310223_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Reason for Visit: 0Rouutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: / T County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: �/�^� %1^ , 7 C L_" // Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: If T �Z
Certification Number:
Longitude:
Swine
Design
Capacity
Current
Pop.
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
a
Wean to FinishA
Layer
I I
Dairy Cow
W n to FeederI
jNon­LayeT
I
Dairy Calf
eeder to Finish
trkvn
SL
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design CurrentDry
D P,oultr. Ga aci P,o ,
Layers
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Q[her
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 Ej No ❑ NA ❑ NE
❑ Yes []No
❑ Yes [:]No
❑ Yes [—]No
[-]Yes
'
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412015 Continued

1!--,
(Facility Number: _3 ( - y2 3 I (Date of Inspection:
Waste Collection & Treatment �^
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
33
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Yes [:]No ❑ NA ❑ NE
❑ Yes Je o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental reat, 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 [l'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 KO ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Io ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑'No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ef; ❑ 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?
ElYes
N ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑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 l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ff ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
05o ❑ NA
❑ NE
25. Is thelfacility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA E]
NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No Q-11A ❑ 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
Q,�❑ 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
Io — ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[2No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
L_I "o ❑ 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 naees as necessarv).
-j``
`
s-.
CA L f I $'2„ d IX1. cI
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
00_ AI
W, 441 rN
, le S 4o 04-11.
U Phone: 'i 1%7f1D 73 C')r
Date: It 4 r`
21412015

Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time: Departure Time: O County: �� Region:
Farm Name: �7''���777""""llll����`"���`� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: n� Title:
Onsite Representative: J gz6t yr' `� � oq cy_'
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: Certification Number: 7 n
9 (-% 2 S 2_
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wet Poultry
Design
'apacity
Current
Pop.
Design Current
Cattle C>apacity Pop.
Wean to Finish
I
11-ayer
I IDai
Cow
Wean to Feeder
I
INon-Layer
11 11Dai
Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, $oulh,
Layers
Design
Ca_ aci.
Current
Pp ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I lBeefBroodCow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify D WR)
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 ❑ Ni" ❑ NA ❑ NE
I--]' es Wo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili ty Number: - Date of Ins ection: /
Waste Collection & Treatment
4. Isis`torage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: lAr"'^) 4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):��
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance or improvement? /
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
21 Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
F24o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dN�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[lo
❑ NA
❑ NE
Required Records & Documents
N
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspection ❑ 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 Alo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection, �_�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes f' I N9 ❑ NA ❑ NE
25. Isthe facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Z ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 0No
❑ 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 do
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes U 1Vo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes t
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
Comments (refer'to question #): Explain any'YES answers and/oranyadditiional rectimmendationsor any other comments.-7-1
Use drawings of facility to better explain situations, (use additional pages as necessarv).
Reviewer/Inspector Name: L )Md
43 V
Reviewer/Inspector Signature:
Page 3 of 3
Date:

(Type of Visit: (D Co}npliance Inspection U Operation Review U Structure Evaluation (J Technical Assistance I
Reason for Visit:
�C"JJ Roouutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: >Q S Arrival Time: ® Departure Time: M= County: .% Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 1. o_(—_r'*T ► v yTacu.—" Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: q9r4f j�i
9C1M "LS
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
11-ayer
Design
Capacity
IDai
Current
Pop.
Design Current
Cattle Capacity Pop.
Cow
Wean to Feeder
I
jNon-Layer
I I
Dairy Calf
Feeder to Finish
Farrow to Wean
bkW 0 3
Design
Current
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
lt .
Layers
Ca aci
P,o .
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes YNo ❑ NA ❑ NE
[—]Yes 0"No ❑ NA ❑ NE
Page l of 3 21412015 Continued

Facili Number: - 2 Date of Inspection:
Waste Collection & Treatment
4. Is storage,capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [j(No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1 ' Structure 2 Structure 3 Structure 4
Identifier: (A W Il.fV(tO6NZ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 42
j o
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes [ /No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ 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 E� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
9�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ 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 u w
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes V
❑ 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 ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facilitv Number: - - 1 1 A Date of Inspection: n I h 1
24. Did the facility fail to calibrate waste application equipment as required by the permit?, 1 ❑ Yes I/ 0
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑NA ❑NE
❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [21/No
❑ Yes [�/No
❑ Yes [(No
❑ Yes CNo
❑ Yes ErNNo
❑ Yes d o
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[—]Yes allo ❑ NA [_]NE
(Comments (refer to question #)::Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signatm
Page 3 of 3
Phone:�q(d �V
Date:
11(dis
21411015

for Visit: CfRoutine O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I L /ti I IN I Arrival Time:® Departure Time: County: Region:
Farm Name: ` Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: M:f r(UAU - Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 1-3 l L J7,
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
WetPoultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,oult .
Layers
Design
Ca aci
Current
P,o
Da Heifer
Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
01
lBeef 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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes [VN ❑ NA ❑ NE
El Yes No ❑ NA ❑ NE
Page I of 3
21412011 Continued

Facility Number: Date of Inspection,
Waste Collection & Treatment
4,Js storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
VNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Stt��Gru//ctuurrnreI Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: (,tryaUly I (AC-566d7/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J(S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ONo
❑ 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
]n No
❑ NA
[_]NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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 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 [hose designated in the CAWMP?
❑Yes
N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V
❑ 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
do
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
��-���/�
E
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 ❑ 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 InspectiO�NV
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
Pagel of 21412011 Continued

Facility Number: Date of ins ection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PGA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 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 J� No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW? ❑ Yes ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ YesVN0o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations fuse additional Dirges as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature',
Page 3 of 3
PhoneNIPML
Date:

