310256_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: t3Com rice Inspection U Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit: ,; ouutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 00 County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
0re v-n.kG.//
Title:
Latitude:
Phone:
Integrator:
Certification Number: t✓ -f
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
L 1.
Non -La er
DairyCalf
ceder to Finish
...� •" - Op
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Desigrt
Ca nci
Current
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
113eef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 Io E_] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
=�
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C 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 eNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ENo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
]� o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections/ ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes U N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 214/1015 Continued

Facili Number: - Date of Ins ection: _��_���
• 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [—]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No V5 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
❑NA ❑NE
/o
❑ NA ❑ NE
Noo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
C 9 ^ � f n c.c. 1 0 k c- " (/ R 60 so o ^
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
tD._A
Phone:
Date: Lt,
21A015

'Reason for Visit: (2F Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: G Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: (D (i..(CN'P 1 - J_T CN Cc', Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Latitude: Longitude:
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 Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes � ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412015 Continued

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

Facility Number: Date of Ins ec[ion: (� 111111
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 6o ❑ NA ❑ NE
k. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ 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 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?
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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes eNNo ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
[:]Yes [J'No
❑ Yes dNo
[—]Yes �No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
fi / I b `� 0
Date: l 67
21412015

Operation Review
for Visit: 0 Routine
Referral
O Other O Denied Access
Date of Visit: (0/17 /Ij Arrival Time: Departure Time:® County:�� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: BfZ.H.NT 01=_-r" 60, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 3 b �0`)q
Certification Number:
Longitude:
Wean to Finish
Pop.
Wet Poultry
Layer
esign
Capacity
Current
Pop.
Design Curren[SMoo
C•artle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
$U
d
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
nn P�oultry
Layers
Design
Ca acit
Current
Pao ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ZNo ❑ NA ❑ NE
Yes
[:]No
❑ NA
❑ NE
❑ Yes
D No
❑ NA
❑ NE
Yes [—]No
Yes [3 No
Yes �rNo
DNA ❑ NE
NA NE
NA Ej NE
Page I of 3 21412015 Continued

Facility Number: Sj I - Date of Ins ection:
Waste Collection & Treatment
45`s 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 Structure 2
Identifier: L)Q&rT01J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5
1-5
❑ NA ❑ NE
❑NA ❑NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes / No ❑ NA ❑ NE
❑ Yes ZNo ❑ 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? eyes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [2"No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E�J o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Cj/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E),4o
❑ 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
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes
�fo
o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 I �J o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faaili Number: - Date of Ins ection: -7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
I
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes gNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes dNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0 No
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
l.d No
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% No
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
]dNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
� o
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
VNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
DNA ❑NE
❑NA ❑NE
Page 3 of 3
21412U]s

Reason for Visit: -0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: D(/ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 19Q..CON (V\aP C'u,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: MOW
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Di. P,oul_
Layers
Design
-a aci_
Current
P,o
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Dischar¢es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[-]Yes /No ❑ NA ❑ NE
[:]Yes [-]No
❑ Yes [—]No
❑ Yes n I�jo
❑ Yes No
❑ Yes o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

11.
Facility Number: ?,) _ n Date of Inspection: r a.�I
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure) Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
WNo
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
'
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Wo
❑ 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
C�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
Ef NP
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ld 'V u
❑ 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
� o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
1No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[Yes
❑ No
❑ NA
❑ NE
the appropriate b
WP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes /p ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ NA ❑ NE
Page 2 of 3 214120I1 Continued

Facili Number: - Date of Inspection: 11
24. Did the facility fail to calibrate waste application equipment as required by the permi ❑ Yes I! I No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [—]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ 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 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
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
E2<o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
a 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
C!�No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
dN
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
V
❑ 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 necessarv).
2) w o FK wti OrkE MkLl Dip N(T G floW ?g pep- Ca�felZ , �R tqrr(-MFT
gc a(�n2ED F2
Aul
A OWalFlL-FR5SU, dP0 1 �✓I�%� A,UD JOrAi9&_tINbR-jJ'1'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
V Phone: C b b
Date:
2 4/2011

(Type of Visit &CompHance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergencv O Other O Denied Access
Date of Visit: s� /t /,'{ Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Q6Zlc.1�-b W—,y T. C0 LL% Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Region:
Certification Number: 4 7 6 d
Certification Number:
Latitude: Longitude:
CurrentWDesign
Capacity Pop.
ish
Wetpacity
]Layer
Current
Pop.
Desigu Current
Cattle Capacity Pop.
DairyCow
TDesign
der
Non -La er
Da' Calf
HFarrow
ish
Da Heifer
ean
toFeeder
eder
to Finish
Dr. P,pul
Layers
Design
C•_a aci_
C•unrent
P,o ,
Cow
Non -Dairy
Beef Stocker
1113eef
Gilts
Non -Layers
Beef Feeder
Boars
I I
Pullets
Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ]�No ❑ NA ❑ NE
[—]Yes [-]No
[-]Yes ❑ No
❑ Yes ❑ o
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 21412011 Continued

lFacility Nudtber: 711 xt, /
Waste -Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
`rStructure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes 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 ore Foamental threat, notify DWQ
12. Crop Type(s):
13. Soil Type(s):
7. Do any of the structures need maintenan
ce or improvement?
Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑Yes [�Io
❑ 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 0/0❑
NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes o
❑ 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 > ] 0% 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
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
�s
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EKo
❑ 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 EKo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes �Io ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

lFacility Nuthber. 1 - Date of Inspection, 1
24. Drd 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 Yo ❑ 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 N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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 [2- o ❑ NA ❑ NE
❑ Yes E2/No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
Ioo ❑ NA ❑ NE
rjfilo�DNA ❑ NE
o ❑ 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).
71) bT_(e' ' w o Q-iC, Lb 6C 060 C , N E`r<- t" TNs 6'c. C.Y'�6s`l Plot)
w Cc g£ZsSL��O LF por A00VZcSSE0.
�S> W 6eo C.ol�_Taso _. ►NfEO m SG-0 n cco T') A F R—ft"oVP.
Reviewer/Inspector Name: " C'Ho ' ie�vea' PhonL D (7`7300
Reviewer/Inspector Signature: �+ l l�1/ hh lV Date: � 1 6-
Page 3 of 3 21412011

Reason for Visit: 6 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: RX
I Z, Arrival Time: —o® Departure Time: County: Q(,QIJ% Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: 9 fclJl (YM::�XLW Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: r1'6
Certification Number:
Longitude:
Swine
Wean to Finish
Design
C apaci
Current
Pop.
WPoultry
etty
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle CRMVYM Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Zg$O
j d
D . P,oult .
La ers
Design
Ga aci
C•ucre-t
P,o P.
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Dischar¢es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ONO
[—]Yes [—]No
[—]Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes CJ 1:1❑ NA ❑ ❑ NE
❑ Yes N ❑ NA NE
[—]Yes o ❑ NA ❑ NE
Page 1 of 21412011 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3
Identifier: LA
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 ONo ❑ 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 env' onmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? es ❑ N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ff /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ef/No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 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 [hjo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes —U/ /No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other-.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facie Number: 3 Date of Inspection, 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ` ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes EJ No
❑ Yes [� No
❑ Yes C�/No
❑ Yes n No
❑ Yes
❑ Yes
❑ Yes Ej No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
wort-k sttLL- NEEDED. ?L-cASC 4✓E Dot�c-
r►fs�F J ARA-_r--r.JyE bF w okl"_DdAlr- ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: b —7J
Date: 11-
/ oil

