310221_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

(Type of Visit: Ca'Complia9ce Inspection p Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: C: o/utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: © Departure Time: )O y -T County: Region:
Farm Name: "= Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
WS,an to Finish
Design or n
Capacity Pop.
11
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
ean to Feeder
C400 b 29Q 1
jNon-Layer
I
f
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , I P,oul ,
I Layers
Design
Ca a
Current
P,o P.
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Puults
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 NA ❑ NE
❑ Yes I NA ❑ NE
I
❑ Yes No ❑ NA ❑ NE
Page I of 3
21412015 Continued

acility Number: I - Z 2 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
❑ NA ❑ NE
❑NA ❑NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): 3 &_ 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ff7No
❑ 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 environmenta eat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E3No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EjeC❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
dNo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10%or 10lbs. ❑ 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
ElNA
❑ 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
ffNo ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
ElYesNo
g50
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design El Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gZ ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFacility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Noncompliant 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:
❑ Yes
No
❑ NA
❑ NE
[:]Yes
[—]No
FJONA
❑ NE
❑ Yes No ❑ NA ❑ NE
[-]Yes No ❑ NA ❑ NE
❑ Yes UfeNo ❑ NA ❑ NE
❑ Yes E 1Vo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
No • ❑ NA ❑ NE
No ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
P_
Date: 2 5 %
21412015

Type of Visit: Corypliance Inspection Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other O Denied Access
Date of Visit: I Arrival Time: Op Departure TIme:Ff50 County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Curren[
Swine Capacity Pop.
can to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
000
1 INon-Layer
I
Dairy Calf
Dairy Heifer
Dry Cow
Feeder to Finish
Farrow to Wean
Q,lP,oytltr,
Layers
Design
Ca acity
C•urreot
Pao
Farrow to Feeder
Faow to Finish
Non -Dairy
Beef Stocker
Grrilts
Non -Layers
Beef Feeder
Boars
Pullets
I
lBeefBroodCow
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 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 [E'o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes []-No
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 214120I5 Continued

Facility Number: 7,7 1
/
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: 76 76 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
MNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment fireat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes2"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 ErNo ❑ NA ❑ NE
maintenance or improvement:
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
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?
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists [:]Design [:]Maps ❑ Lease Agreements
❑ Yes
gN�
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
] NNo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Other:
/
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections / El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 3122 Date of Inspection: Z /%
24..Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 6 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Ej No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ONo
❑ 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
ffNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ENo
❑ 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
[;r.No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
D No
❑ NA
❑ NE
Reviewer/Inspector Signature:
Date: ) Z/ /-1141 b
Page 3 of 3 21412014

(Type of Visit O'Com lance Inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason for VisitRoouutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ,\I 1., ..I //'LI Arrival Time: � 0 Departure Time: 9 J(� County: Region:
Farm Name: `�'/y—`—"y'� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsi[e Representative: / e �� ! / & (y �t7
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
1Tu C6-
Swine
an to Finish
Design ttfugenrM
Capacity Pop.
Wet Poultry
La er
Capacity
Pop.
esign
Cattle Capacity
Dai Cow
Current
Pop.
Wean to Feeder
509 I
JNon-Layer
I
ai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I)t, + P,oultry
Layers
Design
Ca tacit +
Current
Pao ,
Dry Cow
on -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes []�l o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes' ❑ NA ❑ NE
❑ Yes ;'�No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: Q \ - 2 j Date of Inspection: 1 2.
•
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): i 7
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
[:fNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ENo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[]'RIo
❑ 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
Q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[!]-No
❑ NA
❑ NE
t t?
ma m enance or tmprovemen
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 O'No
❑ Yes [3 No
❑ Yes [i] No
❑ Yes [fNo_
❑ Yes [l"No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
bNo
❑ NA
❑ NE
❑ 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 N 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 [fNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: .� - Z ZI Date of Inspection: z S
24.VDid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes CTI o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes E3—No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [i]-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 [ f 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 ' E]-'Ro
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes QNo
❑ 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 0-No
❑ NA
❑ NE
4 omments;(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).
�5rti. /e�ois> (on�i �Jop f
Reviewer/Inspector Name: U ( 1, n
Phone: \ I PA
Reviewer/Inspector Signature:
Date:
1 2"
Page 3 of 3
21412015

• Drvision of Water Resources
Facility Number - 2 2 Division of Soil and Water Conservation
•Q Other Agency
Type of Visit: p Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral 0 Emergency O Other 0 Denied Access
Date of Visit: yZ / Arrival Time: Departure Time: County:= Region: 1
Farm Name: 'IL(�I ELaficj'-1 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
lNon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Layers
Design
65 en
Dairy Heifer
Dry Cow
Farrow [o Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ZNo ❑ NA ❑ NE
[:]Yes
ENo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) Lj Yes jLJ No U NA U NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes do ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: 32 Date of Inspection: C
Z
Waste Collection & Treatment
1
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
I/ I No
JJJ""""'/"'
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
fYyJl No
❑ NA
❑ NE
S cture I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: w
Spillway?:
Designed Freeboard (in):
n n
Observed Freeboard (in): ply
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�3 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
P
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or im rovement?
P
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�No ❑ NA ❑ NE
Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VrNo
❑ 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
&No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ej'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
LZ 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 [;344o ❑ 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 12 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes F4fNo ❑ NA ❑ NE
Page 2 of 3 214120I4 Continued

Facili Number: - Date of Inspection: 2
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes W, 0
25. li the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ILl No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fist survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
[�17No
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
[:]Yes ppo ❑ NA ❑ NE
[—]Yes ONo ❑ NA ❑ NE
❑ Yes J21*7No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
9No ❑ NA
❑ NE
❑NE
Vo❑ NA
❑ NE
v❑NA
❑ 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).
F� it"l 1641ns Yi'?Aa
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:

Type of Visit: 12Mompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 9noutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: -.$ ') Arrival Time: Departure Time: � County: UlAn Region: VIA -
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: v �y
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
l O 04 U V
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity P.
DairyCow
Wean to Feeder
�
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oult .
Layers
Design
Ca aci
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
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 �2rIVo ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [:]No
[-]Yes [—]No
❑ Yes No
❑ Yes o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facility umber: 1 Date of Inspection: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA
Spillway?:
Designed Freeboard (in): �J
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 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 91 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [71 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 Z No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;eNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑Hydraulic Overload ❑Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes No
❑ Yes No
❑ Yes �6No
❑ Yes XrNo
❑ Yes 9No
❑ Yes 7No
❑ Yes No
❑Other: r
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes �No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspectio,,,,n���s((((����
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes y � N
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
o
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: .)
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
XNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[—]Yes
�fNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
JZ
VTNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ONo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes �No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes VT 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 0] 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 lit Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional Daees as necessarv). -
Reviewer/InspectorName: 2Iv,,S�WN 3aW—z' Phone: 06,1 L�Xs-b
Reviewer/Inspector Signature: Date: I, I—R
Page 3 of 3 21412011

Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / Arrival Time: Q® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: C � 0�--0\ C "Ibu\
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone:
Int/e-g�rraator:
Certification Number:
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
[Layer
Design
Capacity
u Qum
Pop.
esign Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
(pL106
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
D�. P,oW
Layers
Design
Ga aci
Current
P,o
DairyHeifer
Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
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 't�No ❑ NA ❑ NE
[—]Yes ❑ No
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes t
o
❑ Yes 0
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page l of 21412011 Continued

Facility Number: - Date of Inspection: 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IVWNo ❑ 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: 9
Spillway?: n GG
Designed Freeboard (in):
Observed Freeboard (in): Li V
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
IYI No
0
❑ 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
qNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�jNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes J�j No
1T
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ZNo
❑ 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
tw56
Y% 12. Crop Type(s): e
PfL( &
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
0 WUP El Checklists Q Design Q Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
El Yes �No
❑ NA
❑ NE
E] Waste Application .❑ Weekly Freeboard Q Waste Analysis Q Soil Analysis
❑ Waste Transfers
0 Weather Code
t❑ Rainfall ❑ Stocking ❑ Crop Yield 0120 Minute Inspections Q Monthly and N 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 No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection: /
24 Did the facility fail to calibrate waste application equipment as required by the permit?
❑'Yes D[I`No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes i7XNo
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes91N o
XNA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 0 No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes f5(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
ppp���
❑ 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 �JNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
-
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYeso
tNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question iI): 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).
tu,1 ► Q
1Ililt g.s a.8
(9) to�l� 3. 3 , I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit:
Compliance Inspection 0
Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit:
Routine 0 Complaint
0 Follow-up 0 Referral 0 Emergency
0 Other 0 Denied Access
Date of Visit: I }c { l // f Arrival Time: Departure Time: County: l�&Apg Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
OnsiteRepresentative: NEq-Q.tl GQ-AoLk
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
'Doll
Certification Number:
Certification Number:
Longitude:
\20yp
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Q
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . 0 P,oultr
Layers
Design
Ca �aci
11
Current
P.o P.
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
El Other
I I
—TurkeyPoults
Turkeys
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes I No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
7oNo
❑ NA
❑ NE
Page I of 21412011 Continued

Facility umber: -3j - Date of Inspection:
/
Waste Collection & Treatment
`y'
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes I/�{ 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:
Ot
Spillway?:
Designed Freeboard (in): l 9 . n l9.0
Observed Freeboard (in): 3c3_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Vf No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No
0
❑ 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 h[[P,No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes IXI 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? T'
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes ONo ❑ NA ❑ NE
maintenance or improvement? \
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et .)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
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.
O WUP QChecklists ❑ Design Q Maps ❑ Lease Agreements
❑ Yes '
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Iy I No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ )Ate T ansfers
❑ Rainfall ❑ Stocking ❑ Crop Yield Q 120 Minute Inspections ❑ Monthly and N Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
Q Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Fgcility N tuber: / I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�6 No
❑ NA
❑ NE
'25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[:]Yes
JANo
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
,q❑]
I yl NA
7�
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
��yy
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond
❑ Other:
❑ Yes I J{No ❑ NA ❑ NE
❑ Yes 1 7 -No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date: TJg11/
Page 3 of 3 21412011

Type of Visit (Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit xRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:� /�/Arrival Time: Q 4 Departure Time: County: C I // Region:
Farm Name: I tsy1 1 L_(_ VJ(ZAAJC1-j F� A am S Owner Email:
Owner Name: Sr'_Q_(ZLk K. 64aUuk Phone:
Mailing Address: `5� S tcAU%mi/cu I [% W r r //{� �JO'; OLl Ucz- Nc
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: E G Integrator:
Certified Operator: C G Operator Certification Number:) �dN
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = u = I = " Longitude: = o = ,
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
RI Wean to Feeder
I&Y
ILI Non -Layer I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
[--]Farrow to Wean
Dry Poultry
❑ DryCow
❑ Farrow to Feeder
El Layers
❑ Non -Dairy
❑ Farrow to Finish I
❑Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
El Turkeys
P=CIOther
Turke Poults
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
0
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility'`Number:3 � —��
Date of Inspection {O
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 Struc e 2 Structure 3 Structure 4
Identifier: ' O• CI
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
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes tNo ❑ 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 �y, No [I NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes lbl No ❑ NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) N
9. Does any part of the waste management system other than the waste structures require ❑ Yes t(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 �kNo ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No [I NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
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
'16No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/oiany recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as riecess"ary):
Reviewer/Inspector Name I
Reviewer/Inspector Signature:
Page 2 of 3
1 Phone: 7/U -
D.7 Date:
t �nxine

acility No 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 CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists
0 Design ❑ Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ Yes I
❑ NA ❑ NE
❑NA El NE
❑ Yes XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ lnnual Certification
0 Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections El Monthly and 1" Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
. If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes 'EANo
❑ NA
❑ NE
❑ Yes *o
❑ NA
❑ NE
❑ Yes 0 No
❑ NA
❑ NE
❑ Yes D�_No
❑ NA
❑ NE
❑ Yes _t&No
❑ NA
❑ NE
❑ Yes ❑ No11%.rIA
❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes po
..(,,d((N
❑ Yes QC1 No
❑ Yes ✓ No
❑ Yes No
❑NA ❑NE
❑NA El NE
❑NA El NE
❑NA El NE
Additional Comments and/or Drawings:
i✓yc.Ig2A'no�/ �u� ao�o
Page 3 of 3 12128104

(Type of Visit Qj�lcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit [IRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other Denied Access
Date of Visit: GXWM nArrriivall Time: ® Departure Time: County: LI Region:
Farm Name: ( 1 I IL.(_ tl`�UL/N'11(G/i palain S' Owner Email: G�
Owner Name: 1� ��A �i � /y� Phone: 19 —l�7O S O ('�11440-4
Mailing Address: q C&AQT(UOA& � Jt !(JLGiI/�QL�(jE �l_ 6 3y�
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: �F-
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: J1.L' C1
Back-up Certification Number:
Latitude: = o = ,++ Longitude: = o = , = ++
' i .. w.'v ..` \ n'�� ,y � `�,qt• µ srk/.'i �. x" wj3 `ma's-.� � 4
= Destgn ,Current Design Current w - Dest It
GU
Swore Capacity Population 4 We4Poultry�11,pacttyPdp�ulation Cattle @apa��ty
Population
Y+
❑ Wean to Finish
�= ❑ La er
❑
Dairy Cow
Wean to Feeder
10Non-Layer I
El
Dairy Calf
.,: ❑ Feeder to Finish
r < :'' �..,, r > '�- �'
`" "� .�?'''',':^t't, "'`"r,,,^,e
❑Dai
Heifer
El Farrow to Wean
? �. '"',�
❑
Dry Cow
❑
Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑
Beef Stocker
❑ Gilts
❑ Non -Layers
' ❑Beef
Feeder
❑ Boars
El Pullets
❑
Beef Brood Co
T ❑ Turkeys
Other ❑ Turkey Poults
❑ Other
' ❑OtheraNumbe
t of SV,uctutes:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes PI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
12128104 Continued