Type of Visit: O `C`opfpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: V Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time:® County: 91 (azi Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: &k)�4-y t v h m 6(J✓
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: I Y-2_5 /
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Design Current
Capacity Pop.
I
I
Wet Poultry
ILayer
INon-Layer
Design
Capacity
I
I
Current
Pop.
Design C•urmnt
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Feeder to Finish
OD 60D
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D .+ P,puI
Layers
Design
Ca iaci_
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [No ❑ NA ❑ NE
❑ Yes [-]No
❑ Yes ❑ No
❑ Yes n I�ib
❑ Yes JVNo
❑ Yes
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facili Number: -2'L Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1
Identifier: LA&0>741
Structure 2 Structure 3
LAC%eCA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes �] No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes Vo ❑ 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 2�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EZfNo ❑ 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 Q 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
2
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes WNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? es ZNI� - ❑ NA ❑ NE
20. Does the facility/ail to have all components of the CAWMP readily available? If yes, check Yes o ❑ NA ❑ NE
the appropriate ox.
WUP El Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2fNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Inspection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o
permit25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes to ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately. -
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Io ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E i S ❑ NA ❑ NE
❑ Yes N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
l5> /L.ivk� Vb sGd
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:( 7G0/' / /E
Date:

Type of Visit: Q CLgmpliance Inspection O Operation Review O 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: L Arrival Time: UV Departure Time: County: DtX(,T_j l Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: ,J VC -PT f1.=7 C U F LL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: qq q, 57_�
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle [ opacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, P,oult .
Layers
Design
Ca achy
Current
P,o P.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullen
Turkeys
Turke Poults
Other
I
lBeef Brood Cow
Other
El Other I
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes
❑ No
❑ NA
❑ NE
❑ Yes FNo
❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
Page I of 21412011 Continued

Facili Number: - 2 Date of Ins ection: / S 10
1
Waste Collection & Treatment
/No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: (AGcb V I tAGa6)J 7--
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �_ 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M 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 environmenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
2 Yes
❑ N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
No
17. Does the facility lack adequate acreage for land application?
❑ Yes
E3
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E14o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[;io
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑-lVo
❑ 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
[:k<o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
L_I Ne
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
i o
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: 'LIS Date of —Inspection. I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is th-facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesVNo❑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
c
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ENo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E 'o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
d 1V o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E�rNo
❑ 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
[: Io
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M N�
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Usedrawings of facility to better explain situations (use additional pages as necessary): '
/Sj ,Ck E b 1-rM4�, ,
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:l
Date:
6-

Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: /® Departure Time: cS F County: NLW� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: R ", or IM-:�-TG N u' Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
DesignCurrent
Cattle Capacity Pop.
DairyCow
7Design
der
Non -La erjEE
Da' Calf
Hsh
ish
0
Da Heifer
ean
Farrowtoeder
Farrow to Finish
D . P�oul_
Layers
Desigu
Ca ?aci +
Current
Pao ,
D Cow
Non -Dairy
Beef Stocker
Gilts
11
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
El Other
Turkeys
TurkeyPouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 2NNo
❑ Yes [—]No
[—]Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes EJ ISM ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412011 Continued

[Facility Number:
Date of Inspection:
--`Vaste Collection & Treatment
s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3
Identifier: LA6WO 1W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 91� 3
]ZNO ❑ NA ❑ NE
[—]No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes Vj No ❑ NA ❑ NE
[—]Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 7No ❑ 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 N ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
wt�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesrNo
❑ 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 CAMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design []Maps ❑ Lease Agreements [—]Other: i
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: ( Date of Inspection, /
24 Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes U No ❑ NA ❑ NE
1.
2 lls 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 Ld ❑ 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
aN<o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office by the
Yes
/
NA
NE
of emergency situations as required
❑
❑
❑
permit? (i.e., discharge, freeboard problems, over -application)
ZNo
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
FNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any ottier:comments -;vr ^ "
Use drawings of facility to better explain situations (use additional pages as necessary).'
Reviewer/Inspector Name:
Reviewer/Inspector Signature,
Page 3 of 3
Phone.( IIo)
Date: S) b l
21412011

1.17
lType of Visitdc pliance Inspection Operation Review Structure Evaluation Technical Assistance
ReasonforVisit Routine O Complaint O Follow up O Referral Q Emergency 0 Other,,/ El Denied Access
Date of Visit: 3 7.1 Arrival Time: L-l� Departure Time: County: 014OLV Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: RRC--Nt Iy1.2" E-Lk. Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: Q c = ' = Longitude: = c = , Q "
r
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
m Feeder to Finish
,66
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑Beef Brood Co
❑ Turkeys
Othwl
er
❑ TurkeyPuults
❑ Other
ElOther
Number of Structures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
El NA
[I NE
❑ Yes
❑
Yes
El Yes
L
❑ NA
❑ NE
❑ Yes [/ No ❑ NA ❑ NE
Page I of 3 12128104 Continued

?acility Number: — Date of Inspection Z t0
R
aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 0 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: (all(r7l/�) LfiCs�+`r Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
- ❑ Yes 16 No ❑ NA ❑ NE
/
6. Are there structures on -site which are not properly addressed and/or managed
El Yes �/1J No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes -- //No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes El,No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes V No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Lam] No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ECNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
PlNO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Comments (refer to question #): ;Explain any YES answers and/or any recommendations or any other comments w
Use.drawingsof facilityto better explain situations. (use"additional pages as necessary).
w
!f) LOCAFE A/E4% ,(16w °k4C�
Reviewer/Inspector Name �" = a' ''N ` .< " (* 1.4 J Phone:
Reviewer/Inspector Signature: - Date:
3 1�
12128104 Continued
Page 2 of 3