Reason for Visit: Q Routine U Complaint O Follow-up U Referral U Emergency U Other Q Denied Access
Date of Visit: Ip ll Arrival Time: Departure Time: 11S County: a(7/� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: aJQuyr tvL-rc.},aca—
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
C>IM
apacity
Curren[
Pop.
Design Current
Cattle Capacity Pop.
Cow
Wean to Feeder
Non -La er
Calf
Feeder to Finish
f�
Heifer
PNon-l
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I)r. P,oult ,
La ers
Design
Ga raci
Currentow
P.o ,
ai
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poulu
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 [:]No
❑ Yes
[—]Yes rNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21412011 Continued

Facili Number: Date of Inspection: i p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
•
[—]Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
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 en onmental threat, notify DWQ
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 YNo
N ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No. ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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
❑ 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
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes No❑
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ 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 I" Rainfall InspectioVl;�6
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi k ❑Yes ❑ N
25; Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�Io
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ "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
ENo ❑ 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
O/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
lN' ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N ❑ NA
R
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑YesNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations,or any other,comments.;. z „z1
Use drawings of facility to better explain situations (use additional pages as necessary).
1.) M.00_k nskJ� WoMc_ 0660 Co .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:

(� Division of Water Quality
umber 1 ��� �;Divisiou"of Sod and�Water Conservation
Type of Visit QrCoo9�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 24
Arrival Time: // Departure Time: County. mYl° VDJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: 00-1+o� MJ-'j'G�EI.I. Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =o =' = Longitude: [�o =
Design Current Design Current Design Current
aSR-me - - -= `Capacih%"'Population ""` Wet Poultry '-Capacity- `Ropulahom "=:Cattle Capacdy Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
' ❑ Non Layer
❑ Dairy Calf
Feeder to Finish❑L)airy
Heifer
='
❑ Farrow to Wean
»». '� "`""
Dry Poultry ' ❑ D Cow
❑ Feeder'`FE
""' ❑ Non
H
Farrow to
i' -Dairy
s
" ❑ Beef Stocker
❑Farrow to Finish
❑ Gilts
a ers ❑ Beef Feeder
Boars
s'❑ Beef Brood Co
sOther
_
Poults:�---.�"'��.=
❑ Other El Other �, Numberof.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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N
El NA
❑ NE
El Yes
Y No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

FacilityNumber:j1 — _6 Date of Inspection 2 0
Q
Waste Collection & Treatment [/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes �I No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Str�uccttureI Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5.
Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o
El NA
[I NE
(ie/ large trees, severe erosion, seepage, etc.)
YNo
6.
Are there structures on -site which are not properly addressed and/or managed
ElYes
❑ 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 environ ental
threat,
notify DWQ
7.
Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
dNo
❑ 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 EfNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ENo ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o ❑ NA
El 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
ENo ❑ NA
❑ NE
17. Does the facilitylack adequate acreage for land application?
❑ Yes
o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
!d No ❑ NA
❑ NE
Comments (refer to question#). 'Explain any YES answers and/or any reeommendations:'or any, other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name e N -, p" • ,Y- a r«, :. Pho+ C[ b 71c 93l
Reviewer/Inspector Signature: Date: Z
Page 2 of 3 1 12128104 Continued

Facility Number: — Date of Inspection `+
I l
Rhauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2,No [INA ElNE
20. Does the facility fail to have all components of the CAW MP readily available? If yes, check ❑ Yes +'I No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections
❑
Weather Code
22.
Did the facility fail to install and maintain a min gauge?
ElYes
B/No
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
WINNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[Er/No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
� o
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LJ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
0No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IJ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
- /No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El
,�
Id No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,�
No
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
,..IJ
2,(No
❑ NA
❑ NE
Addi6iialtomments,and/or.0rawings
Page 3 of 3 12128104

Type of Visit 6CCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (d/Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑Denied Access
Date of Visit: ' I Arrival Time: i 7.6a Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: (3fLfbtfl• Mirci-iF,I - Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [ o = [� Longitude:
Region:
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer I
❑ Dairy Cow
❑ Wean to Feeder
JLJ Non -Layer I
❑ Dairy Calf
10 Feeder to Finish Ajr256 GB
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
Layers
❑ Non -Dairy
Farrow to Finish
El Farrow
❑ Non -Layers
El Beef Stocker
❑ Gilts
❑ Beef Feeder
-
❑ Boars
❑ Pullets
❑ Beef Brood CoAl
El Turkeys
Other
❑ TurkeyPoults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Oo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes U NNo ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection 4 e
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ENo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l.Aclwb�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 34
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[2f 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
VNNo ❑ 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 environ ental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? V Yes
❑ NNo ❑ NA ❑ NE
8. Do any of the stuctures 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 part of the waste management system other than the waste structures require El Yes
CI No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
dNo []NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
PNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
El No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]E�J Yes
NNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E I Np
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L�J NO
❑ NA
[I NE
d') SGo "tc D3 h Car✓tE af�,
IReviewer/Inspector Name I j Phoned 0 6 b
Reviewer/Inspector Signature: Date: to 161
o ­ I,.r 2 � 12/2R/64 Cnn6nued

Far"ility Number: 3� —dS_ Date of Inspection
Reghired Records & Documents Z c
19. Did the facility fail to have Certificate of Coverage &Permit readily available? ❑Yes �ZNo
o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C2"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑Yes /No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ll o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ,..�No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes IQ No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes V N [I NA El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El
Yes L� No ❑ NA ❑ NE
Other Issues �//
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes ter 0 El NA El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes L'J 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 E?No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑xo El NA [I NE
General Permit? (ie/ discharge, freeboard problems, over application) El—
///
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? Yes No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes AJo ❑ NA ❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