Facility' Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
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 XNo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes ANo ❑ NA ❑ NE
❑ Yes ONo ❑ 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 ANo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No [INA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 4No [I 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 [I NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
� No
❑NA ❑NE
El NA El NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Name I MOAN S Phone: `7/0 1`T(sYl Scy
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: 3) —aA Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. 0 WUP G1 Checklists ❑ Design 0 Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ANo
❑ Yes �No
El NA El NE
El NA El NE
❑ Yes AJ No ❑ NA ❑ NE
❑ Waste Application 0
Weekly Freeboard
❑ Waste Analysis 0
Soil Analysis ❑Paste Transfers
❑)olnual Certification
0 Rainfall ❑ Stocking
❑yrop Yield 0
120 Minute Inspections
❑' Monthly and V Rain Inspections
❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
[]Yes k No ❑ NA ❑ NE
❑ Yes ❑ No 4 NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes I No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
[I Yes ' \KNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 3 of 3 12128104

' Division of Water Quality.
Facility Number Division of Soil and Water Conservation
- — — — D Other Agency 11
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ' Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: VA- t Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: \ Title: Phone No:
/
Onsite Representative: J G(LA- �/ (LA 13 Integrator:
Certified Operator: �E Q� �'�" Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = I = " Longitude: = o = ,
'Design Current' = - 'Design CurrenV_ _
nine, '.Capacity'Population 'Wet.PoultryCapacity`. Population 'Cattle
Other
IL]Non-Layer I I I' Ll Dairy Calf
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑N D'
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
on- airy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood G
Number of St
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 I�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Yes
El No
❑ NA
❑ NE
r-❑-
I_J
❑ NA
❑ NE
[]Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
El NA
❑ NE
12128104 Continued

Facility Number.. —aI Date of Inspection 1 0�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: I_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ NA ❑ NE
maintenance or improvement?
�No
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
.tit 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 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
A No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ 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?
Cl Yes
No
❑ 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-commenfs. 4
Use drawings of facility to better explain situations. use additional pages as necessary):
�-o (l, L o'r- $ 6c)Un
Reviewer/inspector Name I Plitin
Reviewer/Inspector Signature: Date:
Page 2 of 3
12128104 �'

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes -RNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 14No ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
El Yes ANo
❑ Yes lj�No
❑ Yes 1;�No
❑ Yes &�No
❑ Yes VNo
❑ Yes R'No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
DjrNo
❑ NA
❑ NE
❑ Yes
kTNo
❑ NA
❑ NE
❑ Yes IdNo ❑ NA ❑ NE
❑ Yes do No ❑ NA ❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number 27 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 00outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /O t 07 Arrival Time: iT .' ,f Departure Time: County: 0 1*"P LQ1 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
i
OnsiteRepresentative: is-atz Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = U = ' = Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
(Itloo ❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Do= �.
Design Current
Capacity Populato
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: I
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 allo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
El NA
❑ NE
❑ Yes ❑ fNo
❑ Yes {1(� 10
El NA
❑ NE
❑ Yes -CJ No
❑ NA
❑ NE
12128104 Continued

Fadility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure .y Structure 2 Structure 3 Structure 4
Identifier: � �,V (.fiG,0/,/Z"
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes &No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentallth/r at, notify DWQ
7. Do any of the structures need maintenance or improvement? [I Yes L.( ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑yesZo
❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑yes ❑ NA ❑ NE
maintenance or improvement?
Waste ADolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 73/wo ElNA [INE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑Yeso ❑ 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?
❑ Yes
IComments (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):
NEFO 9 00 / %
�,t_ Su/bGE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA ❑NE
Reviewer/Inspector Name Phone: 6- 13D p
Reviewer/Inspector Signature: 1,t,,,Q Date: lO n, A9
I2128104

„• Facility Number: — Date of Inspection
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �L1J�, No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes O No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
a 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 ElWeather
Code
[/
22.
Did the facility fail to install and maintain a rain gauge?
Yes
El,
� No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
El NA
❑ 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
dNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
dNo
EA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑
El No
NA
❑ NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
do
El NA
El 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
ENo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
[I NE
33.
Does facility require a follow-up visit by same agency?
ElC Yes
,_,/No
No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Ir (Division of Water Quality
Ij Facility Number 0
Division of Soil and Water Conservation
0 Other Agency
Type of Visit Co Hance Inspection 0 operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Degied Access
X1t1
of Visit: 4D Arrival Time: ® Departure Time: County:
Farm Name: TT���� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ` J Title:
Onsite Representative: a (ImpT
Phone:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Region:
Location of Farm: Latitude: [=o [=,= Longitude: =°=, =
- Design Current - Design Current D
Swine Capacity .Population Wet Poultry' Capacity Population ;Cattle
❑ Wean to Finish �;. ❑ La er I I ❑ Dai Cow
Wean to Feeder I P680 1Y 00 ❑Non -La er I Eli Calf
Feeder to Finish - -' ❑ Da Heifer
❑ Farrow to Wean Dry Poultry ❑ D Cow
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other - - - - — - - - -
❑ 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?
LJ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify D WQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes E�rNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes (y 4 ❑ NA ❑ NE
❑ Yes No ❑ NA FINE
12128104 Continued

Facility Number: —
Date of Inspection dL
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?
,e^ Structure 1 S�tructu/fie 2 Structure 3 Structure 4
Identifier: Weyy , �s"r"^' 1—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
fie/ 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 Ld>vo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ONE-
0 Yes [;Io ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th at, 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 UIC ❑ 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 PIo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[]Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 6 Qy% S
13. Soiltype(s) At/,Q
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
❑NE
V❑NA
❑NA
❑NE
VNo
❑ NA
❑ NE
❑ NA
❑ NE
AIo
❑ 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 additionalpages as necessary):
L#agtb ST°Cl U/G1— f O_CjJZrrAL A U _
1,4��1� LJSPbC Td6r!s,
Reviewer/Inspector Name I -o ;-I (LtU . V Phone:
Reviewer/Inspector Signature: Date: 9 6L
Page 2 of 3 I2128104 Continued

Facility Number: Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes7No
❑ NA
El NE
20.
Does the facility fail to have all components of the CA WMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desi gn ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Applic tion ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soii alysis ❑ 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
El
El NE
23.
If selected, did the facility fail to install and maintain mon irrigation equipment?
El Yes
Vo
❑ NA
❑o
NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
20
❑ NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
9
[I NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
❑Yes
o
Zo
❑ A
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
VA
❑ 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
ZNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,., l o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E3/No
❑ NA
❑ NE
Comments and/or
Page 3 of 3 12128104