LFacility Number: 93 _ Date of Inspection .ti9
lteauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Ej Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes O No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design g ❑ Maps p ElOther
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes '
E o
❑ NA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
E No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[21 o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E N/o
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
L��JNN(
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
E�rNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Ko ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
//
E2 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
�,_�
�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
— /
I,d PN
❑ NA
❑ NE
33.
Does facility require afollow-up visit by same agency?
❑Yes
iWs�N/o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit (I pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑Denied Access
Date of Visit: 3'o Arrival Time: ® Departure Time: County: lDUt°lailj Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: C3 FJ x& ''F -rTu-
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =o =. = Longitude: = o ='
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
f/
ONO
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
0
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
Eo
❑ NA
El NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 12128104 Continued

w , 1
Facility NumDate of Inspection
1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: _ L'4e'� LjA&.0t% V
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Jam/
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 ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental tlt�eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes VNo
J❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes d o ❑ NA ❑ NE
maintenance/improvement? �
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑Yes E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
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
l� tv
❑ NA
ElNE
No
❑NA
El NE
�
N
❑ NA
❑ NE
F[�J
VN❑NA
❑NE
❑ NA
❑ NE
IReviewer/Inspector Name I Jp t-j 1 Phone: I
Reviewer/Inspector Signature: - A.. _ 'Af Date: s
Page 2 of 3

1 /
Facility Number, — ,3 Date of Inspection
Required Records &Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Yeso
Wo
❑ NA
❑ NE
❑ Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ 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?
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?
No ❑ NA ❑ NE
❑ Annual Certification
❑ Yes y o
❑ NA
❑ NE
❑ Yes �Zo
❑ NA
❑ NE
❑ Yes IQ�N
❑ NA
❑ NE
❑ Yes L7 No
❑ NA
❑ NE
❑ Yes [a/No ❑ NA ❑ NE
❑ Yes �I No ❑ NA ❑ NE
❑ Yes
0� o
❑ NA
[I NE
❑ Yes
�[J No
❑ NA
❑ NE
❑ Yes
L!J No
El NA
❑ NE
El Yes
❑ NA
❑ NE
❑ Yes
LI No
[I NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
(Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit P,coop'�pliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit U� Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: (, p Arrival Time: Departure Time: county: ..S lkot.D Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Geea.t c !PE ITU5
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [ o = [� Longitude: [1 ° F]
Design Current
Design Current
Desi106urrent
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capala
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
JLJ Non -Layer I
Dairy Calf
® Feeder to Finish G LVVr6
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ La ers
El Non -Layers
El
❑ Turkeys
❑ Dry Cow
❑ Non -Dairy
El Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
O No
❑ NA
❑ NE
❑ Yes 5K ❑ NA ❑ NE
Page I of 3 12128104 Continued

---------------
Facility Number: 31 — 2_23
Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LA(va0d I LAG6an( Z
Spillway?:
❑ Yes IJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Designed Freeboard (in):
Observed Freeboard (in): t-i 3 —1 g
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 El Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental ttlreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application (/
ElEl10. Are there any required buffers, setbacks, or compliance alternatives that need El,,
Yes 1� I No NA NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
El NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Eo ❑ NA
[Io NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[ Yes
L'J N o ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
�o ❑ NA
[I NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments,fer [o question #) Explain any»YES,an wersmany recommendations Ian other comments
tUse drawings of facditycto better explain sttuah_ons (use,aFd tonal pp; E as tiecessa ,
..ix + q^!rt" y «d"s.!iYx✓1 Y >1)"c k.»w:b Fn'9.. Y. .. .. rTv^
UPIP TE LS--ASF AGRGE✓1fNT wSt 4 moP t_AtAw'
dLt-
Reviewer/Inspector Name J a NA i rgdw Phone: C yob) 73W
Reviewer/Inspector Signature: Date: % 3
Page 2 of 3 1 12128104 Continued

Facility Number: 31 — 2z3 Date of Inspection
I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ENo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. El,
Yes L7 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspectionss /❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ElNA [INE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA [I NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �Q/No //No [3 NA ❑ NE
LY 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Y s No El NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? Vs El No [INA [INE
[INo
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? Yes 2'No ❑ NA ❑ NE
Other Issues /
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ,,L�—d,,/T/./�� ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes L ❑ 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? ❑ Yesz
❑ 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 ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application) ,YNo
,[/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? El Yes ❑ NA ❑ NE
Additional Comments and/or Drawings: 11 - `
Page 3 of 3 12128104

p Division of Water Quality
Facility Number aaj O Division of Soil and Water Conservation
-- O Other Agency
(Type of Visit @f Com fiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistancd 1
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access I
Date of Visit: 3� o% Arrival Time: f76 Departure Time: County: iif/�(.1%% Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ri 609-Of P ETTVS
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
to Finish
to Feeder
Other
❑ Other
Owner Email:
Phone:
Title:
Integrator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -La et
Dry Poultry
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?
Longitude: Q ° = ' = "
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2�1No
❑ NA
El NE
❑ Yes
EJI o
❑ NA
❑ NE
12128104 Continued

i Facility Number: 3 — 02 a 3 Date of Inspection SL114Lo 7 I
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: u9Cfoc,✓ / LA6 vvpj 2-
Spillway?:
Designed Freeboard (in): 6,,i
Observed Freeboard (in): t/Z Y3
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 G3No ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes EXu ❑ NA ❑ NE
8. Do any of the strictures lack adequate markers as required by the permit? El Yes LJ No El NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require El�
Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 0No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ET/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
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
Id",No
L4 NNo
D<O
O No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
U) OUEET.1_oA, -ti MAY_T_m~ 4Wu-ur/r SToCKZOG- rok Uo(v.
Reviewer/Inspector Name
Reviewer/inspector Signature:
Phone: ( i/
Date: _
12128104