3
Type of Visit d Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: rr q Departure Time: County: J91161ij Region:
Farm Name: _
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
OnsiteRepresentative: �YALLit iMrlajF,L-i Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c Q 1 = " Longitude: = ° = , =
Design Current
Design C•unrent
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
❑ Laver
Cattle Capacity Population
❑ DairyCow
❑ Wean to Finish
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
2?tO 2 ii50
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
Farrow to Finish
El❑
Laers
El Beef Stocker
ElNon-Layers
❑ Gilts
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other,
❑ Turk- Poults
Number of Structures:
❑ Other
❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes B<o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No [INA ❑ NE
❑ Yes E�] NNo�o ❑ NA ❑ NE
❑ Yes [2 o ❑ NA ❑ NE
❑ Yes Id No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: ' —� Date of Inspection
Waste Collection & Treatment
4. Is`storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: L11460yd
Spillway?:
Designed Freeboard (in):
/
Observed Freeboard (in): 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ENo ❑ 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
1
{J 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 thrgat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes 'IY'Y/,ro ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 3/_nNo ❑ 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 ElE Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,�1
10. Are there any required buffers, setbacks, or compliance alternatives that need ElE Yes o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ErNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [I Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
El NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
ElEr Yes
,El
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
S.+' o
❑ NA
❑ 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?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�'"`•/ AMP LAY or` ZouY Ott (LCE,vJE,
•
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Phone: q14M — 3
Date: o 0
/ 12128104 Continued

Faeility Number: 31 — 25� Date of Inspection a o
Reunited Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Ea No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0*'No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
EkKo
❑ 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 El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
�ElNNo
C—J NNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
BN
[I NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ es
No
[I NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
CJ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
! N�o
[I NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[I Yes
❑ 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?
[IYes
CI No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
,�/
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
ET No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�,/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
LAN
❑ NA
[I NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number ( 2 s(� O Division of Soil and Water Conservation "
O Other Agency
Type of Visit OA6ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q' outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I I �
Farm Name: �_
Owner Name: —
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time: ) b b Departure Time: County: L TJ'J Region:
Onsite Representative: a QL-Nt M_i?Cf 1 (.%
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =,
= Longitude: = ° = I = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
0
;IJ G
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑Dry Cow
❑ Non -Dairy
❑ Beef 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 LI No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
0
N ❑ NA
❑ NE
❑ Yes
❑ Yes
,❑
l�� N/y ❑ NA
❑ NE
❑ Yes
LYNo ❑ NA
❑ NE
12128104 Continued

facility Number: 31 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 2 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
NStructure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: (.t1 6_y6
Spillway?:
Designed Freeboard (in): I ? n
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes dNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.) -
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes WNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [r No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) VI
9. Does any part of the waste management system other than the waste structures require ❑ Yes !d No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Zo
I❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ 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? El Y u s
15. Does the receiving crop and/or land application site need improvement? Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0No
❑ NA
❑ NE
90
❑ NA
❑ NE
❑ NA
❑ NE
/o
❑ NA
❑ NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Td «ze FrcL,p Td c.c.. w 560
Reviewer/Inspector Name Phone: l0 79 — %3 VW
Reviewer/Inspector Signature: Date: $ / 0
12128104 Continued

Facility Number: 3 — as Date of Inspection 1�
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes L•CI No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E�No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
No
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
,�3
❑ 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
O No
ElNA
❑.NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E,/No
IJ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EYNNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D Noo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Q No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
,D<o
L7 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
-
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,(
E No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
/
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
L�� No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
///
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El���
Yes
El32. NA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or
12128104

Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
-_ -- _. -- -- 0 Other Agency >;.
(Type of Visit 0 Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Ro❑D utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other enied Access
Date of Visit: Arrival Time: /i./ S Departure Time: County: DuoLZIOl Region:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: 0AVI�) �+IyES
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude: Q o = , =
Design Current
Design Current
Design Current
Swine Capacity Population
` Wet'Poultry CapacityPopulation
' Cattle
Capacity Population`„
,.� ❑ Wean to Finish
�I- ❑ La er
❑ Dairy Cow
f
❑ Wean to Feeder
C. ❑ Non -Layer
`' ❑ Dairy Calf
® Feeder to Finish rZ.99D
-
❑ Dairy Heifer
`
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
-, ElFarrow to Feeder
❑Non -Dairy
El Farrow to Finish
❑ Layers
�;.❑
Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
III
' ❑ Boars
Pullets
❑ Beef Brood Co
— --
❑ Turkeys
-
. Other
❑ Turkey Poults
z ❑ Other
❑Other
Number of Structures
--
—
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes , 9 ❑ NA El NE
❑ Yes �No ❑ NA ❑ NE
12128104 Continued

Ir
Facility Number: 'X — G
Date of Inspection 3 v ob
,Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA &--
/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes UNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes MeNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ZNo ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Z 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 {/J No ❑ NA ❑ NE
maintenance or improvement?
Waste Apulication
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 His ❑ 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) t3 e N) SG A
13.
Soil type(s) ALI­,A)jy_rzL,4r.
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No ❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No ❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ No ❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
ZOO wLiP C L ARE tvzrr11 iL=Lovt YJS3 NEEDS To M15 AbW (L64 15 R)v►Ko�l� �
A PPI.. 4n C.io✓ N cfL— � / 6J oilcw ;6O, rwd co -coo tS�! s F#A_. sSG a
/?&_00Xt_ V- tW OMAR- 9�0"J6- l6atb- otJEdLSE�� OA/ AL(-, 6 PULLS,
Reviewer/InspectorName I , TAJK/ 1ASPAJ(4,(,- I Phone:( 710j )7&
Reviewer/Inspector Signature:
Pane 2 of
Date:

Facility Number: 31 — 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 a components of the CAWMP readily available? If yes, check
the appropriate box. WIR ❑ Checklists ❑ Design ❑ Maps
g p ❑Other
❑ Yes ZNo ❑ NA ❑ NE
es ❑ No ❑ 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 InspectionsWeather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
I-3 NNoo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
�N
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NNq
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LfN/o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
Yes
El2
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Io
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes M�Nc ElNA ❑ NE
❑ Yes L_9 No ❑ NA ❑ NE
❑ Yes E2 No ❑ NA ❑ NE
❑ Yes PkKo ❑ NA ❑ NE
❑ Yes Ej-i�o ❑ NA ❑ NE
—
❑ Yes /o ❑ NA ❑ NE
(Additional Comments and/or Drawines: 1
Page 3 of 3 12128104

L
(Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit A Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access)� ©O Date of Visit: <P Arrival/Time:
J /— Departure Time: Sounty: 4_ / AJ Region:�C�
Farm Name: �i4Ty?ft//(.9
1S( ffCJiJ/r,P, /N Owner Email:
Owner Name: ////1% Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
PV
tj
Onsite Representative:�.d�% /�/GIGt�/i�.GIi�AV D Integrator: Az26� e
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 M' 0 Longitude: mom, M
Swine
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
I ILI Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: I Ir I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes A No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes A No ❑ NA ❑ NE
❑ Yes A No ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection l-/O7I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes y,� 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: !^Q,n
Spillway?: V�
Designed Freeboard (in): Zq,-5
Observed Freeboard (in): so
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.) io
(((
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �,(J 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? ❑ YesNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 1 Yes ❑ No ❑ NA ❑ NE
maintenance or improvement? T
Waste Application �Q
10. Are there any required buffers, setbacks, or compliance alternatives that need ElYJ Yes No ❑ NA ❑ NE
maintenance/improvement? 6
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VJ No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes A No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes A No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'•❑ Yes ONo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes JZ(No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes [ZNo
❑ NA
❑ NE
e e. 01-
47) 1,, 4, L
Reviewer/Inspector Name Phone: Z (o
Reviewer/inspector Signature: Date: &A'Z1aS
Continued