IType of Visit (25 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit $6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other El Denied Access
Date of Visit: !O Arrival Time: '. 2, Departure Time: County:
Farm Name: / )/ZLG '�&'4'jcg )!!i�</ s Owner Email:
Owner Name: — fiQi�c/ Phone: _
Mailing Address:
Physical Address:
Facility Contact: �Title:
Onsite Representative: Z< Cl7�lYf�/
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = ' = Longitude: = o = ,
Design Current Design Current
Swine Capacity Population rWetPoultry Capacity Population
10 Layer
❑ Non -La et
Other
❑ Other I I Ji
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population `
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef 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'0No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
)9No
❑ NA
❑ NE
[:]Yes
WfNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection /O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes XNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:_
Spillway?: Ao Ao
Designed Freeboard (in):
Observed Freeboard (in): 8 _�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ), No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Y(No ❑ NA ❑ NE
maintenance or improvement? TT
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes XNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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) �W
14.
Do the receiving crops differ from those designated in the CAWMP? ElYes XNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes ZNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`[] Yes 16No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes ,'}�I No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA ❑ NE
IReviewer/Inspector Name �,. f = ,, Phone:/"y ��ip—�fuo� I
Reviewer/Inspector Signature: r, 77�tg Date: /O�j,/ �p�

Facility Number: —2Z Date of Inspection D 7J
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? VYes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. XYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:1 Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall Z] Stocking ❑ Crop Yield ;Z 120 Minute Inspections 21 Monthly and 1" Rain Inspections Z Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JeNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
��V...rrrNo
tq No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ffNo
❑ NA
Other Issues
661-1
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�(
VJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ 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
XfNo
❑ 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
;2�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
VJ No
/
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�1Nr,Ao �o C 1�s��o Zv✓ ��> Z00
7�f; G' ,,/t �vPy �aC 6;Vl c
20) Gln►P Nos 7 ,8,� �P���o GJ��yA GIo,O.���,o �.2ez .s��,�
St`S ��jyl, �l1zCc 7ZDN S%STf�M %/1J�F� /h�z`� G*w
Nr�eo /L��o,� >0cc�--
kEfP sfocv 2n�� /P�'G'o�P�S,, �ihP �i9�i✓Fi�-cG ,o��y
Awl, �!/6Qi�f /ikn s /�!�GG /%LN
12128104

Type of Visit 0 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 4 Z ()ate of Visit: 7 2 Time: II
0 Not Operational O Below Threshold
O'Permitted 0 Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: _
Farm Name: M L_rS.:I3_.S_A County: a>?��
Owner Name:
14aflmg Address:
Phone No:
Facility Contact: -----Title: Phone No:
Onsite Representative: ) E rz� i _ �2R� Qom_ Integrator. Re StAC-ic: _--- ------
Certified Operator: _ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• = =11 Longitude =• =' =-
;dDo a-°.CCurrent
Dmg� Cnrreat
Design Current
SwtPoh
` p
.:
Caaei ,Puhhon-Capacity
Wean to Feeder
C;ticcx)
d�j
_ Layer
Dairy
Feeder to Finish
Non -Layer
Non -Dairy
Farrow to Wean
Farrow to Feeder
Total
Design` Gapauty
Farrow to Finish
Gilts
BoarsIr
g
f
s
Total SSI.W
N»tiher of Lagoons � ,-�
,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it teach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 37 a-b _
12112103
❑ Yes 01
❑ Yes ❑ No
❑ Yes [I No
❑ Yes E] No
❑ Yes O No
❑ Yes ❑ No
❑ Yes M No
Structure 6
Continued

Facility Number, Date of Inspection a
%5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, I] Yes No
seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Q'N
IO
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 maintenanceltmprovement? ❑ Yes
��
❑Tio
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ElYes 0410
9. Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes pNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 13E2(nJRf• cG) C
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 0
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 [3•No
15. Does the receiving crop need improvement? ❑ Yes 0'No
16. Is there a lack of adequate waste application equipment? ❑ Yes O No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ' j
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ©!�-
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes O'No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑Q 1 io
Air Quality representative immediately.
" 'v:, 3e� +.i ..:rsz,s ;= e r
(Am�ntS {refer t0.qu:46esha`n)iEirplam any
_
YPS answers a�lor a� remmmmdahoas,Or egv4other Comments:',
use,am,�yw sttoahoas,{�eaddt_ti pagtsa�� ❑Field COPY ❑Final Notes 1
WA.
, 0;,J
(Yuj=tJ- GtJt(.
I�c�.a.os taJ �s..Dcn�
Reviewer/Inspector Name,yh'";, '�`` ` '::±' _� ff�a...�
Reviewer/inspector Signature: Date:
12112103 Continued

Facility Number: S1 _ ZZ Date of Inspection ! dt
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?
(id WUP, checklists, design, maps, etc.)
❑ Yes
0
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
[3 N�o
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
O No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
❑ Yes
01410o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
o
28. Does facility require a follow-up visit by same agency?
[I Yes
—
ON-o
29. Were any additional problems noted which cause noncompliance of the Certified AWW.
❑ Yes
p o
NPDES Permitted Facilities
30. Is facility NPDES Permit?
the covered under a (If no, skip questions 31-35)
❑ Yes
Ld'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
J❑ No violations or deficiencies were noted dig this visit. You will receive no farther correspondence about this visit. I
12112103

Type of Visit O Complianoe Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit fo✓Routine O Complaint O Follow up 0 Emergency Notification _ Q Other ❑ Denied Access
Facility Number ) 'L2 I Date of visit:
M Permitted 0 Certified O ConditionIally Certified 13Registered
Farm Name:
Owner Name: J_C_ , r A/.
Malting Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
9 Z.SOL Time: - 5�0
rO Not Operational 0 Below• Threshold
Date Last Operated or Above Threshold:
Countr
Phone No:
Pho'nee No:
Integrator: P�'�Tr-✓� e-
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' = =« Longitude =' 01 =
Design 'Current 'y=Destgn -Current-- - Desige Current
-. Swine `�= .Capacity, Po ulshon=P.outtry ":Ca actty =Po ulation -::<Cattle " `" =Ca scity _ Po`ulsdon _
❑ Wean to Feeder ILI Layer ' ` Dai
❑ -: Feeder to Finish ❑ Non -Layer I r-'MNon-Dairyru
_ - ❑ Farrow to Wean
_'. ❑ Farrow to Feeder € ❑Other r --
❑ Farrow to Finish Total Dest n Ca aci
❑ Guts _ g P q
❑ Boars Total SSL'-W
Nnmber Lagoons DE � ; ❑Subsurface Drains Present ❑ Lagoon Area j ❑ Spray Field Area
Holding"":Ponds % SoGd Traps �,Oc . ❑ No Liquid Waste Management System =
Discharges & Stream Impacts
1. Is any discharge observed from any pan 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 ves, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes JZ"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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: %
Freeboard (inches): Z 7 33
05103101 Continued