Facility Number: — Date of Inspection ?�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L'I No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application El Weekly Freeboard El Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall El Mocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes LI No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,[]'*NNo ❑ NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes Id No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes E! NNoo [I NA [I NE
26. Did the facility fail to have an actively certified operator in charge? [Iytvo Yes L❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ET'No
❑ NA
❑ NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
WNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
ONo
❑ 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
El NE
33.
Does facility require a follow-up visit by same agency?
ElC,Yes
�/N/o
No
❑ NA
❑ NE
Comments and/or
I2128104

Division of Water Quality /
Facility Number 3i ZLj O Division of Soil and Water Conservation /
-- - — — — O Other Agency
Type of Visit (a Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up o Referral 17 Emergency 0 Other ❑ Denied Access
Date of Visit: 0(i Arrival Time: Departure Time: County: n 00&:X k� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
Onsite Representative: b EdA&E 5Icirt%1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
vine Capacity Population
to Feeder
to Finish
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = U ='
= Longitude: = ° =
Design Current
Wet Pool" Capacity Population Cattle
❑ Layer �. FEI Dai Cow❑ Non -La er j..Dai CalfDai Heifer
DryPoultry D Cow --
❑ 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?
m
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I..
Number of Structures: C
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
❑ Yes Id No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I NA
El NE
❑ Yes
❑:�No
[I Yes
UNo
❑ NA
❑ NE
❑ Yes 3No ❑ NA ❑ NE
12128104 Continued

Facility Number: 3j — 223 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes/No [I 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: Li'aaV / 1A (r wJ L
Spillway?:
Designed Freeboard (in): `%. 7 I P9
Observed Freeboard (in): y %4 by
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[3 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? E4/y�'es
❑ No ❑ NA ❑ NE
8. Do any of the strictures lack adequate markers as required by the permit? ❑ Yes
dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any par of the waste management system other than the waste structures require ❑ Yes
,..//
E,No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
21 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
�/
E3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 1?(14) S 60
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NNo
[INA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[IYes
:Np
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
El Yes
El❑ NA
[I❑ NE
17. Does the facility lack adequate acreage for land application?
❑Yes
�
NA
NE
18. Is there a lack of properly operating waste application equipment?
[I Yes
�
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i.) C3�GK D6 a� I�TKE waLc NEEOS FCXI+1&, SEwb tkTtCrt 00CRSfsC4j6 �.Iw Amp
wzrq �l/ 4a DAPf to
Reviewer/inspectorName I OONI/ pgjW ,V Phone: 7IU I
Reviewer/Inspector Signature: p� Date: 4/P-7 oL
Pnon 7 of i 12128104 Continued

Facility Number: 3 % — },t Date of Inspection 17
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes
"
7No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
�❑
[2 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
B�'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NNo
[I NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,ET
1_7 NNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LI/ No
[I NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ElNo
O NINA
❑ NE
Other Issues r,
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes EKo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�Ko
❑ 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
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
Ej 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
gKo
❑ NA
❑ NE
Page 3 of 3 12128104

I Type of Visit 0yc��El
Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other Denied Access
Date of Visit: LF:.
Farm Name: _
Owner Name:
Mailing Address:
Physical Address:
Departure Time: Z"y�- ounty:
Owner Email:
Facility Contact: _ Title:
Onsite Representative:�OQ�
Certified Operator: i1N6lJC-,kqp H Z W C,>
Phone No:
Integrator: d az a.5�
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Region:
Location of Farm: Latitude: = U = , = Longitude: = o = , = «
Discharges & Stream Impacts '
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes to No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
12128104 Continued

Facility Number: —ZZ 7
I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
rrryyy
El Yes 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:;_ At,
Spillway?: 4/0 1410
Designed Freeboard (in): _ —
Observed Freeboard (in): !2 4!�2_
5. Are there any immediate threats to the integrity of any of the structures observed?
�{
❑ Yes �l 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 [I 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 ;ZNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes m No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[]Yes O No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Z No
❑ NA ❑ NE
maintenance/improvement? .
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 Drifi ❑ 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
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
;21No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
'ONo
❑ NA
❑ NE
� D �i�,r t%di�/�Ct- . ��4/!m �5 (i[JL�cc /,� A-�i� yip--7.i✓� . ��00.0 S 6 " ��`7
IReviewer/Inspector Name Phone: O- — I
Reviewer/Inspector Signature: Date: & O

s
f
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes /No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VrNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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
2 No
❑ NA
❑ NE
❑ Yes
JZ No
❑ NA
❑ NE
❑ Yes
VfNo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
VfNo
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA XNE
❑ Yes XNo
❑ NA
❑ NE
❑ Yes (VNo
❑ NA
❑ NE
❑ Yes 10___,,,///No
❑ NA
El NE
El Yes L/ No
❑ NA
❑ NE
❑ Yes 4 No
❑ NA
❑ NE
❑ Yes jn No ❑ NA ❑ NE
jAdditionalComments and/or Drawings:
12128104

of Visit flrCompliance Inspection O Operation Review O Lagoon Evaluation
for Visit Routine O Complaint O Follow up O Emergency Notification O Other
Facility Number Date of Visit: Time:
0 Not Opera
Permitted E3
Farm Name: __.
Owner Name:
Mailing Address:
❑ Denied Access
0 Conditionally Certified 0 Registered Date Last Operate3kir Above Threshold: _
County:
No:
Facility Contact: _____.___.__ Tide: __— �__.�. _ _ �__ Phone No:
Opsite Representative: �� _ i�L_.>_� .—�.. Integrator. ��Olee------------
Certified Operator:,,._ —_ .. Operator Certification Number. _� _ _.-__—•
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =1 =11 Longitude =• =' 0.1
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes IRNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ,&No
Structure I Stru�ure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ___ __ --RR"'
Freeboard (inches):
12112103 Continued