J
• Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes --"'No ❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VI 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 ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking OCrop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ZfNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
IZNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
?fNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LEI No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
32.
General Permit? (ie/ discharge, freeboard problems, over application)
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
12128104

(Type of Visit 9F Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit JdRoutine O Complaint O Follow up O Emergency Nolffication O Other ❑ Denied Access
Facility Number Date of Visit: '-I'--Y-"-- - T'me: /2
Not Operational O Bei
A Permitted E3 CeertMed E3 Conditionally Certified�- �13 Registered Date Last Operated Above Threshold:..
Farm Name: _...11 �zL1._._ _.._�ll�i liK... x1i�L � ...1.6f2.(_n County: ... VA—z!'_�......._..___._
Owner Name:
Malting Address:
Phone No:
Facility Contact: ......... -._........................... __..____.......__Title:.._....__.. ---..
Onsite Representative: ?E�' ___._._.
f%�1.Q._. L>f✓f l._.CIntegrator:
Phone No: ......
_
`mil/
„. t....�
_.......... -....... .._..(
70 ............
Certified
Certified
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' 0" Longitude =• =' ="
to F
to
V to
V to
V to
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes A No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes YrNo
❑ Yes VNo
❑ Yes FINO
Structure 6
Identifier:
Freeboard (inches):
12112103
Continued

Facility Number:. — Date of Inspection _
5.
Are there any immediate threats to the integrity of any of the structures observed? (iTe/ trees, severe erosion,
❑ Yes
�No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
No
8.
Does any part of the waste management system other than waste structures require maintenancerimprovement?
❑ Yes
VNo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
E�No
elevation markings?
Waste Apulication
10.
Are there any buffers that need maintenancatimprovement?
❑ Yes
RfNo
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes )21 No
❑ Excessive Ponding ❑PAN ❑ H drauli Overload ❑ Frozen Ground ❑ Cop r and/or Zinc
12.
Crop type �R/11&OA
13.
Do the receiving crops differ with tho a designated in the Certified Animal Waste Magagement Plan (CA )?
❑ Yes
m No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
P(No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes $] No
16.
Is there a lack of adequate waste application equipment?
❑ Yes A No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below []Yes XNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes )dNo
Air Quality representative immediately.
Comments (refer to gneshon #) Ex@ a any YES aasweis and/or any recommendations pr any ot6cr rnmmeiitss
Use _drawtgs of facility to better eaplam sttaatio _0 �dittonal,pages as necessary) ! ❑ Field Copy ❑ Final Notes
16C9/l7fin F�
I?E«E�r ,SN.4�Eo
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: / O
12112103 Continued

Facility Number: — Date of Inspection _ S
Required Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
1
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes A No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes �No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes XNo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie/ discharge, freeboard problems, over application)
❑
A No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ;dNo
28.
Does facility require a follow-up visit by same agency?
❑ Yes No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes "No
//
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Yes ❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes id No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes 0 No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes,$No
❑ Stocking Form ❑ Crop Yield Form []Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
r
ddmonal Co�tiunents and/or Drawing"s �-� �-"t �`
12112103

ANIMAL FACILITY ANNUA CERTIFICATION FORM
Certificate of Coverage or Permit Number Z I - 2-S(o
County Year 200�
Facility Name (as shown on Certificate of Coverage or Permit) ✓1 �� K T�
Operator in Charge for this Facility
�s Certification #
Land aprrTication of animal waste as allowed by the above permit occurred during the past calendar year
_YES NO. If NO, skip Part I and Part II and proceed to the certification. Also, if animal waste
was generated but not land applied, please attach an explanation on how the animal waste was handled.
Part I : Facility Information:
1. Total number of application Fields O or Pulls (ease check the appropriate box) in the Certified Animal
Waste Management Plan (CAWMP):Total Useable Acres approved in the CAWMP
2. Total number of Fields ❑ or Pulls [please check the appropriate box) on which land application
occurred during the year: % Total Acres on which waste was applied
3. Total pounds of Plant Available Nitrogen P 19 e
g (AN) applied during the Year for all application sites::
!6 9 8S
4. Total pounds of Plant Available Nitrogen (PAN) allowed to be land applied a bth`e r�'�T
the permit: _ 9 7 -2 - ni,Y y_ C.A W W and
MAR 1 4 2005
5. Estimated amount of total manure, litter and process wastewater sold or give to other persons and taken off site during the year — 6[ /P: F ny,
tons ❑ or gallons El(pleasopnate box)
6. Annual average number of animals by type at this facility during the previous year:
2Y78
7. Largest and smallest number of animals by type at this facility at any one time during the previous year:
Largest 3 (S $ 0
(These numbers are for informational purposes only since the only permit limit on the number of animals
at the facility is the annual average numbers)
S. Facility's Integrator if applicable:
Part II: Facility Status.
IF THE ANSWER TO ANY STATEMENT BELOW IS "NO", PLEASE PROVIDE A WRITTEN
DESCRIPTION AS TO WHY THE FACILITY WAS NOT COMPLIANT, THE DATES OF ANY NON
COMPLIANCE, AND ENPLAIN CORRECTIVE ACTION TAKEN OR PROPOSED TO BE TAKEN TO
BRING THIS FACILITY BACK INTO COMPLIANCE.
1. Only animal waste generated at this facility was applied to the permitted sites during ❑ No
the past calendar year.
AFACF 3-14-03

2. The facility was operated in such a way that there was no direct runoff of waste from R Yes ❑ No
the facility (including the houses, lagoons/storage ponds and the application sites) during
the past calendar year.
3. There was no discharge of waste to surface water from this facility during the past
calendar year.
4. There was no freeboard violation in any lagoons or storage ponds at this facility during
the past calendar year.
5. There was no PAN application to any fields or crops at this facility greater than the
levels specified in this facility's CAWMP during the past calendar year.
6. All land application equipment was calibrated at least once during the past calendar year.
7. Sludge accumulation in all lagoons did not exceed the volume for which the lagoon
was designed or reduce the lagoon's minimum treatment volume to less than the volume
for which the lagoon was designed.
&- es ❑ No
E I es ❑ No
@-Yes ❑ No
Yes ❑ No
❑des ❑ No
8. A copy of the Annual Sludge Survey Form for this facility is attached to this Certification. p- es ❑ No
9. Annual soils analysis were performed on each field receiving animal waste during the Pes ❑ No
past calendar year.
10. Soil pH was maintained as specified in the permit during the past calendar Year? ❑ No
11. All required monitoring and reporting was performed in accordance with the facility's
es . El No
permit during the past calendar year.
12. All operations and maintenance requirements in the permit were complied with during @'lames ❑ No
the past calendar year or, in the case of a deviation, prior authorization was received
from the Division of Water Quality.
13. Crops as specified in the CANVW were maintained during the past calendar year on all &d es ❑ No
sites receiving animal waste and the crops grown were removed in accordance with
the facility's permit.
14. All buffer requirements as specified on the permit and the CAWMP for this facility were [� es ❑ No
maintained during each application of animal waste during the past calendar year.
"I certify under penalty of law that this document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that qualified personnel properly gather and
evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of
my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and imprisonment for knowing violations."
rf
N&4� �N� a �l� -os
Signature of Pe ttee Date
different
Permittee)
Date
AFACF 3-14-03