Facility Number: ,�) —2 Zl Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
seepage, etc.)
_ONO
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 ONO
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes 1ZNo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
9.
Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
'VNo
elevation markings?
❑ Yes ;3"No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes 0No
11.
Is there evidence of over application? ❑ Excessive Ponding PAN ❑ Hydraulic Overload
El Yes �'No
12.
Crop type 13erN+vdrn -pe s4vre �/ �❑
Xty) smet j� eCii"At"t
13.
�gevl-tll,Y4
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14.
a) Does the facility lack adequate acreage for land application?
_L�`No
❑ Yes ONO
b) Does the facility need a wettable acre determination?
❑ Yes
c) This facility is pended for a wettable acre determination?
'PrNo
❑ Yes �2`No
15.
Does the receiving crop need improvement?
2rYs ❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes j2rNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
�/
El Yes No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
WUP,
/�ILI
❑ ZNo
(ie/ checklists, design, maps, etc.)
Yes
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes ONO
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
21.
Did the facility fail to have a actively certified operator in charge?
_ONo
❑ Yes �No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑
(ie/ discharge, freeboard problems, over application)
Yes
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
zF110
❑ Yes ❑IAo
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 L�(No
E3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.Comments (refer to queihon #): Fxp '- ' any'YES answers and/or any recommendaaops or,apy other -.comments.
�❑
.Use drawings of:facility I better explain stuasons. (are additional pages as necessary) ��- `-
_ _ ❑ Field Conv Final Notes t
)4. 'tie we Fqb%e o,creS D(e �a�-nrt: }ion hAs bee" Gom f je&4 ,
IR. PIec.Se yv4 44e' 44,e la-#ev pir-A aP ZDD)
;- +t,e record book, qnd Pvf -foe 2ooZ soil 4eO ;h record beak
al-ro, Mr• G•-Ad> 5-ay.r lie has -fhe Weeds bL4 409 qre
Gv✓re/n��� e1Set,/l�cr,
Hw
Reviewer/Inspector Name fo"ij'te,./q;.%l q ky S - : " , `. _ =
Reviewer/Inspector Signature: Date:
0510310I
Continued

Facility Number: 7- L Z Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑Yes -�o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes_,2'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? El Yes allo
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 -10 Vo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes -&"Vo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments '.and/or .Drawings: ` i - = r- � -, ... -
The be rwtvtYzi Fie ldSIrJ
e Ae 4e4 Vy 6ev+fe4t)t'o1-�-FYa✓+.
Grq�j r-O'Ss grtd n'O 9✓Sss. h'I.J. Grad/y �0�4/ns 4o
beK6; crde Jo -)Iles, rto�,l e�wtudc� S,.G.sses,, c%
04ke,- -/AA-1 nd4ed ?4,Ve :
r4is Fac 1:�y is Laell we4,n��;neo(, �1,� rtcords ��e welt
kerb,
05103101

��Divrr.sroii of.Water Quality
- 1D Division of Soil and -Water Conservation _
Q.Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit '911�outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 2 Z 1 Date of Visit: S Time: i' oG Printed on: 7/21/2000
10 Not Operational A Below Threshold
❑ Permitted ❑ Certified ❑-pConditionalllly Certified ❑ Registered Date Last Operated or Above Threshold: .......
Farm Name: ............. L."1....... 1....JJi^`.j7.rQtMS.............................................. County: �U.�/!rl...................................
--� /� ................... ............................
Owner Name: ............_ve.r.' y...C�1'>;'tLj!............................................................... PhoneNo:. _..... ___.__._.
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative:., !."�. _`=�rn`Q I_ ....................................................... Integrator:
....................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude =•
Design Current
'('arorrifv Pnnnlafinn
�'
ate`
Wean to Feeder
Zf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca adt ,']Po -ulation
❑ Layer ❑ Dairy
❑ Non -Layer I ILI Non -Dairy
❑ Other -. .
Total Design Capacity
TOW SSLW
Number of Lagoons 'L JL] Subsurface Drains Present jj❑ Lag•on Area J❑ Spray Field Area
r Holding Ponds / Solid Ttaps ❑ No Liquid Waste Management System
DischarEes At Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ................................. ...... ..._Z.Q.................................................... .................................... .............................
Freeboard (inches): 3 v
5/00
❑ Yes 0i No
❑ Yes jffNo
❑ Yes 91,10
❑ Yes PWo
❑ Yes'11�o
❑ Yes ❑'1(Io
❑ Yes 0
Structure 6
Continued on back

Facility Number: Date of Inspection 15/12glgl Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc-)
6- Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes XNo
(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 stuclures 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 [IPAN ❑ Hydraulic Overload
12. Croptype 5-rMvar, �l°<1/ t—So illl 7rolth
❑ Yes /ZNo
❑ Yes ZNo
,,....��••
N
❑ Yes y�o
❑ Yes ,TNo
❑ Yes '1 { 0
13.
/
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ZNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes,,�No
b) Does the facility need a wettable acre determination?
❑ Yes,,E�f]No
c) This facility is pended for a wettable acre determination?
❑ Yes 01"o
15.
Does the receiving crop need improvement?
❑ Yes.0 No
16.
Is there a lack of adequate waste application equipment?
❑ Yes ❑"No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
fie/ WUP, checklists, design, maps, etc.)
❑ Yes
19.
Does record keeping need improvement? fie/ irrigation, freeboard, waste analysis & soil sample reports)
,,�---,,,...000No
[I Yes 0t No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design? -
❑ YesXNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes P1110
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes 9No
/�o
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
24.
Does facility require a follow-up visit by same agency?
❑ Yes�o
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Ye�No
dI6 •vi9latititis:ot- deficiencies were it ditrilig this:visit' - Yob :will-feeeiye tio: further -...
.:coriesuondeitce:abotitahis:visit_::::::::.:::::•:::::::::::::::::•:•:•:
:
111e {o6' 1-f y IvO crops are well kef4 • Need jb 4ave a-� least
one yeq�s 1.:/,!,Y' , aF ezrl cag41'oh �'er-o�o(s ava�Iable -lor ),isfecl;one
kee� lam!! rncords �0 5 ���rs.
Reviewer/Inspector Name
Reviewer/Inspector Signature: U3CavV4'10 j') �� Date: D/Z091'/O1 5100

Facility Number: —L Z' Date of Inspection D printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within. 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ YesXNo
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 YfNo
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 )2,No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �No
32. Do the flush tanks lack a submerged fill pipe or a pennanent/temporary cover? El Yes ./❑ No
5100