Facility Number :
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ tlydr4ac: Overload ❑ Frozen Groupd
12. Crop type
13. Do the receiving crops differ with those
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?
I --
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes VNo
❑ Yes XNo
0"Yes ❑ No
❑ Yes XNo
❑ Yes XNo
❑ Yes dNo
❑ Yes )ZNo
Yes ONo
❑ Yes P"No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes j2fNo
❑ Yes XNo
❑ Yes .,dNo
❑ Yes ONO
❑ Yes XNo
❑ Yes VrNo
Cots;(referm YEsanswersand% - _:�„
gaeahon Rk� any rxaaommdatious.or aWheroommmts "
Use dcawmgs of>sa�tyto�bdt�re�cplawtuabons (2ea-MMdditio�l pages�.aeoessary) ❑Field Copy ❑ Flnal Notes
- .....fir-�_
Reviewer/fnspector Name
Reviewer/Inspector Signature: i Date: O
-154
MUM v Continued

Fa' ' 'ty Number: :9/ ZZ Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes F�No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes ONo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes PfNo
❑ 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 ANo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes .0 No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes ANo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes VNo
28. Does facility require a follow-up visit by same agency?
❑ Yes 1No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes PNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes gNo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes P'No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ONO
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
JVNo
❑ Yes )2No
❑ Stocking Form ❑ Crop Yield Farm ❑ Rainfall Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted daring this visit You will receive no farther correspondence about this visit
-
jai'+TYiaL..G62.%SlC3...?C.i:
AT A9cK Sao �f GJ dZ Lt�Zz,�{ �f/r E.PoS�o�
//�� �i QAz.✓ �EED�, ��ED T �K
> �NSPpEGTZp�J
D✓�L/Rm
12112103

of Visit
Reason for Visit
Compliance Inspection O Operation Review -0 Lagoon Evaluation
Routine O Complaint O Follow up Q Emergency Notification 0 Other
Pate of visit:
Facility Number
Permitted O ceertrtified [3 Conditionally Certified 0 Registered
Farm Name: 15P1 J r .�
Owner Name: _ �W� GA9'0'5 / ;r ;
Mailing Address:
Time:
❑ Denied Access
Date Last Operated or
Above Threshold: _
County://U�G�/✓
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative:.�1`i / r t��r-'/,���i Integrator:
Certified Operator: Operator Certification Number:
Discharges & Stream Imoacts-
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
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 pan 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
Stru e l S tore 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes
No
El Yes
,,,.❑l
1���No
El Yes
/,1���Q///No
ElYes
/l�No
Structure 6
/
Continued

,
Facility Number: — Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
J2<0
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
01
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 anv of the structures need maintenance/improvement?
❑ Yes
5rNo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
210
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
'2<0
Waste Aoolication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
21'NO
11.
Is there evidence of over applican ? ❑ Excessive Ponding ❑ PA ❑Hydra is Overload
Ye
Nc
12.
Crop type QIl
/f/❑
13.
Do the receiving crops differ with those de/191ated in the Certified Animal Aste Management Plan (CAWMP)? Yes
, NO
14.
a) Does the facility lack adequate acreage for land application? _
❑ Yes
Of No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
Does the receiving crop need improvement?
El15. Yes
No
16.
Is there a lack of adequate waste application equipment?
El Yes
�4No
VJ No
Required Records & Documents
T��(
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
,JLJ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
��
(ie/ WUP, checklists, design, maps, etc.)
El Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
El
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
,�,�"
(ie/ discharge, freeboard problems, over application)
El Yes
1„Q rvo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El Yes
J No
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
Xf No
E3 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
Comments (refeito question #)::Esplatn aay YES answeti and/or any recommendations or`i nv othWe'ommeats. - {
,Us'e drawings of faan7ity to better ex lain situations; 6- _additional pages as necessary) - 1 E] Field Conv ❑ Final Notes
`yfo� �� G.9oo,✓ #2. S�2G�si/T F.�s�o,✓ l✓o�o
Reviewer/Inspector Name n "... -
Reviewer/Inspector Signature: Date: 0-1 OL
0510310] 1 1
Continued

Facility Number: � — Date of Inspection /
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
/No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt
❑ Yes
�No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters. etc.)
El Yes
�r
" Zo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑Yes
,t,�Q
/14
32.
Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover?
❑ Yes
!❑ No
Additional Comments and/or Drawings:
i
44aws � O�,o�
05103101

1:; ,•' Division of Water Quality
V
I'. Q ivision of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow uup��--O'gggEmergency Notification O Other ❑ Denied Access
Facility Number ! Date of Visit: E Printed on: 7/21/2000
J1I O Not Operational Q Below Threshold
Permitted I] Certified (] Conditionally Certified ❑ Registered Date Last OperatedA
Above Threshold -
Farm Name:......,�j.j..!.�.....Y/{..!............jt........................................ County:................................ l.Cf..:...,.r.......
wt i
Owner Name:
Facility Contact:
Title:
Phone No:
-,. Phone No:
Mailing Address : .............
................... ............................................................................................................................ ..................
Onsite Representative: .......LD.r-................................................ Integrator:..._...... ..�f .... 'h......,..
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
WSwine []Poultry []Cattle []Horse Latitude • 01 =„ Longitude =• 01 =..
Design Current
to Feeder
to Finish
e to Wean
oto Feeder
to Finish
Number of Lagoons
Holding Ponds/ Solid Traps
Design Current
Poultry Capacity Po ulation
❑ Layer
❑ Non -Layer
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
Drains
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/ruin"
d. Does discharge bypass a lagoon system" (If yes, notity DWQ)
❑ Yes 1�No
❑ Yes ❑ No
❑ Yes ❑ No
-HW
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Wo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ to
Waste Collection & Treatment \\
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �No
Stru"'4 S� ucture 7 Structure 3 Structure 4 Structure 5 Structure (i
Identifier: ................. ;..S............. ................. 3-5.t..........................................
....................................
....................................
....................................
Freeboard (inches):
5100
Continued on back