ao�Zz&
ANIMAL FACILITY ANNUAL CERTIFICATION FORM
Certificate of Coverage or Permit Number /VC1q 231 2SL County i V V-11- Year 200-5
Facility Name (as shown on Certificate of Coverage or Permit) (V�Q C,K 10 i
Operator in Charge for this Facility 0QLQZA Certification #_ 1 8 O 0
I,aLand lication of animal waste as allowed by the above permit occurred during the past calendar year
YES NO. If NO, skip Part I and Part II and proceed to the certification. Also, if animal waste
was generated but not land applied, please attach an explanation on how the animal waste was handled.
Part I : Facility Information:
1. Total number of application Fields 0 or Pulls li (olease check the appropriate box) in the Certified Animal
Waste Management Plan (CAWMP): Total Useable Acres approved in the CAWMP
/9.a �--
2. Total number of Fields ❑ or Pulls B (please check the appropriate box) on which land application
occurred during the year: C0 Total Acres on which waste was applied / 9 0 Z
3. Total pounds of Plant Available Nitrogen (PAN) applied during the year for all application sites:
4. Total pounds of Plant Available Nitrogen (PAN) allowed to be land applied annually by the CAWMP and
the permit: n 0 7 1 .
5_ Estimated amount of total manure, litter and process wastewater sold or given to other persons and taken
off site during the year /V / i� tons. ❑ or gallons ❑ (please check the appropriate box)
6. Annual average number of animals by type at this facility during the previous year:
-Z 36
7. Largest and smallest number of animals by type at this facility at anyone time during the previous year:
Largest ;? 890
Smallest
(These numbers are for informational purposes only since the only permit limit on the number of animals
at the facilityy is the annual average n bers)
8. Facility's Integrator if applicable:
Part II: Facility Status:
IF THE ANSWER TO ANY STATEMENT BELOW IS "NO", PLEASE PROVIDE A WRITTEN
DESCRIPTION AS TO WHY THE FACILITY WAS NOT COMPLIANT, THE DATES OF ANY NON
COMPLIANCE, AND EXPLAIN CORRECTIVE ACTION TAKEN OR PROPOSED TO BE TAKEN TO
BRING THIS FACILITY BACK INTO COMPLIANCE.
1. Only animal waste generated at this facility was applied to the permitted sites d D" es ❑ No
the past calendar year. RE GF l�
MAR 0 1 2004
AFACF 3-14-03

2. The. facility was operated in such away that there was no direct runoff of waste from D-'Yes ❑ No
the facility (including the houses, lagoons/storage ponds and the application sites) during
the past calendar year.
3. There was no discharge of waste to surface water from this Facility during the past'-
El"Yes ❑ No
calendar year.
4. There was no freeboard violation in any lagoons or storage ponds at this facility during
0' lies ❑ No
the past calendar year.
5. There was no PAN application to any fields or crops at this facility greater than the
EI Yes ❑ No
levels specified in this facility's CAWMP during the past calendar year.
6. All land application equipment was calibrated at least once during the past calendar year.
E�Ies ❑ No
7. Sludge accumulation in all lagoons did not exceed the volume for which the lagoon
E;-Yes ❑ No
was designed or reduce the lagoon's minimum treatment volume to less than the volume
for which the lagoon was designed.
8. A copy of the Annual Sludge Survey Form for this facility is attached to this Certification.
❑'`Yes ❑ No
9. Annual soils analysis were performed on each field receiving animal waste during the
❑des ❑ No
past calendar year.
10. Soil pH was maintained as specified in the permit during the past calendar Year? ❑Yes ❑ No
11. All required monitoring and reporting was performed. in accordance with the facility's LT I es ❑ No
permit during the past calendar year. '
12. All operations and maintenance requirements in the permit were complied with during D" Ves ❑ No
the past calendar year or, in the case of a deviation, prior authorization was received
from the Division of Water Quality.
13. Crops as specified in the CAWMP were maintained, during the past calendar year on all Yes ❑ No
sites receiving animal waste and the crops grown were removed in accordance with
the facility's permit.
14. All buffer requirements as specified on the permit and the CAWMP for this facility were P'les []No
maintained during each application of animal waste during the past calendar year.
"I certify under penalty of law that this document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that qualified personnel properly gather and
evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of
my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and imprisonment for knowing violations."
Mack Jom1
Permittee Name and Title (tvne or Drintl
Mature of Innittee Date
a 0�
;nature Operator in Charge Date
different from Permittee)
AFACF 3-14-03

Appendix 3. Lagoon Sludge Survey Form
A. Farm permit or DWQ Identification Number
B. Lagoon Identification
C. Person(s) taking Measurements
D. Date of Measmements
31-256
Mack Jones - MJ 1
Norman Hatem
1131104
E. Methods/Devices Used for Measurement of
- -a. Distance from the lagoon liquid surface to the top of the sludge layer.
Metered 1.112- PVC d Dlsc
b. Distance from the lagoon liquid surface to the bottom (soil) of lagoon
Metered 1.112" PVC
c. Thickness of the sludge layer if making a direct measurement with "core sampler"
WA
F. Lagoon Surface Area (using dimensions at inside top of bank 1.60 (acres)
(Drawsketch of lagoon on a sepemte sheet and list dimensions, and calculate surface area.)
G. Estimate number of sampling points:
a. Less than 1.33 acre: Use 8 points
b. If more than 1.33 acre, 1.60 acres x 6 = 10 , with a maximum of 24,
(Using sketch and dimensions, develop a uniform "grid" that has number of intersection points that match most ciosiey
with the estimated number of sampling points needed. Number the grid ime segim points on the lagoon V id to
correspond with the data to be recorded for points of measurement.)
H. Conduct sludge survey and record data on "Sludge Survey Data Sheet
I. At time of sludge survey, also measure the distance from the Maximum Liquid Level
1.1'
to the Present Liquid Level (measure at the lagoon gage pole):
J. Determine distance from Maximum Liquid Level to Minimum Liquid Leve
2A'
(Determine from Plan or other lagoon records)
K. Calculate distance from present liquid surface level to Minimum Liquid Level:
1.3'
(Item J - Item L assuming present liquid level is below Max. Liq.Level:
L. Record from slludge survey data sheet the distance from the present liquid surface level
12.3'
to the lagoon bottom (average for all measurement points):
M. Record from sludge survey data sheet the distance fiom the present liquid level surface level
10.2'
to the top of the sludge layer (average for all the measurement points):
N. Record from sludge survey data sheet the average thickness of the sludge layer:
2.0'
O. Calculate the thickness of the existing Liquid Treatment Zen (Item M - Item Iq
89'
(note: If Item O is less than 4 R, a sludge removal and utiliratim plan my be required by
N.C. DWQ. See your specific permit or contact DWQ for more imforratimt.)
P. Proceed to Sludge Volume Worksheet if desire to calculate sludge volume for rectangular shap
lagoon with uniform side slope.
Completed by:) Robert B. AAitChell n) ,yQ -1; �,0�' o, Date: 2/22/04
Print Name ,- sisuaure