JV_Routine 0 Complaint C) Follow-up of DWQ inspection 0 Follow-up of DSWC review () Other
Facility Number Date of Inspection fig —if —'s
I P% Time of Inspection 24 hr. (hh:mm)
E3 Permitted kertified E3 Conditionally Certified E3 Registered Date Last Operated:
Farm Name: ......... ................... I — Y:�� County: .......... ............
........... . P.-
OwnerName: ... ....... IK.Kn� ................. ....... Q±.aq .................................. Phone No: ....................................
FacilityContact: ... ; ..........................................................................
Phone No:
Mailing Address: ....................................
... .......... ... ......................... : ............... 7,y,�e ............................. .........................
Onsite Representative: ...... a.-L.QJ� . ............ Integrator ............................. s. -61%
....... to . . ................................
Certified Operator: ................................................. ; . ............................................................. Operator Certification Number: ..........................................
Location of Farm:
Latitude = 0 =1 =-1 Longitude = 0 =1 =11
-,Swine
ean to ceder
cedeT �io Finish
EOT! To Wean
w to Fee7er
Ll Farrow to Finish
-Design. . Uirrenu Design -,Current:
Cij�� Population Poultry Capacity Population Cattle
P Layer �atry
1E] Non -Layer Non -
I[] Other
Total Msign. Cat
JLJ Boars I I 'I'otal SSLW�7'.
.7�
j
Number of L400ns 1[:] Subsurface Drains P;;Tent 110 Lagoon Area I[] Spray Field Area]
Holding Ponds /Solid Traps; 1[1 No Liquid Waste Management System
Discharges & Stream Impac
1. Is any discharge observed from any part of the operation? C] Yes g'No
Discharge originated at: [] Lagoon [] Spray Field [j Other
a. If discharge is observed, was the conveyance man-made? [I Yes [I 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 la.pon system? (If yes, notify DWQ) 0 Yes E] No
2. Is there evidence of past discharge from any part of the operation? [I Yes Q<qo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? El Yes No
Waste Collection & Treatment
4. Is storage capacity (fireeboard plus storm storage) less than adequate? 0 Spillway El Yes 0
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6T
Identifier: /V""-. IV4�v'. 2-
Freeboard(inches): ............... 2-...q . .. ... .... ............... ...... ................................... .................................... .................................... ..................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Yes Q�q 0
seepage, etc.)
3/23/99 Continued on back

Facility Number: — Date of Inspection E / LOet) Printed on: 7/21/2000
• 5. Are there any immediate threats to the integrity of any of the structures obsery d? (,el trees, severe erosion, ❑ Yes VNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes [A No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
Ayes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
VMo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
\
elevation markings?
❑ Yes
KNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
j������,8////NO
11.
Is there evidence of over application? ❑ Excessive Pending [I PAN El Hydraulic Overload
❑ Yes
A No
12.
Crop type _ 5 4 y S G
\
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application'?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? fie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
L�J' i'9ti 061bAioris:ot- deficiencies were'toted dut`ing this'visit'.- Yoir will receive rid rui4h& -;
correspondence. about this vts►t........
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):
❑ Yes ((lo
❑ Yes _1�No
❑ Yes j4No
❑ Yes _KNo
❑ Yes 1�'No
❑ Yes O�No
❑ Yes 5�ilo
❑ Yes 5�No
❑ Yes 6KNo
❑ Yes A"'r--._
[]Yes �?,No
❑ Yes ,RT.Dle-
❑ Yes Mio
❑ Yes 10No
❑ Yes bfNo
�a vw� IOD�S dli c..�
("►� c p „� „� t lip 4c f l 1AJ d� VI o a m cwk , -b Pyc v G ,a. _
Reviewer/Inspector Name L - C-7 y,
? 1`�_
Reviewer/Inspector Signature: //1- _ 'y///n IA ` IJ. I Date:

.�, .Facitky Number: —2 Date of Inspection 00 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below ❑ Yes Uj(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
5ZNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
WO
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
tOo
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
UNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
���,,KfffNo
y� No
5/00

-- [3 Division of Soil and Water'Conservation-:Operation-Review-
Q Division of Soil and Water -Conservation -.Compliance Inspection ;", - - _
Division of Water Quality - Compliance Inspection - , ,
QOther.Agency - Operation Review
a Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other 1
Facility Number Date of Inspection 11/1 /
Time of Inspection ®24 hr. (hh:mm)
Cl Permitted ® Certified 17 Conditionally Certified 13 Registered No[ O erational Date Last Operated: ..........................
Farm Name: M � R�........�'�. "a`�C�• [ f County: .....VV ll4
.................................... . ........................_9.....":................................................................................................
OwnerName: Clt' t^ r. ...... G............................................................. Phone No:.......................................................................................
Facility Contact:
Title:
MailingAddress: .....................................................................................................................
Onsite Representative:....J.¢_i^P
Gd�
.....................................................................................
Certified Operator:
Location of Farm:
Phone No:
Integrator: .... !......�est-a�' e
..............�.....................................................
Operator Certification Number: .........................................
Latitude w O' =11 Longitude =a =' ="
- _ --- Design Current -
Swine CanacltV Population :1'oultr
29 Wean to Feeder
nQ
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Design Current,., _ - Design Current
..Capacity Population --Cattle Ca acit Population.
❑ Dairy
:r JEJ Non -Dairy
] Other
Total Design Capacity
,.Total SSLW
Traps 0 - .. ❑ No Liquid Waste
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Ig No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes $jNo
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes jg No
c. If discharge is observed, what is the estimated flow in gal/min? n q
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes Dd No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes PO No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 5d 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: L eP 9; J v-
Freeboard (inches): .................................................................................
z.......................................................................................................................... .
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes A No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3/ — Z.2_1 I Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or �-`/-
closure Ian? I ❑ Yes V No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes , No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ,K No
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Yes JK No
12. Crop type 1. "V-%V e1, ��AZyq
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 9No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 29 No
b) Does the facility need a wettable acre determination? ❑ Yes .n No
c) This facility is pended for a wettable acre determination? ❑ Yes 46 No
15.
Does the receiving crop need improvement?
❑ Yes 2g No
16.
Is there a lack of adequate waste application equipment?
❑ Yes O No
Required
Records & Documents
-
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes JdNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
'
(ie/ WUP, checklists, design, maps, etc.)
XYes ❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
29 Yes ❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes W No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes B No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes JK No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes 19 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes 19 No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
iNO'0 afiQlls.Otdifficlen6eg-R'QCC IIOted.d&iitg Obis,visit'. You Wlii•I'CCI,'.lVC lid futthQt-, ,
corres orideitce:about:thlSvisit:-:.:...""".":.:.:.:..... .
Comments (refer --to n _question,#); Explain any YES answe`is and/orany recommendations or any comments —
Use drawings of facility to better eaplain "situations. (use additional pages as+necessary):;- •
"'
lL. SM411 9rajIri Ovefsee4 s/'t,n•!e[ �e_ added -�o waste �/qn rF
`
GVolsIC W )I/ be. A'Oplled on 4.
)9..6e sore fo 114ye /q.yoon de<`3ns -%r WA la1oorlt G✓i�l. fe��df.
Jq• a✓,e 900/� �or 6Ll° e?y-!r ^; -/'0 gnd 60yd'2 yr
a -fief Tie 4-�a Orl e w�s,� analysis, Keep pas} sprlo l
rcr,ar S. , t •
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Number: -u,t Date of Inspection
Odor Issue
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below kryes ❑ 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 Jg No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P 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 ;gj No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes kij No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 3eNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes JM No
3/23/99