Facility {Number: — Date of Inspection I "eV
Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obees, severe erosion, ❑ Yes I�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 df 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 q No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes JRNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 0 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes IFNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes T
No
12.
Crop type
13.
Do the receiving crops differ with those design (,d in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
Ej No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
5allo
b) Does the facility need a wettable acre determination?
❑ Yes
[allo
c) This facility is pended for a wettable acre determination?
❑ Yes
KNo
15.
Does the receiving crop need improvement'?
❑ Yes
�No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[XNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
94 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
No
(ie/ WUP, checklists, design, maps, etc.)
❑
Lr'N'
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
V No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge'?
Yes
El Yes
,[A
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
,mot
No
(ie/ discharge, freeboard problems, over application)
❑
[�
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[�(No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
•
. . . . OisilllltS,OI`(1CtIC1e,. . . . W . .. 4 e. (tUi'[I1Q Z}i1S, VISIt. .l.oi} Will •1'&avo ti0 t�UI'tI1C[' .
ctiriespmideitce: aboutahis.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):
�po0 72 �tj �+GveS �o �. SCj liijf aCv� WI/�
eor L
%!i''. �/ �' J
Reviewer/Inspector Name r j'/pv ' 6,p�_ / U/ 11
Reviewer/Inspector Signature: /- Date: %$� 5100

Facility Number: � Date of Inspection /
Odor Issues _.- ,,,......1II,,,,,,,��
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ty�rvo
liquid level of lagoon or storage pond with no agitation? ''\\
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
VO,c aQ pLvt$ dQlovv)'l ►tea ` S
C-10J t tod GGP�
z-
❑ Yes AN
❑ Yes f No
❑ Yes No
❑ Yes ATNo
❑ Yes�No
❑ Yes -PNo
J

Division'of Sod and Rater. Conservation Operation Review
oni p Divisiof Sol and Water ConsenVition Compliance Iuspechon
13 Dtvts(onjof Water Quality - Compliance lspectioii
13Other ftency .Operation Review
e
Routine p Complaint p Follow-up of DWQ inspection p Follow-up o review p ter
Facility Number �33—� Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted 0 Certified p Conditionally Certified p Registered in Not Operational Date Last Operated:
Farm Name: AlhertsamEarm............................................................................................ County: Duplin WiRO
Owner Name: ................................................... Marwell.Foods.Inc............................... Phone No: 919-.17.373. 311..........................................................
FacilityContact: ...............................................................................Title:............................................................... Phone No:....................................................
Mailing Address: P.O..Box.100.09....................................................................................... Goldshara..NC ..................................................... 27532..............
Onsite Representative: ra.d.I.intau................................................................................... Integrator: GaldsLbara.Hog.Farms.......................................
Certified Operator: Kyuwoad.M....................... Holland ............................................ Operator Certification Number: 1653.5.............................
Location of Farm:
Latitude E-33-11 ®' ®"
Longitude ©e ®, ®,,
esign ur I euv. Swine Capacity Population'- Poultry
®Wean to Feeder
® ee er to mis
❑ arrow to ean
❑ Farrow to Fee er
p Farrow to Finish
❑ Gilts
p Boars
liesign current. liesign current
;apacity Population Cattle = Capacity Population
❑ airy
❑ on- auy
Total Design Capacity 11,500
''Total SSLW - 712,500
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon p Spray Field p 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) p Yes ®No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? p Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ...............29...............................2....................................................................................... .............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
3/23/99 seepage, etc.)
❑ Yes ® No
Continued on back
Printed on 11/23199

Printed on 11/23/99
ace rty um er: 31 _223 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? O Yes ® No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
H Yes
O No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
O Yes
® No
9.
Do any strictures 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?
O Yes
® No
11.
Is there evidence of over application? O Excessive Pending O PAN
O Yes
®No
12.
Crop type Coastal Bermuda (Hay) Fescue (Hay) Small Grain Overseed
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N No
14.
a) Does the facility lack adequate acreage for land application?
O Yes
O No
b) Does the facility need a wettable acre determination?
O Yes
O No
c) This facility is pended for a wettable acre determination?
❑ Yes
O No
15.
Does the receiving crop need improvement?
❑ Yes
H No
16.
Is there a lack of adequate waste application equipment?
O Yes
H No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
O Yes
H No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
O Yes
®No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
®No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
O Yes
H No
21.
Did the facility fail to have a actively certified operator in charge?
O Yes
I@ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
O Yes
® No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
O Yes
® No
24.
Does facility require a follow-up visit by same agency?
O Yes
®No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? O Yes H No

ki
Printed on 11/23/99
act ity um er: 3I _223 Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
p 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?
p Yes
® No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
tg No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
®No
30.
Were any major. maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
p Yes
®No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
®No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
p Yes
® No
p
=
t
•ice.-
.£.
—
_:F
pi-
x
5
...
..
_.
_
2.
N
?4.
—
..
r
t
�
F c
# f�
s
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y"
?
yAfr
1.
Printed on 11/23/99

