus
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
"Design 'Current Design . Current
.Poultry Capacity Population Cattle 7 Capacity .Population
❑ Y ❑ a Layer Dairy
uy
- ❑ Non -Layer ❑ Non -Dairy
10 Other
Total Design Capacity, 6,400
Total SSLW 192,000
Number of Lagoons L -...�® �uosuriace yams rresent II❑ r.nguun urea In spray r mu area I
Holding Ponds / Solid Traps _ - ❑ o Liquid ante anagement System
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes p 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:
Freeboard(inches): ...............4.6...............................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

rTa � ADiviston of Water Quality -- I I
a Q Ihviston of Soil and Water Conservation -
Q Other Agency
AN
(Type of VisitCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Z p ' Date of Visit:
u Permitted [3Certified Q Conditionally Certified 0 Registered
FarmName: LAwia...... ..... 5@.:k.1 ................. ............................... ..............................
Owner'Name:.... Ah—A................................... f/.kQ.....................................
FacilityContact: .........................................................................�....Title:..........................
Mailing Address:
Onsite Representati
Certified Operator:
Location of Farm:
Date Last Operated jJorr Above Threshold: ......U.................
County:...........lL1 .
Phone No:
Phone No:
.................................
........................>.
/Integrator:........,, ,Of.Si70Yd !� Ne/
Operator Certification Number:,,,,,.,....
Swine ❑ Poultry []Cattle ❑ Horse Latitude Longitude �• 0..
Design Current
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Poultry 'Capacity Popelation Cattle
❑ Layer I 1 10 Dairy
❑ Non -Layer 1 10 Non -Dail
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I0 Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area
Holding Ponds / Solid'Traps.
E:=
❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
krNo
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?
LJCIA-
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: .......... 2.4>-.........................3`....��..........................................................................................................................................................
Freeboard (inches):
5100
Confinued on back

Facility Number: ?�`— Z.UN Date of Inspection E% Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures obse ed-. (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes f1/I No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN []Hydraulic Overload
12. Crop type
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
( No
No
No
[VNo
A4
W No
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
RNo
c) This facility is pended for a wettable acre determination?
❑ Yes
10
15.
Does the receiving crop need improvement?
❑ Yes
,5'
tk No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
�No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
INo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
o
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑Yes
N0
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[PI No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
I�7No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
,,,...ttt�,,(No
.\fiiN0
24.
Does facility require a follow-up visit by same agency?
❑ Yes
'((No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
; iqMoat ii¢tis;oi•ftf1de-ndbg•wgreh6feddiWitlgfbis;visit;-Yoitfuttho$ •; ;
itiriispm d6&ab6utithis visit:':':':':•:•:• :.:.:::.:::::::::::•:-:•::::::•:•:•:::•:
ct, L" PS-d
�'Skcl.cQ 4u-e ll
Reviewer/Inspector Name -r
Reviewer/Inspector Signature:. :1 ,Ad g. : 4444 4 0 , 4.. Date: Z /141 / 0 l 5100

Facility Number: — 9 Date of Inspection I J y► lj►/)1 I Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes O"No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
[` No
'
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
CkNo
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
1� No
32.
a
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
V(No
5/00

0 Division of.Soil and Water Conservation Operation Review
Division of Soil and Water Conservation Compliance Inspection -
Division of Water Quality - Compliance Inspection
Other Agency-- Operation Review. .
IQRoutine 0 Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
—•I (1
I Time of Inspection 24 hr. (hh:mm)
Q Permitted 14 Certified [3 Conditionally Certified 0 Registered Not O erational Date Last Operated:
Farm Name: t IQ.�� �lt`.'.'�J._I `1 <w}w�.._........._.... County:..._.... _ 1t '-�
SJS..
Owner Name: ...... 9kh!-.�,._T1e!M� t
...................................................................... Pltoiu No:.......................................................................................
FacilityContact: ............................................:.................................Title:................................................................ Phone No:...................................................
MailingAddress: ..................................................................................................................... .......................................................... ..........................
OnsiteRepresentative:`�j �� ��-�,...,._.......-..._ Integrator: �...................................................................................................................................
Certified Operator: ................................................... ..... ...... ................................................ Operator Certification Number:..........................................
Location of Farm:
Latitude =a=1 =1 Longitude =• =1 =11
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder
C10
6 GO
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer I 1 101 Dairy
❑ Non -Layer I I IE]Non-Dairyl
❑ Other
Total Design Capacity
Total SSLW
I Number of Lagoons oL JU Subsurface Drains Present JJLJ Lagoon Area JLl Spray Field Area I
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Imlracts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation'?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: N-5 Ni
Freeboard(inches)...........�.�............................. ..........................................................................................................................
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes ONo
❑ Yes J�`No
Structure 6
1/6/99
Continued on back