Routine
3 Division of Soil and Water Conservation Operation Review.
+.13Division of Soil and Water Conservation Compliance Inspection
_ A Division of Water Quality, --Compliance Inspection `
Other Agency -Operation Review
of
Facility Number 3 / 2 2 I Date of Inspection I WO/
Time of Inspection 24 hr.
0 Permitted jd Certified Q Conditionally Certified E3 Registered Not O erational Date Last Operated .
Farm Name: County:..._.... n .............................
9l
r ... ....
......................g.......G...g...................................................Fa...
58-z864
1
Owner Name: .........sl_�'.tltit........ jK
..... :........'.._m.`1.................................................. Phone No:A�r�,....%.5�...-&.ii...ZBL.H.a^`eJ...........
FacilityContact: ...................../......................................................... Title:................................................................ Phone No:...................................................
MailingAddress: ..................................................................................................................... ..................................................................................... .
OnsiteRepresentative: ....... i.��.y...... (J �l:N. ......................... Integrator•...../,�,Sa.�l_C.....�fMS
r J
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude =•=° =- Longitude =• 01 =11
_ Design Current . Design Current _ . - - Design : Current
-. Swine " Ca iacity Po ulation Poultry : Capacity Population - :Cattle- ' Capacity Population.�
Wean to Feeder &p L10 I0 Layer I ❑Dairy
❑ Feeder to Finish 10 Non -Layer I ❑ Non -Dairy
❑Farrow to Wean = _-
❑ Farrow to Feeder - ❑ Other
❑ Farrow to Finish . Total Design Capacity
❑ Gilts,
"❑ Boars Total SSLW
`Number of Lagoons - 0 - Subsurface DrainsPresent ❑Lagoon Area ❑Spray Field Area
❑
"Holding°Ponds / Solid, Traps - ❑ No Liquid Waste Management System -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
a if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: L4 t I JL4
Freeboard (inches): ........._Z.k?............. 3O................................... ......
..........................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0 No
seepage, etc.)
Continued on back
3/23/99
❑ Yes K No
❑ Yes ❑ No
❑ Yes []No
❑ Yes ❑ No
❑ Yes $No
❑ Yes 0 No
❑ Yes VNo
Structure 6

Facility Number: �) — ZZJ Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? '
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
Ip
❑ Yes
$j No
❑ Yes
No
❑ Yes
❑ No
❑ Yes
g No
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ❑ No
12. Crop type IC O"'A SA &I Ige-el t✓6,A 140%1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
fie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? fie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
yi61'afiotis;ot deficiencies •were i►gted during tLis;visit: Yoit ;w.ifl•receiye i.6 further; ;
1.,. corresnoiideitce.aboufthisvisit_':':':'.'.':'.'.':':':'.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
❑ Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
❑ Yes gNo
J� Yes ❑ No
❑ Yes ❑ No
IComments:(refer to question #):.,Explain any YES answers'and/orany recommendations or any other comments = p-1
Use drawings of facility to better wiplain situations. (use additional pages as necessary
17. LAJcoorl rt f JeO 6vA sel C� hol.tises stay reed Slvdye OcAnotrt+ • `
ZtJ. LAeg resvkpi r.n recork nod 6e n a} curry.
-por in.5 e01,0*1, 40 vt�co ov, Nov.
J•Ot�l}flt2 i ns�Oct�}"( ov` W .-}6 t�eGer•LlSpresevt�•
Reviewer/Inspector
P ntw y s (q 10� 39,5. 3r Qjlo eY�;=203 .
Reviewer/Inspector Signature:
Date: to
3/23/99

Division of Soil and Water Conservation [3 Other Agency
$Division of Water Quality
IM Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
j�'� Dale f Inspection 3
1 Facility Number ��
I FTimeo(o3f Inspection ® 24 hr. (hh:mm)
0 Registered OCertified E3 Applied for Permit 0 Permitted 113 Not Operational JFarm Name: .........................................................._�............................................................ County:.
n......... .. .../Date Last Operated: .........................c..y................
Owner Name: ...... e..._(ti�f...................................................... Phone No: ...._- b Jc�' v6 1
...............................................................
Facility Contact: ......................................................
Mailing Address: _.'....�0.�y
Onsite Representative: O vZ
Certified Operator. ..................................................
Title:
Phone No:
Integrator:
Operator Certification Number :.........................................
Latitude =• 0' =" Longitude 0. 0' ="
,-Design. Current _ Design ;Gurrerit - Design Current
Swore;, Capacity,Populatiorc Poultry Capacity Population Cattle Capacity Population �-
can to Feeder Op LA 0 6 I0 Layer I ` ❑ Dairy
7 ❑ Feeder to Finish ._ ❑ Non -Layer I I0 Non -Dairy
❑ Farrow to Wean
❑Farrow to Feeder' I[] Other
❑ Farrow to Finish; Total DeslggCapacity,o
_ ❑ Gilts 31N
❑Boars Total SSLW
`Number of Lagoons / Holdin Ponds, ® ❑Subsurface Drains Present ❑Lagoon Area 10Spray Field Area
f ;ye ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement?
❑ Yes
Ef No
2. Is any discharge observed from any part of the operation?
❑ Yes
CR No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
P1 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
JM No
c. If discharge is observed, what is the estimated Flow in gal/min?
N
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
ONO
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
A No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
ONO
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
C�No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[ONO
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
dNo
7/25/97

Facility Number:3� 1
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
i KNo
Structures (Lapoons.IioldinP Ponds. Flush Pits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
allo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier: ..............................t................ .................................... ................................... ...................................
...................................
Freeboard(ft):............3.R-......................3'....1........................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
M No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
E(No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an i n mediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
KNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
1� No
(If in excess of WNT, or runoff entering waters of the State, notify DWQ)
15.
Crop type ... m 6
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
MNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
CR(No
18.
Does the receiving crop need improvement?
❑ Yes
P(No
19.
Is there a lack of available waste application equipment?
❑ Yes
MNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
IXNo
22.
Does record keeping need improvement?
D(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
ONo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
'IW'Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit? -
❑ Yes
ONo
[3-
No.violatioiisor defdeiwies.were noted duritig this:visit. You.will ir&4a ito tirther
Orresppndeuce about this;visit::::
�bok� i°`�s 1 •t .a- ( ��� C� .�i
6"Q/
aG ��-ys l� Lrr1 6d ^t'
Wt�t?����X i .GV�t�Zi Ir P�� �` S� fti 1 -70sio-7
Reviewer/Inspector Name
Reviewer/Inspector Signature: ���„ �. Date: (4'-(3" la

Facility Number: ..�_.. Date of Inspection:
Additional; Comnientsand/or:Drawmgs )+tom`
a�� W `�\\ ��� �I �"�^-�c� lit\ �� '� (��G-�-E�•-� �;`'1i� �S 4
��^� / �� C� r-�t�-'�-E.T ✓`�-�'-� lr�Cti ��,+-t -F2tr S��c`-� "FI �-• es
4/30/9Z