n _
- .Division of Soil and -Water Conservation'- Operation -Review -
" Q Division of Soil and Water. Conservation -Compliance Inspection
_ = !$Division of Water Quality `- Compliance Inspecti '
-- -..0 Other, Agency - Operation Review
of
F
Facility Number Date of Inspection 1 ',q3 Icig
Time of Inspection 24 hr. (hh:mm)
Permitted 13 Certified 0 Conditionally Certified 13 Registered Q Not Operational I Date Last Operated.
Farm dame: c-..'...v'� County:....... ..LLB.
OwnerName:....` \ .5!.�F._�F...t................................................._........ Phone No:..........................................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:.......................................
MailingAddress: ....................... : ....... **'** .................. ................. ...............................-....-........-.-...................
Onsite Representative: ...�CG.... "It
„`J -............................................ Integrator: bG VO............. ..
.............. b ........................................................
]� 9 /a
Certified Operator.........( ...... ....... .. g�............................................................. Operator Certification Number:..._I................. i s
....
Location of Farm:
Latitude =•='=1 Longitude 0•=`0..
awme capacity t-oputatton
❑ Wean to Feeder
Feeder to Finish qoo
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I I ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I I I❑ Subsurface Drains Present IILI Lagoon Area I❑ Spray Field Area I I
Holding Ponds / Solid Traps � ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)7 ElYes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. 11 discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes CffNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes [;KNo
Structure I Structure 2 Structure 3 Structure 4 Structmc 5 Structure 6
Identifier:
Freeboard (inches): .........a-�
a.............................................................................................................................................................
1/6/99 Continued on back

Facility Number: 31—/a'd,3 Date of Inspection
6. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence
�,o.,f over application? ❑ Ponding KNitrogen
'�..1.
12. Crop type ... ...t..._5..J.'.......................................................................................
0
❑ Yes XNo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
CJ' Nn.violattons'or. deficiencies.were noted during this' visit..'Y'ou will.receive no further
'-PQIT
.......dehee:abotifthis visit: •'
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use`drawinp of facility to better explain situations. (use additional pages as necessary) _ - -
❑ Yes ef No
'Yes ❑ No
XYes ❑ No
❑ Yes [XNo
❑ Yes XNo
413,
[Yes ❑ No
❑ Yes XNo
❑ Yes [jrNo
❑ Yes XNo
❑ Yes tpNo
❑ Yes �rNo
❑ Yes jSrNo
❑ Yes [jrNo
❑ Yes [�No
❑ Yes [�(No
❑ Yes W No
❑ Yes Wo
jv 4- VP-5 �1G/^1� 2 t/g/l.o l GrItf-"T . ._ ate 2 c� P` .StyeA
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: G 3 11/6/99

0 Division of Soil and Water Conservation ❑ Other Agency V
�'' �• 0 Division of Water Quality �e
Routine O Com laint O Follow-up of DW ins ection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
[Time of Inspection S : GG 24 hr. (hh:mm)
0 Registered 13 Certified 13 Applied for Permit q Permitted JE3 Not Operational (Date Last Operated:.-
FarmName:.._ ... f.-Sl. 5,4 .../........,(.........................�.......�.............. County: .......... ..1(11. \................................................
Owner Name: ...... GU5. tL-1— y S...L.(F, :j4\ GZCS�....... Phone No: ._ .L-.1. `3�30........................
FacilityContact :......Q.........:..../.�....�...........I./.../................................ Title:..........r...................................................... Phone No:...................................................
Mailing Address:..... ?._G..... tk.' ...... \.....al `N� � . a .............................. .............................. ..........................
Onsite Representatives.. 59 ...!R. ............................................................. Integrator:..... c3.........................................
Certified Operator:...._......................................................................................................... Operator Certification Number;
Latitude =• =, 0" Longitude 0' =' ="
Design_ Carrent=°Destgn,e Current. Design ,Current
Swtnen Capacity,Popubftion_ Poultry Capacity Population Cattle Capacity Popahition
Zl ; ❑ Wean to Feeder ❑ Layer z • ❑ Dairy
Feeder [o Finish 400 ILI Non -Layer I 1 ❑ Non -Dairy
i ❑ Farrow to Wean e
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish-' Total Design Capacd"y-.
❑ Gilts
❑Boars Total SSLW
Number of Lagoons'! Holding Ponds , ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Ereld Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes W No
2. Is any discharge observed from any part of the operation? ❑ Yes Eq No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ( No
c. If discharge is observed, what is the estimated Flow in gal/min? `\ A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes allo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes [H No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 19 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ,Ef No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes tat No
7/25/97

Facility Number. 3
8. Are there lagoons or storage ponds on site which need to be property closed? 0 Yes tEfNo
Structures (Lazoons.11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? 0 Yes [9No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ................................................ 5. ................... .................................... ................................... ...................................
...................................
Freeboard(ft): ....... ( M'. ... Q�c'] ..... ........... . RS .............. ................................... .................................... .................................... ..........
10.
Is seepage observed from any of the structures?
El Yes
CgNo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
0 Yes
JXNo
12.
Do any of the structures need maintenancelimprovement?
19 Yes
0 No
(If any of questions 9-12 wasanswered 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?
0 Yes
C�No
Waste AptAication
14.
Is there physical evidence of over application?
0 Yes
[XNo
(If in excess of WMB, runoff entering waters of the State, notify DWQ)
15.
Crop type ... 'X_.�\..( ..... . ..................................................................... ...............................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
[I Yes
WNo
17.
Does the facility have a lack of adequate acreage for land application?
0 Yes
9No
18.
Does the receiving crop need improvement?
0 Yes
VNo
19.
Is there a lack of available waste application equipment?
[I Yes
ONo
20.
Does facility require a follow-up visit by same agency?
El Yes
PrNO
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
0 Yes
OTNo
22.
Does record keeping need improvement?
[Yes
0 No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
0 Yes
KNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
0 Yes
to No
25.
Were any additional problems noted which cause noncompliance of the Permit?
0 Yes
KNo
[3-
No vitilki6ns,or del!idefi66 w&e noted during this. visit*. -Xodwill receive ii6liirther
c &606fidebce ahout this'visit
wand
LCA'
z4)
r-Y
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: I-) �� C_ J, n L Date:

❑ DSWC Animal Feedlot Operation Review
®DWQ Animal Feedlot Operation Site Inspection
1W Routine V Complaint V Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection /L 7
[
[ Time of Inspection 'Oo 24 hr. (hh:mm)
Megistered E3Certified [3 Applied for Permit JaPermitted 113 Not Operational Date Last Operated:
FarmName; ........ M60A.-sm....... err[.e-............................................................................ County:...]i*n...................................................................
Owner Name: .......... MmX.NIt.�.�....... aS.j....lnt:....................................................... Phone No:.�9.(..7..7$-3��..................................................
Facility Contact: ........... ...._� dL��Dt�.................................. Tille:........FSpytac�fe................................... Phone No:..�?� �.�� r.. .d.............
Mailing Address: ...... :i�..Q.....�G11......... 1.kA.Q9.................................................................. ...... GiA)Alxia.y.....tic—.—..........................e..........Z1-?72........
Onsite Representative:
//....... ,N\\_�..:�ln�................1........................................................ Integrator:..... S4.. a- kaT......l�j.....1.laapa.S.........Y...............
Certified Operator, ..... .trtvf-w....... I.._...........Lin.Ibr..........................................._...... Operator Certification Number :..... IO.�,i-1
................
Location of Farm:
Latitude 0• ©' ®" Longitude 0• FRET ®"
Swine Capacity Population
❑ Wean to Feeder
® Feeder to Finish
of
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design,., :Current.
Poultry Capacity: Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I I - ❑ Non -Dairy
❑ Other I.
Total Design Capacity , I" I-)
Total SSLW
I -Number of Lagoons/ Holding Ponds-, ❑ Subsurface Drains Present 110 Lagoon Area ❑Spray Field Area' "I
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'.
b. If discharge is observed, did it reach Surface Water? (If yes, notify D\��Q)
c. If discharge is observed, what is the estimated flow in ,al/nnn9
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge'?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement'?
6_ Is facility not in compliance with any applicable setback criteria in effect at the time of desien?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes
®'No
❑ Yes
® No
❑ Yes
§3 No
❑ Yes
q No
PIA
❑ Yes
Od No
❑ Yes
O1 No
❑ Yes
IR No
❑ Yes
19 No
❑ Yes
( No
❑ Yes
No
Continued on back

viiactiityNumber: 31 — Zz3
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
'ZNo
Structures f Lagoons Holdine Ponds, Flush Pits. etc.1
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
® No
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ... .. ...... ... .. . . ..... .. .. . .. . ... .. .. ...... _4.............. . .......... ..... .. .. ..... .. .. .... .. .................................... ...................................
...................................
Freeboard(ft).........,���................................ ............................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
IN 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
No
(If in excess of WMP, or entering waters of the State, notify DWQ)
15.
Irunoff
Crop type ......... 6YmV&............................................................... .......... SM11..3kAA..............................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
Q No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
[5a No
18.
Does the receiving crop need improvement?
❑ Yes
tK No
19.
Is there a lack of available waste application equipment?
❑ Yes
M No
20.
Does facility require a follow-up visit by same agency?
❑.Yes
KI No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
kj,[\o
22.
Does record keeping need improvement?
JR 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
$5 No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
5D No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
0 No
No.violations or deficienctes.were noted during this.visit .You will receive no further
correspondence about this'visit.,' 1
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
Y ....a_ s a
iz oxtaS an 004 Wolf o-� )agotx, 4 Z sl,ojl % reseei)ci) W++(,� &fro�rtaIe V¢eie4")R
e
Ca vr, II
zz. yi,'W so,1 o.�;jo,4e Sany�ec analyses should 6e v,. sik. A ma,� of qu-
IRCOS UJ risers sit 4 be it\ ple ,, tR?"11 TO'M% 561l) be, oh51l4
7/25/97
ReviewertInspector Name
Reviewer/Inspector Signature: A5 _ — /_1. A I — Date:

•
•
Site Requires Immediate Attention:
Faciliry No. �i - o
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: s 1995
Tim -
Farm Name/Owner:
Mailing Address:
County: _ _W
Integrator.
On Site Representative: _
Physical Address/Location:
Type of Operation:
Design Capacity: :7 zC0
try _ Cattle _ R'l I'Sh
Number of Animals on Site: 3Z00
DEM Certification Number. ACE DEM Certification Number: ACNEW
Latitude: Longitude: ' Elevation: Feet
Circle Yes or No '
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ce,s6 No Actual Freeboard: -I—Ft. D Inches
Was any seepage observed from the lagoon(s)? Yes o �Io Was any erosion observed? es No
Is adequate land available for spray? es r No Is thecovercover crop adequate? es r No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?�Yebr No
100 Feet from WeHs? Yes or No Z
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(S)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
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 spec acreage with cover crop)?
Additional Comments:
L. Le LA5
• Inspector Name
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.