Appendix 4. Sludge Survey Data Sheet
Sludge Survey Data Sheet
Completed by: Brent Mitchell
Prim Name
Lagoon Idemffic tion:
Mack Jones - MJ 1
Date: 2/22/04
Si�atme
(A)
Grid
Point
No.
(B)
Distance from liquid surface
to top of sludge
(C)
Distance from liquid surface
to lagoon bottom (soil)
(C)-(B)
Thickness of sludge
layer
Ft. & inches
Feet (tenths)
Ft. & inches
Feet (tenths)
Ft. & inches
Feet (tenths)
1
0902'
092
l i uz
112
02W
02.9
2
1906"
10.5
1700'
12.0
01'08•
01.5
3
low
10.6
12W
12.6
02W
02D
4
low
10.5
12W
12.0
01W
01.6
5
11w
II.0
13W
131Y
021]0"
02.0
6
10'W"
10.0
12W
12.a
07ar'
02.0
7
09W
09.5
12'OS"
12.4
0711•
02.9'
8
0910`
09.8'
12'OCi
12.7
021V
02.4
9
low
10A
121)6'
12.6
02'()(i
02.5
10
11'04"
11.3
1710"
12.6
01W
01.5
Average
1003"
10.7
12W'
12.3
=1
02.0'
" All Grid Points and corresoondina sludge laver thickness must be shown on a
sketch
See Appendix 6 for the conversion from inches to tenths of feet.

Appendix 5. Sludge Volume WorkSheet
The average thickness of the sludge layer is determined from the Lagoon Sludge Survey
Form. In this example, the average sludge layer is thickness is 2.5 ft. The dimensions of the
lagoon and the side slope are needed for calculations. If the lagoon is a standard geometric
shape, the volume of the sludge in the lagoon can then be estimated by using standard equations.
For rectangular lagoons and constant side slope, calculate length and width at midpoint of
sludge layer, and multiply by the sludge layer thickness to calculate sludge layer volume as
shown in the example. If the lagoon is an irregular shape, the sludge volume can be estimated
by using the total surface area in square feet and taking the square root to obtain the dimensions
for a square lagoon, and then use the same procedure as listed below.
Example
A. Average Sludge Layer Thickness (T)
2.5 ft.
B. Depth of lagoon from top of bank
11 ft.
to bottom soil surface (D)
C. Slope = horizontal/vertical side slope (S)
3.00%
D. Length at top inside bank (L)
457 ft.
E. Width at top inside bank (W)
229 ft.
F. Length at midpoint of sludge layer
398.5 ft.
Lm = L - 2 S(D-(T/2))
G. Width at midpoint of sludge layer
170.5 ft.
Wm = W-2 S(D-(T/2))
H. Volume of sludge (V)
169,860 ft. 3
V=Lm Wm T
I. Volume in gallons 1,273,950 gal.
Vg=V-7.5 gal./f 3
Your Lagoon
02.0'
14.9'
3.00
450.0'
155.0'
367.0'
72.0'
52,848 ft. 3
396,360 gal.

�/oDae .moo: i
�1
h
h
/a6
�47'
/o'
f
i
�
VI
"

Type of Visit V Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visiit V Routine O Complaint O Fotlbw up O Emergency Notification O Other ❑Denied Access
Facility Number Date of Visit:
[3 Permitted [3, Certified EI.Conditionatly (Certified ❑ Registered
Farm Name: --
Owner Name:..........L.'_1.+`-_--�!
Mailing Address:
�� 02 Time: /
0 Not Operational O Below Threshold
Date Last Operat or Above Threshold: .........
Phone No:
FacilityContact: .............._.. ......__...----._._.. _ . . Title:............................................................... Phone No: ..... _................ _..................... _...
Onsite Representative: ,. _._ .__._._...-, lntearator:.�L1015 io e)
Certified Operator: . . ....... . ................... ....... . . ... Operator Certification Number.
Location of Farm:
Swine []Poultry []Cattle []Horse Latitude Longitude =• = =`
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes/No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) . ❑ Yes ❑ No
C. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify D WQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ] ] Yes )9'No
3. Were there anyy adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment �`/
4. Is storage capacity (freeboard plus stone storage) less than adequate? ❑ Spillway ❑ Yes V(No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:..........._�.................... ................. ............ ... ... _............................ ....... .......... ... .... .... _.......... ..... .................... ......... _......
2
Freeboard(inches): ....... __^)—?.................... ........... _.............. ........ _........... _............ .... ........ _.....................

—Date of Inspection
�;_Aie
the a any immed ate threats,tc the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ ( Yes No
.' - seepage, etc.)
.
6. Are there structures on -site which sr'e not properly addressed and/or managed through a waste management or
closure plan?
El Yes j� 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 maintenancefiimprovement? -
❑ Yes No
8. Does any part of the waste management system other than waste structures require maimenance/unprovement?
- ❑ Yes No
9. Do any stuctures lack adequate, gauged markets with required maximum and minimum liquid level
/—
elevation markings? ?
El Yes N0
Waste Application
(7No
10. Are there any buffets that need maintenancelrmprovement?
❑ Yeso
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydr lic Overload
-
//��❑Yes
12. Crop type -J:JfeinN
13. Do the receiving crops differ with ose designated in the Certified Animal Waste Management Plan_ (CA
)? ❑ Yes 7No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes No
b) Does the facility need a wettable acre detemm naficn?
❑ Y
c) This facility is pended for a wettable acre detetmimtion?
❑mks rN:
15Does the receiving crop need improvement?
❑ Yes [�No
16.�sthere a lack of adequate waste application equipment?
- ❑ Yes /�] No
Reouire-d Records & Documents -
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes [�No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? /
(iet-WUP, checklists, desiga, maps, etc.)
❑ 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?
❑ Yes YNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes No
23. Did ReviewerAnspector fail to discuss reviewlmspection with on -site representative?
, ❑ Yes"No
24. Does facility require a follow-up visit by same agency?
❑Yes
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? .
—— //No
❑ Yes 00
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit �
aC%mmen% re%t eafzon Lzp�3g�asjagy_¢{RSanswersandXo4z= .re..... mom ei%erawmmenis
K Vl �a...... il
Field Copy
❑ Final Notes
07�- r//i`�/ti�, J`7F � E« /1%a�✓ �-�/�,o:
��co,eos- "
IReviewer/InspectorName
Reviewer/Inspector SignatureQ/� ��y Date // a?