a
Facility Number: 3 —'g_V� Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/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 top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Arc there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Ponding ❑Nitrogen
12. Crop type _„_CG ��25 `
......................................................I.....................
0
❑ Yes 9No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(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 certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
Id Yes ❑ No
❑ Yes qNo
❑ Yes Of No
❑ Yes 9No
❑ Yes ((No
...........................
❑ Yes KNo
❑ Yes KNo
❑ Yes Wo
❑ Yes %No
❑ Yes 0No
❑ Yes ONo
❑ Yes 19 No
❑ Yes 9No
❑ Yes [XN0
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ,fNo
24. Does facility require a follow-up visit by same agency? ❑ Yes P�No
El' No.viulations or. de$ciencies.were noted. dnrin.g.this'visit.. You wilfreceive no hirther .. .
pgrrrespbfideitce'Abut`this visit: ....................''' .''.''.
Comments (refer to question #): Explain any YES answers and/or anyrecommendations-or any -other comments.Use drawings of facility to better explain situations. (use additional pages as necessary):;_
5;;, c« 5; ts. r\,— A N tf Q , z - 5, ks i tf cil ve jei c� P
Reviewer/Inspector Name
Reviewer/InspectorSignature:�(_ js JDate: `d,1(01.1 `i 11/6/99

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
O Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection 2
Facility Number
Time of Inspection 24 he (hh:mm)
E3 Registered Certified E3 Applied for Permit E3 Permitted JE3 Not Operational Last Operated:FarmName::...._ � +�C.......`. hrY.............................................. County:........!,Date
....... `\
Owner Name: ....... &� ...... .�1. >�� l`^9.............................................................. Phone No:... 5a — �g.... .....................
Facility Contact: .............................................................................. Title:
Mailing Address:... fa... (.gi `, `•k,__�.
Onsite Representative: ... ".`.'..`..`..rL._'_iw-, .....................
CertifiedOperator:...............................................................................................................
Phone No:
Operator Certification Number:...... ...................................
Latitude =•='=" Longitude =• =' ="
Design"- Current
Design " Current Design 'Current
Swore ;
Capacity, Population
Poultry _
Capacity Population-_ Cattle Capac_ty Population
Wean to Feeder
&46Q
10 Layer.
❑ Dairy
❑ Feeder to Finish
, ❑ Non -Layer
I I": ❑ Non -Dairy
•, ❑Farrow to Wean
..
-
2 b$s, "n _ s
❑ Farrow to Feeder
❑ Other
g�^
❑ Farrow to Finish
_
i� Total Design Capacity
❑ Gilts
.0Boars
-Total SSLW
Number of Lagoons / Holding Ponds"
❑Subsurface Drains Present ❑Lagoon Area I[] Spray Field Area
❑ No Liquid Waste Management System -
General
1. Are there any buffers that need maintenancelimprovement?
❑ Yes
XNo
2. Is any discharge observed from any part of the operation?
❑ Yes
J'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
[]Yes
M No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gal/min?
/�0
h/A .
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
NrNo
3. Is there evidence of pact discharge from any part of the operation?
❑ Yes
W No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
-O No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
O No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
Ej No
7/25/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeoons.floldina Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Structure 2 Structure 3
Identifier: A—
................................................................
Freeboard (ft):............pl.t ....................
�� .i............................................
10. Is seepage observed from any of the structures?
❑ Yes 0 No
❑ YesI$NO
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ..... c:,/w,l,s
...........................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
LI No.violations or deficiencies: were noted during this: visit. You.will receive no further
• correspondence ab;ouf Phis;visit:• :::::::: • ::::: -:: • :::: ; :: ; • :: ; ::::::
❑ Yes M No
❑ Yes jg No
■
❑ Yes 0 No
❑ Yes 15 No
❑ Yes W No
❑ Yes t4 No
❑ Yes ta! No
❑ Yes (9 No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes JR No
❑ Yes to No
❑ Yes (R No
1?� Ic-, tsllz V%,QesA A�o b2 v�vey2F a� bct
1o�9oct-ems, rt� � Q�r� � 1 00�' J�a �s kv l� • �� ,
7/25/97