❑ DSWC Animal Feedlot Operation Review
®DWQ Animal Feedlot Operation Site Inspection z
G. Routine 0 Com laint 0 Follow-up ofDAVQ inspection 0 Follow-u of DSWC review O Other
Date of Inspection to q
Facility Number 22
Time of Inspection 24 hr. (hh:mm)
Registered ®.Certified E3 Applied for Permit E3 Permitted JE3 Not Operational I Date Last Operated:
Farm Name: ...µ.y..!_�...._. ru» .�t.......f.;Lkk...r..�+ L........_............................... County:.... ?.u. .1.i.....................q.............
OwnerName:.. tL...r... .......�.:.............G..............................................Phone No:...,..q.1..g.).......6S.Sa..7"....1...)._S g......................
FacilityContact: ............................................................................. Title:................................................................ Phone No: ...... :............................................
MailingAddress: ... S.75..... ...... Ka.sL-C:........................ ...M. .1:............... t..c. ..................... r... ..6.
Onsitc Representative: ... Mai..... .t.......................................................... Integrator. .... g. ^.a a.tct..'d..............._...................................
Certified Operator: .........................._... ................. Operator Certification Number ..........................................
Location of Farm:
Latitude =• =' =" Longitude 0. =' ="
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
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
General
1. Are there any buffers that need maintenance/improvement?
Subsurface Drains Present
2. Is any discharge observed from any part of the operation?
Discharae originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ).
c. If discharge is observed, what is the estimated Flow in galfmin?
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?
Area !U Spray Field Area
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes 12 No
❑ Yes ® No
❑ Yes 19 No
❑ Yes ® No
0!A
❑ Yes N No
❑ Yes ®.No
■z�
f.Yes ❑ No
❑ Yes KNo
❑ Yes IINo
Continued on back

S
�- Facility Number:
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Structures (Loons Holding 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: ........Z.' .................._... .3.... I............... .................................... ................................... ......................................................................
Freeboard(ft):.......................................................................................................................................................................................................................
10.
Is seepage observed from any of The structures?
❑ Yes
® No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12.
Do any of the structures need maintenance/improvement?
'® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
R No
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15.
Crop type .... ................................................................................................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
® No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
IR 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?
❑ Yes
®No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
($No
22.
Does record keeping need improvement?
® Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
El Yes
r�'
[9No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JRNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
CR No
No.violations or deficiencies were noted during this.visit You will receive no further
11
correspondence ahout this. visit:-.
pt i• e• r o v v...-.N.� j v i V hz S `iv gy
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Reviewer/Inspector Name
Reviewer/Inspector Signature: CL. J„ -_, ,d, 7 Date:

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SM VISITATION RECORD
DATE. f 45 I
1995
• Time: 1 / 55 -A, �y
Farm Name/Owner: Z
Mailing Address: S IKP- 2 -5 i
•
County:
Integrator.51
Phone: 2cf3— 3&00
On Site Representative: Phone:
Physical Address/Location: &OmG 6-A ,5 # T
Type of Operation: Swine yG Poultry _ Cattle _ IVv1-5et�
Design Capacity: 92 Zoo Number of Animals on Site: 71Z 0
DEM Certification Number. ACE DEM Certification Number: ACNEW
Latitude: 55 ' CUP' (A. 9S Longitude: -71 ' CX0 ' 43. C0 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No Actual Freeboard: --4-- FL Inches
Was any seepage observed from the lagoon(s)? Yes No Was any erosion observed? Yes No
Is adequate land available for spray? es r No Is the cover crop adequate? Yes r No
Crop(s) being utilized: 2 QXYY16LIZ
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings es r No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o(SR)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line?
Yes ois
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o 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)? OrNo
Addirional Comments:
L . L
Inspector Name
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.

State of North Carolina "'T a
Department of Environment,
IfflWA
Health and Natural Resources 4 •
Division of Water Quality _
James B. Hunt, Jr., Governor M
Jonathan B. Howes, Secretary p E H N R
A. Preston Howard, Jr., P.E., Director
April 3, 1997
Jerry K. Grady
Mill Branch Farms
639 Maysville School Rd
Mt. Olive NC 28365
SUBJECT: Notice of Violation
Designation of Operator in Charge
A: = as ,a+ :: Cz: ra; t. n Mill Branch Farms
Facility Number 31--221
Duplin County
Dear Mr. Grady:
You were notified by letter dated November 12, 1996, that you were required to designate a
certified animal waste management system operator as Operator in Charge for the subject facility by
January 1, 1997. Enclosed with that letter was an Operator in Charge Designation Form for your
facility. Our records indicate that this completed Form has not yet been returned to our office.
For your convenience we are sending you another Operator in Charge Designation Form for your
facility. Please return this completed Form to this office as soon as possible but in no case later
than April 25, 1997. This office maintains a list of certified operators in your area if you need
assistance in locating a certified operator.
Please note that failure to designate an Operator in Charge of your animal waste management
system, is a violation of N.C.G.S. 90A-47.2 and you will be assessed a civil penalty unless an
appropriately certified operator is designated. Please be advised that nothing in this letter should be
taken as absolving you of the responsibility and liability for any past or future violations for your
failure to designate an appropriate Operator in Charge by January 1, 1997.
If you have questions concerning this matter, please contact our Technical Assistance and
Certification Group at [phone].
Sincerely,
for Steve W. Tedder, Chief
Water Quality Section
bb/awdesletl
cc: Wilmington Regional Office
Facility File
Enclosure
P.O. Box 29535, �I tfft C FAX [phone]
Raleigh, North Carolina 27626-0535 11 , �� An Equal Opportunity/Affirmative Action Employer
Telephone [phone] �rl � W% recycles/ 10% post -consumer paper

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
Jerry K. Grady
Mill Branch Farms
639 Maysville School Rd
Mt. Olive NC 28365
SUBJECT: Operator In Charge Designation
Facility: Mill Branch Farms
Facility ID#: 31-221
Duplin County
Dear Mr. Grady:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or -our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919/733-0026.
Sincerely,
A. Preston Howard, Jr., P. ., uector
Division of Water Quality
Enclosure
cc: Wilmington Regional Office
Water Quality Files
P.O. Box 27687,
Raleigh, North Carolina 27611-7687 N%f�y.
C An Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 50% recycled/10% post -consumer paper

•
C�
Site Requires Immediate Attention:
Facility No.7Z2 Z
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �'Z� , 1995
1 Time: �G (�j�
Farm Name/Owner: M , It br ,ck
Mailing Address:
County: IAJ00
Integrator. LA
On Site Representative:
Physical Address/Location: FYOm F,2i'5o,1 t 463 V � (,
Phone: 0` 3- 36ey0
Phone: 916f -(�5 3— 4;-F8
�hf on 51e /
Type of Operation: Swine ✓ Poultry _ Cattle NU/ SGe
Design Capacity: 32� Number of Animals on Site: 3
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: �55 ' N� ' 21. 2— Longitude: JL' W 14 4 Elevation: —Fee-
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 r No Actual Freeboard: 2 Ft i0 Inches
Was any seepage observed from the lagoon(s)? Yes 00 Was any erosion observed? Yes o No
Is adeauate land available or spray? Aor No Is the cover crop adequare? Yes r No
Crop(s) being utilized: � M e I C" z' -
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? ESY
r No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ore)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes 00
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or&) If Yes, Please Explain-
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es r No
Additional Comments:
G . (_
• Inspector Name
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.