.0510310I -
Facility Number.
Date of Inspections/n-
Continued-'
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead annals 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 permanenthemporary cover?
E] Yes (� No
L] Yes /(�(NO
0 Yes No
❑ Yes No
❑ Yes � No
0 Yes �No
❑ Yes ❑ No
r,.

(Type of Visit om Cpliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number a ql I
Date of Visit: [
Permitted E3 Certified ONConditionally Certified 0 Registered
Farm Name: ......P♦)11 a..._!.C.`.K. .....TOY..\d.!5.......... -yin. c..r—..
Owner Name: YYY
Facility Contact:
Title:
Time: lD 017
Iperational O Below
Date Last Operated or Above Threshold: ........ ...............
County: . ...................
Phone No:
Phone No:
MailingAddress:.................................................................................................................................................. .....
Onsite Representative:.S.12.i ... ! ,L C`.1•>L. ....._';,.lrt.�.............._.4�.4�„�a.{.- Integrator:.._._lT..d. 1T3bY..`_-0.... 5_.1.�..
Certified Operator: .................................................. .................. ........................................... Operator Certification Number:.........................................
Location of Farm:
Swine ❑ Poultry []Cattle []Horse Latitude F___j- =� =<, -'Longitude =• 0, =•.
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity tyPo ulation Cattle
Capacity Population
❑ Wean to Feeder ❑ Layer Dairy
Feeder [o Finish ?- �Q ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean -
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑Boars Total SSLW;.:i
J� Number of Lagoons =;� j ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holdrng•Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �Kno
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min? — /VA'
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
I Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ' -No
01/01/01
Continued

Facility Number: — �• Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ANo
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ......... a:...l.....................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, []Yes �4 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes %No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) J
7. Do any of the structures need maintenance/improvement? ❑ Yes 6� No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes p \N0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level \-
elevation markings? ❑ Yes RNo
Waste Application
10. Are there any buffers that need maintenance/improvement? []Yes /No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ,s
12. Crop type � tt '-� C9
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes XNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes -ZNo
b) Does the facility need a wettable acre determination? ❑ Yes rA;allo
c) This facility is pended for a wettable acre determination? ❑ Yes � o
15. Does the receiving crop need improvement? ❑ Yes 6E5No
16. Is there a lack of adequate waste application equipment? ❑ Yes ,�I.o
? -tJ-y-es--$No--
a er supp y we wt m e oun aryl--�nkno No
_Required Records & Documents
19. Fail to have Certificate of Coverage & General Permit or other Permit readily available? []Yes A No
20. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes JJNO
21. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) []Yes KNo
22. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 6KM
�
23. Did the facility fail to have a actively certified operator in charge? ❑ Yes I/��
2(No
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
o
25.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
;!�iVo
26.
Does facility require a follow-up visit by same agency?
[]Yes
f jNo
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
3!�No
Odor Issues
28.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
[]Yes
'VIo
liquid level of lagoon or storage pond with no agitation?
29. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 12y No
01/01/01 Continued

Facility Number: -1 Date of Inspection
Printed on: 1/4/2001
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon?
32. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
33. Do the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes No
❑ Yes
❑ Yes Jgcblo
❑ Yes 9.90
❑ Yes XNO
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
I&AUJAM

r;
V vrwsron or -on ana water: t.onservatton vper•anon tcevrew
E3 Division of Soil and Water`Conservation Compliance Inspection"
]Division of Water Quality - Compliance Inspection -
0 Other. Agency - Operation Review
M,Routine O Comulaint O Follow-un of DWO inspection O Folloe-up of DSWC review O Other
',. Facility Number �, ' I Date of Inspection
"Dime ofinspection d 24 hr. (hh:mm)
13 Permitted 0 Certified 13 Conditionally Certified ❑ Registered 113 Not Operational Date Last Operated:
Farm Name: ...._!..`.� -� v1 ......,J..G 'S ......_ County :............ .... ..\_
........................... .................................................... C� p/p.................../................................
Owner Name: Phone No:..._\(_\..'...1�D...gp.1/3.............................
Facility Contact: Vl_a?.".2'J............. Title: .....l. ..✓ ...... Phone No:...IL.L' b Sg .I
MailingAddress: ............................................................................................................................................................t ..........................
Onsite Representative:........ �l OtiQg.......................................................... Inte-ratin .....
T/� (� .. ...............
W.....:..... ....�J...............................................................................
Certified Operator:
Location of Farm:
Operator Certification Number: ..........................................
Latitude =' =' =" Longitude =• =' ="
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder 10 Layer I ❑ Dairy
Feeder to Finish 10 Non -Layer I JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'!
b. If discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier:
Freeboard (inches): a'�
....................
1 /6/99
Structure 3 Structure 4 Structure 5
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
(N�Vo
❑ Yes
KNo
❑ Yes
1noNoL
Structure 6
Continued on back

�!'s
acility Number-3 � —a 6 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 maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauecd 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 of over application? ❑ Ponding Nitrogen
12. Crop type !K �s4s...........�.`5..7....�. .... I.......0
0
❑ Yes 0No
❑ Yes �(No
❑ Yes NrNo
❑ Yes t<No
❑ Yes XNo
❑ Yes � No
Yes []No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes )4 No
14.
Does the facility lack wettable acreage for land application? (footprint)
- ❑ Yes
Wo
15.
Does the receiving crop need improvement'?
❑ Yes
XNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
�ZNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
WNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
OYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0 No
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
O No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
NrNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
tff No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
0 No.vWation§ or. deficiencies .were noted dtirin'g.tliis visit:. Yoti will.reeeive no ftirili& . -.
I.
ctirresjtbtideitce:tibbitt:thisvisit.: ; '•'• ' • •' '.'.''.'.'•'•'•'•'•'•'•'.'•'•'•'•'•'•'•'•' ....'.'.'
Comments (refer to question #):" Explain any YES answers and/or any. recommendations or any oilier comments
Use drawin s of facility to better, explain situations. (use additional pages as, necessary):,,
t� A5
o�/ec� ( c"Q
cid �
'It --,fit �.�� .�-e �-�� �� ��, pie
1 � �e 9 � ecL
hh {{,��,�� ve, � �e. f e�1 l 1 lI1� j
h) lk V`-cn-.Q '" C/P��iG\C� Wt-SI �'1CvQ C�-Vr`i�ti\ \'•PPG�1 MhIN rlcisSn�S.1'\cYtt'6�.
Name
s Y&&�
Reviewer/Inspector Signature: L� �_A. v� Date: 3 /)- 1 1 I1/6/99