❑ DSWC Animal Feedlot Operation Review • x
® DWQ Animal Feedlot Operation Site Inspection t
of DSWC review
Facility Number 3 _ Date of Inspection
�...; ,..,, _ _ .� Time of Inspection G`tirS 24 hr.
0 Registered Pd Certified 0 Applied for Permit 0 Permitted 10 NotOperational ,Date Last Operated: ..........................
FarmName: ............ 1-wer Ow-tee.-5 ................................................................ County: ....... D4Af.n........................................ ..............
.........
A (t .......................................................................... Phone No: .... .4hj)..S%g.r.. 9b5.............................................
Owner Name:.......... !1d11/.......... . r
FacilityContact: .......... 1!_n........
,1G(......................_Title: .....Up@Y................................... Phone No:.��.d�_Lia7fi.t........
MailingAddress: :... Z114...... B1-al.....IS.teiIDts.....��.:................................................... ........�� 1j...��9!1�(`................................... ...2-V .1......
Onsite Representative:....., �'L�....LAmrr............................................._......_..... Integrator: .... [OrdAhoro........ y6jc.........................................
Certified Opera[or:......./M0.tS�G.��..............lUri.lt.................................................. Operator Certification Number, .......... Ito..?:..r9.........
Location of Farm:
Latitude 3S ' GS ID Longitude -1 ' -r , =91
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity.. Population
Wean to Feeder I f, 4M ID Layer 1 ❑ Dairy
❑ Feeder to Finish 10 Non -Laver 1 ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder 10 Other I_
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW �12 dGv
Number of Lagoons / Holding Ponds 0IDD Subsurface Drains Present 110 Lagoon Area JWSpray Field Area E
❑ No Liquid Waste iVianagement System
1. Are there any buffers that need maintenance/improvement!
2. Is any discharge observed from any part of the operation?
-Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (I(* yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there,any adverse impacts to the waters of the State other than from a discharge'?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes (A No
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes ;@ No
❑ Yes ® No
Yes ❑ No
❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes [$No
Continued on back

Facility Number: I —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes C.No
Structures (Lapoons.tioldine Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .......... .V.-A ................ ...............4..& ........ ...............:.............................................................................................................................
Freeboard(ft): ..........1'"(............................_Z"°.............. ................................... .................................... .................................... ....................................
10.
Is seepage observed from any of the structures?
❑ Yes
09 No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
50 No
12.
Do any of the structures need maintenance/improvement?
N 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
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ......... .CwS.ik[...... 6.Y»401................................ SDt{YkPfaS...... ..............................................................................................
.................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
(ZYes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
IX No
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
`R Yes
® No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
I$ No
22.
Does record keeping need improvement?
$,Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
19 No
25.
Were any additional problems noted which cause noncompliance of the Permit'!
❑ Yes
W No
(� No.violations or deficiencies were noted during this.visit..You_will receive no further
1.�
ahout this visit:-:
I. buf*r- sir,Ps ,hand bl�u0 e csiawis1ctrwm r
n t�
5'.Leta aaeas YS F-eO shwlbe- AW
I2. Et-os;on area an lnntr LAX tl 4 (moon #I
aj Yts9deJ. lntxur wolfs 1690txs
10d.
at -#,
;r t
Sk J
be_ �;IGJ w�� , e�,t�
s6uO
t�
he ✓,OW[d•
Bat,-
spA oc t cK\ (acQobs
bI III ye �M Fhld rvlw c COCK iS ItsW in crrt� eJ OAA. Neo plw,
s Cobti t>,uda t rop ,(Would be, tnLp"J-
� 5 rcwr�s Should he t by V ur nvnt6ers {sell nom6s. Ot Jalt.J so;l 44st Sko�IJ
L i _r 7/25/97
Reviewer/Inspector Name:,
Reviewer/Inspector Signature: 4A�.C._ _AJA" _. _ _ - _ _ Date:

Site Requires Immediate Attention: Al 0
Facility No. errs D r
DIVISION OF ENVIRONMENTAL MANAGEMENT aO j
ANIMAL FEEDLOT OPERATIONS SIIE VISITATION RECORD _
• DATE: v 1995 �C, arJ
Time: (Y 3u
Farm Name/Owner: eei+- L'ti'LC 40; 4 f
Mailing Address:
u t
County: ?,,p�;n
Integrator. L6 � t Phone:
On Site Representative: r 119 Phone:
Physical Address/Location:
Type of Operation: Swine Poultry _ Cattle
Design Capacity: 31yv Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0 S ' 1, Longitude: Z° t/ 2 Sd' " 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) Yes or No Actual Freeboard: -Z Ft. ! - Inches
• Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
zq_zl
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No. z 1
DIVISION OF ENVIRONMENTAL MANAGEMENT .
., ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 2 /2 1995
Time: / 3 � 30
Farm Name/Own
Mailing Address:
County: 4'T ,p
Integrator:
On Site Representative: Phone: (/ S i7o a ofi
Physical Address/Location: AleJP / �L4 G a oA/ 14 of r u �, vy n � 10
Type of Operation: Swine Poultry Cattle _
Design Capacity: 2U o o n-tt?SGAY Number of Animals on Site: 3 a r� 0
DEM Certification Number: ACE DEM Certification Number. ACNEW
Latitude: �_' 6 5i ' 10 '_' Longitude: Z" 4Y ' D 1 " 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) 6?or No Actual Freeboard: '_Ft. (:;, Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? jf�s or No
Crop(s).being utilized: OG<itiwl �i.✓r�c L�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Y�or No
100 Feet from Wells? lea or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes 04�0 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)? Ke_�1or No -
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.