Division of Soil and Water Conservation (3 Other Agency
Division of Water Quality
Routine O Cum laint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection O
Facility Number
111111 Time of Inspection 24 hr. (hh:mm)
0 Registered Certified 13 Applied for Permit 0 Permitted [] Not Operational Date Last Operated:
Farm Name:...., G �" 1 � %i.- .......................... Count\.`.�...................................................
...`.................�.................................... y: .....q..... ^P/.
Owner Name.......... .............................................................. Phone No: ...,,,l�q^tO - S3 3
.....................................................
FacilityContact: .............................................................................. Title: ....�..............p........................................... Phone No:...................................................
Mailing Address: ... 2q �7."�A
..... 4. �hct�2l...... CI.....a .:._QXwe�� �......` 3�5................... ..........................
OnsiteRepresentative%....Y`.'5. ..��t.gE................................................. Integrator: ........1.-. _ G........................................
CertifiedOperator:.................................................. .............................................. ............... Operator Certification Number:.........................................
Latitude 0'=`=" Longitude =• 01 0"
Desrgn
7=Current,t� ° Design Current' Design Current.=
Svnne
CapacityvPopulalion
Poultry Capacity Population Cattle- . ; Capacity ,Population
°10 Layer ❑ Dairy.'.
k ❑Non -Layer ❑Non -Dairy
❑Other,
Total Design'Capacity':
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
N Total SSLW
❑ Boars
''c
Number of twos! Holdt Ponds
❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
r"
❑ No Liquid Waste Management System T
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
WNo
2.
Is any discharge observed from any part of the operation?
❑ Yes
4No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
ONo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
0 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
KNo
3,
Is there evidence of past discharge from any part of the operation?
❑ Yes
CZNo
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
KNo
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
I(No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
KNo
7/25/97

1 acility Number ��
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes XNo
Structures (La2oons.Holdine Ponds, Flush Pits. etc.) /
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes IgNo
SWcture l Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ............. �.tu l
Freeboard(ft):.._........_'_'...-(....�...1L
.......................:..................................._.._...................._._...._.........._.............._........_.........................................
10.
Is seepage observed from any of the structures?
❑ Yes
E[No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
Ig No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
O 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 markets?
❑ Yes
($ No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
MNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
1 \
15.
Crop type .!�...... f..-�. 1 f.... c!„�f...._rc�E....�.....�
............... ...............................................................................................................
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
ig No
18.
Does the receiving crop need improvement?
t,Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
MrNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
tQt N0
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O No
22.
Does record keeping need improvement?
&Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the,Animal Waste Management Plan readily available?
❑ Yes
IM No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
E�No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
A No
0•
No.violationsor deficiencies.werenotedduring this;visit. You:will ieceive-ito•further :"
.'
correspoudeuee about this.visit:
t $) co�s��� �25 VWaA (-,Q2d !^ lye
Sj (ale. C
7/25/97
Reviewer/Inspector Name
Ma
Reviewer/Inspector Signature: � `x'���__ Date:

'. ❑ DSWC Animal Feedlot Operation Review n `>
�ODWQ Animal Feedlot Operation Site Inspection tx
Routine 0 Com laint 0 Follow-up of DWQ inspection 0 Follow-up of DSNC review 0 Other
Date of Inspection (�
Facility Number
..,......ilit..,...........: be Time of Inspection � 2A hr. (hh:mm)
E3 Registered 1p Certified' M Applied for Permit 0 Permitted 0 Not Operational Date Last Operated:
FarmName: .... Da.v..J..t/�'A4K...miS....... X�trm............................................. County:.../.. .............................................................
OwnerName: ..........%Pn............1�nnRS........................................................................ Phone \o:..l �tl��... ..-li3.....................................
Facilitv Contact:....J1Nl1aJc:...sQ.!uS.....................................gTitle:........Qriihttf........................................ Phone No:(q/.y�...�.r...-5i3.�.3..........
Mailing Address:...... �3Zr...... ijtact,r......�ita 4.........PU :.............................. .....At ....... 011J..G_O.C�.................................... Z$ .
Onsite Representative: ..... &ViA..... ..30K.S.............................................................. Integrator: ...... & 44)_.Lr.a......Kx
Certified Operator:............!.LG.J:....M�........ lAa.vs..................................................... Operator Certification Number, ...._.....!_SO .
Location of Farm:
Latitude Longitude =• SL `="
Design
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Gilts
Boars
Number of Lagoons / Holding Ponds C
Poultry Capacity Population Cattle
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dail
❑ Other
Total Design Capacity
Total SSLW
Subsurface Drains Present
apacity. Population
2 F0
3$S B'bo
❑ Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
N1No
2. Is any discharge observed from any part of the operation'?
❑ Yes
[ANo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'
❑ Yes
[ANo
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
❑ Yes
V1 No
c. If discharge is observed, what is the estimated Flow in gaUmin?
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ)
❑ Yes
P No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
'9 No
4. Were there any adverse impacts to the waters of the State other than from a discharge'?
❑ Yes
19No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
UNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? -
❑ Yes
J4 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
C&No
7/25/97
Continued on bad

I•aality Number: 31 — ZSG
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Stncctures (Lagoons.tloldin ! Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:................................................................................................................................................................................
...................................
Freeboard(ft):........zA......................................................................................................................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes
1ANo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
O No
12. Do any of the structures need maintenance/improvement?
❑ Yes
gNo
(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
.4 No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
Dd No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type........00U.X.........................................SQy6 ..................... ........... ...... ... ............ -'jo.bauo................................................................................
16. Do the receiving crops differ with those designated in the AnimalWasteManagement Plan (AWMP)?
MYes
❑ No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
0 No
18.
Does the receiving crop need improvement?
❑ Yes
j@ No
19.
Is there a lack of available waste application equipment?
❑ Yes
allo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
' yLNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
R No
22.
Does record keeping need improvement?
gYes
❑ 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
E4 No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
F1No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
V1 No
No.violatiwn§ dficiencies ere noted during tis,isi.ill reeeo further.,
. .. . . or . ...e
. .. deficiencies. . w.. .. drihv
. . . .. . . . .t....Youw
. .. . . c. .iv. .n. ...
correspotidence about this visit.,.
N. TOVQCto set beans1i4r�e lh r'telds desya-eJ , Corn, iTo" ^ ow'� soybeans .76
h� txJdt,d ce4kAe) p[axt• (l
LZ. Updaw so,l 04 WOSyt- 75: "-all'Sts 5h64 be it. ccr�:'( �A 01h - Sprw,� t-ccard"
S%ouP 6— �`'1'� l I rolr ruM6et—evwd AelI V\umber up34tz IRK-2 {bro, none{ ly.
7/25/97
Reviewer/Inspector Name
ReviewerfInspector Signature: h i« / �- /A/A„ Date: