310282_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: (/Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: D County:
Farm Name: J {`}� �j�L•�� si" Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: t ion&aln A 09�
Certified Operator:
Title:
Phone:
Integrator:
I l{r1 Region:
Certification Number: 1 I i e I
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design Current Design C►urrent
Design Current
Swine Capacity Pop. Wet PoultrT Capacity Pop. Cattle
Capacity Pop.
Wean to Finish Layer Dairy Cow
Wean to Feeder
tD4
I
INon-Layer
I El Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
tci Non -Dairy
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers
I Beef Feeder
Boars
Pullets
I Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
[—]Yes 0 No
❑ Yes ❑ No
[::]Yes [:]No
❑ Yes No
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

21
Facili 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 [DNA ❑ NE
Structure 1 Structure 2. Structure 3 Structure 4 Structure 5 Structure 6
Identifier: R I 1A t - DO D p2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
k 30 3o
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes PrNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes VNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
No
❑ Yes 2�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No [DNA ❑ NE
maintenance or improvement? r
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes F No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes J2'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ZrNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ONo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes J2'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
❑ Yes Jallo
❑ NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
2 1. 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 Po ❑ 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

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ 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 _124o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes ❑ NoNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes J^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 ;2-f4o ❑ 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 ;2 f4o ❑ 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 _[24o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage-Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [�o ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes�No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes'Q-1qo ❑ 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 expla `Atuafions'(use addrttonal;pages as` necessary):.
D Z� f
Reviewer/Inspector Name:VM&At Phone: fci (01
Reviewer/Inspector Signature: Date: -7 21
Page 3 of 3 A 21412015

Type of Visit: Q Co�fipliance Inspection V Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: C Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 1D Departure Time: © County: 1) 7 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: ,/� 4yh ,,'Tift'le: /�
Onsite Representative: '-fora TIW� � 'jy u Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 17 ! -�
Certification Number:
Longitude:
Design C►urgent
Design
Current
Design C►urgent
SwiifM apacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,Oultr,
Ca acit
P,a
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E�J/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �o
[] Yes o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

I.FacilityNumber: - Date of Inspection: off$ (,
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: (j tAC064jvL U&eod Do) -
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '1 o ;y
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
ZNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E:fNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
VNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[]
❑ NA
❑ NE
t nt�
mam enance or tmproveme
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E2 /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 ryo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [' o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes KN
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes I_.d `moo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�—�,� , ❑ NA
[2'<o
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
F2-N/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
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
N ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No ❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Vacility Number: j I - Date of Inspection:
'24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z'Uci❑NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �(No ❑ NA ❑ NE
Other Issues
No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes V
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes O No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
ZNo
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
C] Yes
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes �o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes fNo
❑ NA
❑ NE
34, Does the facility require afollow-up visit by the same agency?
❑Yes o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers.and/or any additional recommenditions:©r,any, other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Q i e
Date: g g &
2 4/20 5

Type of Visit: (Z) Coliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: U Routine 0 Complaint Q Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: c ®6 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: J-0"n bAIJ W-ILLEPI-1
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish I ILayer I
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder I INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean Design Current
Farrow to Feeder D , P,oul Ca aci P,o ,
Farrow to Finish ILayers
Da"j Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts Non -La ers
113eef Feeder
Boars jPullets
Beef Brood Cow
Turke s
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No
[:]Yes ❑ No
[:]Yes ❑ No
❑ Yes ❑
[:]Yes
[:]Yes VNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA 0 NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility Number: - Date of Inspection: X 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 I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: Wu 1 LA60 001 0
Spillway?:
Designed Freeboard (in):
r�r
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 environment I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes FVNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes to ❑ 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?
/No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 0
❑ 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
IVNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes '
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes �o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes }o
❑ NA
❑ NE
Required Records & Documents
N
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[3 Yes �VNo
❑ 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 U140 ❑ 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? ❑ U
Yes '� ❑ NA ❑ NE
f
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

FaciliV Number: - J.V, Date of lns ection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2j'*No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 9No ❑ 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:
❑ Yes No ❑ NA ❑ NE
❑ Yes Ca"No ❑ NA ❑ NE
❑ Yes / No ❑ NA ❑ NE
❑ Yes O/No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ej No ❑NA ❑NE
No ❑ NA ❑ NE
To ❑ NA ❑ NE
Comments (refer.; to question ft Explain any. YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional oases as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
NOW
drQ
Phon� b0
Date: i
21412015

Type of Visit: C3 C
o Hance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ly Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: /J AN > Integrator:
'1 Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design Current
Design urrent
C
Swine Capacity Pop.
Wet Poultry Capacity Pop.
p.
C►attle Capacity Po1111
Wean to Finish
La er
Da' Cow
Wean to Feeder
Non -Layer
Da' Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Cunt
Kr: Le
D Cow
Farrow to Feeder
Dr,P,oul tr, Ca aci_ P,a
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
I
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
IOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: T
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes a ❑ NA 0 NE
Page I of 3 21412011 Continued

Facili umber: - 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 [DNA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: N r66g�al i A6,obyJ 3 c q
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 6 30
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 3 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? [:]Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E,3 /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes VN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 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
❑ YesVN
❑ NA
0 NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall 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 6/No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

FaciliNumber: Date of Inspection: 914
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
VN° ❑ NA ❑ NE
o ❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 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 o ❑ NA ❑ NE
i
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes N ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes No ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional, recommendations or any other comments.,' I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: �1V�N 6W&Phone J(/ X'— Jq?
Reviewer/Inspector Signature: Date: -R /i q / (�
Page 3 of 3 6 I4

Type of Visit: (ff'Com} lance inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: 1, Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ' } ,., Title:
Onsite Representative: �ONiart�] 1 f LJ.t-t-E rL
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone:
Integrator:
Certification Number: 11 l im
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
DairyCow
Da Calf
DairyHeifer
Design
Capacity
Current
Pop.
Wean to Feeder
f
Non -La er
Feeder to Finish
Farrow to Wean
Design Curren#
DrF P,oul Ca aci . P,o
La ers
Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turke Poults
Other
Beef Brood Cow
11111
Other
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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
[DNA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ o
❑ NA
❑ NE
[:]Yes
WNo
[DNA
❑ NE
❑ Yes
�ylo
❑ NA
❑ NE
Page I of 3 21412011 Continued

IF;ciHty Number: 5- Date of Inspection: q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[—]Yes
Ca/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: (-,A G40 01 LAG6om 1, L.A&" 3 �71J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q Lj 4 Q LI b -3)
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EjNo
❑ 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
Cj/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 environmen I threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
El YesgNNo
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
dN o
❑ 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?
/No
11. Is there evidence of incorrect land 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 101bs. ❑ 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 E6o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Fft'40 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ZNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes [�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes EKo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes UT�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes L'J 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
M 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

Facility Number: - Date of Inspection: Z. 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 6 <No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes No. ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ��No [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
❑ Yes ZNo ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
O N
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
Z�o
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes❑
NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�70
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments:
Use drawinus of facility to better explain situations (use additional hazes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone(%t0b —7 3 1
Date: A zy,
2/4/20 1 1

Type of Visit: @j Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance j
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access I
Date of Visit: Arrival Time: Departure Time: I 11= County: 17Uf �k% Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: (4,-Q I.& , Integrator:
Phone:
Certified Operator: Certification Number: 1 l_g -7
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Swine
Wean to Finish
Design Current Design Current
Capacity Pop. Wet Poultry C*apacity Pop.
Layer I
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Q
-Loo
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
De, Paul. C•_a aci P,o
Layers
Pry Cow
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
IN
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)?
❑ Yes d No ❑ NA ❑ NE
❑ Yes ❑ -No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 2� ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes rNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: " - Date of Ins ection: a Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Z/No 0 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: (A stV& / cArr03 tk-42
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 5 � 'I - 36
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 U No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes EEI/No ❑ NA ❑ NE
maintenance or improvement? ,
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes g/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 290
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
0 Yes No
❑ NA
❑ NE
Reguired 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 I 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
r
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 permit ❑ Yes � ❑ NA [3 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 9To ❑ 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
ff No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
F34
❑ 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?
WNo
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
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 CAWIVIP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [�/No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ Yes
YNo
❑ NA
❑ NE
No
❑ NA
❑ NE
N
❑ NA
❑ NE
o
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional: recommendations.or.any other. comments
Use drawings of facility to better explain situations (use additional pages as necessary), i"_:
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
214,12011

(Type of Visit: Q VRoutine
pliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
isit:Reason for VO Complaint O Follow-up O Referral O Emergency C) Other O Denied Access
Date of Visit: ll Arrival Time: � Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: I AtQt a_ &&t,Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Cattle
Design
C►specify
Current
Pop.
Wean to Finish
Wean to Feeder
La er
Dai Cow
Non -La er
Da Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design Current
DrF P,oultry Ca acih' P,o ,
Layers
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pultets
Beef Brood Cow
Other
OFTO-ther
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes Zo
o ❑NA ❑ NE
Yes
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - 2
Date of Inspection:'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. if yes, is waste level into the structural freeboard? ❑ Yes
�No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 1 Structure 27 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: � LA(� (� La r,003 3 IA& !� �P
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
[2/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 environm7vo
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
WNo
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
[DNA
❑ 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
�7N�.
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
U(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
[2/No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check ❑ Yes PAo ❑ 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 ❑ 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

11,
Facility Number: - Date of Inspection: it
24,. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes wilo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�] o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes rNoo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E 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 Q 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 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 [2j"No
❑ 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
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.•.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
}a'j a Phonet 96M1 /3 0 u
qZL� Date: i
21 011

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:
Departure Time: �y n� County: L! Region:
Farm Name: IOU
t
4�LE I-k*"ITC- ITC- 14 f 1 FC{Z loot Owner Email:
Owner Name: �1i('iQl,�� L]A1L Phone: Clio -QC&1J_S9_50
Mailing Address:
Physical Address:
Facility Contact: ,,, r f vlTitle:
Onsite Representative: - AV `1 �'�'� «L
Certified Operator: i A L-
Back-up Operator:
Location of Farm:
Phone No:
integrator:
eratIrPertificationNumber: )�
Back-up Certification Number:
Latitude: = 0 = i 0 « Longitude: = ° = d = u
Design Current
Design Current Design Current
Swine CGapacity Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
JbWU13
JE1 Non -Layer I
Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Layers
❑ Farrow to Finish
Non -Layers
❑ Beef Stocker
El Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
El
El Beef Brood Co
❑ Turke s
Other
❑ Turkey Poults
1 10 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
qk No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
*o
❑ NA
❑ NE
❑ Yes
Of No
❑ NA
❑ NE
12128104 Continued

Facility Number: ) —!gj Date of Inspection 13T/o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes XNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3- Structure 4
Identifier: w W N' bDI
Structure 5 Structure 6
Spillway?:
,�+G
Designed Freeboard (in): P . S
Observed Freeboard (in): 1�C 3 C? �l4 yQ
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes KNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes *No ❑ NA ❑ NE
m aintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes kNo [I NA ❑ NE
Cl Excessive Ponding ❑ Hydraulic Overload El Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ofAcceptableCrop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ►L7 Q- �P� !3 �-1 45 C tr►e (P
13. Soil type(s) AUT 9SA(11 t-c f- L-a �6 S 7dAi(
V
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
Pk No ❑ NA
❑ NE
Cotnments (refer: to question #)::`Explain any,-YES:answers and/or any recommendations or- any other comments"
Use drawings of facility twbetter explain situations. (use additionallpages as:necessary)
Reviewer/Inspector Name W.4m0A AIN6' ✓R Phone: )Q/ _� 7�'% �d�
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number:' --(PIUCLE Date of Inspection O
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
XNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
XNo
❑ NA
❑ NE
the appropriate box. Q WUP ❑ Checklists ❑ Design U1 Maps ❑Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
XNo
❑ NA
❑ NI✓
0 Waste Application 0 Weekly Freeboard Q Waste Analysis 0 Soil Analysis ❑ Waste Transfers ❑Xnual Certification
[] Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections 0 Monthly and 1"
Rain Inspections 'El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
gNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ 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
XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
////❑ No
gNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
} No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
General Permit? (ie/ discharge, freeboard problems, over application)
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
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
5Iw41K) Jci 99 -0.9% a.q
C14 ugeQ r1W 't,4(1
�41 1 of bb # Q L pGao,A1 CJ_SICIUS TtZN 6E- LoaK_Efl AT 3 T1zL N� S
t (LiawFACL - LooL rnr7o A
5wwc IN 10> I t'Q 1s COU--> �___ubucH T6 ASK (76�_ U- Ignp)ow
Page 3 of 3 12128104

Type of Visit 'Compliance Inspection O Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit 36Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: (4C�o! �Departure`T1ime: County: IA/ Region:
Farm Name: N_ry-, �0LAQ a i F'E(Z 1 Swner Email: c�
Owner Name: 1V C�Q UeJCbD_ � l L Phone: 9 )0' Q&_3 b 3 d Xa
Mailing Address: "la-` MA O=E (,IL & /y C D 2- SCQ I
Physical Address:
Facility Contact: Title: Phone No:
On site Representative: tsg�G LAN1 E R-- _ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = c = f = S, Longitude: = ° 1:3 ED
Design Current
Swine Capacity Population
❑ Wean to Finish
Design C►urrent
Wet Poultry Capacity Population
❑ La er
Design Current
Cattle Capacit—APopulati
❑ Dairy Cow
® Wean to Feeders
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
El Beef Feeder
❑ Boars
Pullets
❑Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑Other
Numher 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 KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
[INA
[:1NE
[_1Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: —n}229 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes kNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structures 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �� - S • S _ . S 19 • S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA [INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes 9No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes o
❑ NA
❑ NE
maintenance or improvement?
I \
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes SNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ;No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) !7 Oq_ (C-") �-- 5 (_��
13.
Soil type(s) ALt !. FAA
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 jqNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes R No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes 4No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes ±"o No
❑ NA
❑ NE
GST ca
`o9 01C CAR-17-*%
CKD PSIMS +01C4C:7/0F
W.4.
D� 1
SJ D `aL
wH t
LA_ 0�
w j ))c
�,
�. Co
9, G
�.
9l1-009
�-�
a•$
�•�
3.�
LRevviewer/Inspector
er/Inspector Name I Phone: 91� 7[rjSignature: Date:
Page 2 of 3 12128104 Continued

Facility Number: 3 — a Date of Inspection
Required Records & Documents
19. Did the facility fail to have 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 XVo ❑ NA ❑ NE
the appropirate box. 0 WLIP ❑ Checklists Design 0 Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard [El Waste Analysis 3 Soil Analysis ❑ )4ste Transfers ❑ A/ival Certification
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
%,No
ElNA
[INE
ElYesto
ElNA
El NE
El Yes
El NA
El NE
❑ Yes
0,,No
❑ NA
❑ NE
❑ Yes
❑ No
�kA
❑ NE
❑ Yes
R�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
JqNo
❑ NA
❑ NE
❑ Yes
,O No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
Additional Comments and/or Drawings:
a
Count Ica ee 5 fl t (47 t� I-) 2,7,q ✓) aN To c_3q TOI --
���1 �
Page 3 of 3 12128104

3 Division of Water Quality
Facility Number I �f ` f3 Division of Soil and Water Conservation �—
O Other Agency
Type of Visit (Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 16 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: y Arrival Time: Departure Time: County: GI Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: La/vie NIL- Integrator:
Certified Operator: Nei ei 1-WW 6 % L— Operator Certification Number: r
Back-up Operator:
Location of Farm:
0
Latitude:
Back-up Certification Number:
="
Longitude: = ° =' =
Design. Current Design Current ii
.: Design; Current
Swine Capacity PopulationWet Poultry Capacity Population Cattle Capacity P..palation .3
❑ Wean to Finish
Wean to Feeder 1d L106 80
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
QTurkey 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy!
❑ Beef Stocker
}
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures -
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of
❑ Yes ,M No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[I Yes
J0No
El NA
El NE
❑ Yes
ONo
❑ NA
❑ NE
12128104 Continued

FacilityNumbcr: 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes -4 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): �j. S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes k 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 00 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions"were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste ADnliCation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Dallo ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > l0% 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 NJ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 26 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):
1 ` m & T 6 uL T" s" c- S/gwq c E F0 a- t 0 -4 '4 ?L l w, -UGC-( (AL b.S ' d(D 5cx(- Sf� M
L� 0 Fa C a C s4- Cz
yre�eA-N oN LOIJA
Reviewer/Inspector Name _ — _ " q - — - - — - — � Phone: 73 6
Reviewer/Inspector Signature: Date: Y/19 d2
Page 2 of 3 I2128/04 Continued

Facility Number: ( Date of Inspection y 3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA XNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 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 6fNo ❑ 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
JoNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
56 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Co No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
El No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Do No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
X 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
J4 No
❑ NA
❑ NE
General Permit? (icl discharge, freeboard problems, over application)
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
No
❑ NA
❑ NE
Additional. Comments and/or Drawings:
Page 3 of 3 12128104

t
-s
0 Division of Water Quality
Facility Number % Z g 0 Division of Soil and Water Conservation
0 Other Agency`
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: J� /Z/p J Arrival Time: } rc� Departure Time: i County: /V Region: ��
j
Farm Name: �f/Rt-r Y,� / A/1!h _5 Owner Email:
Owner Name: A/f k9 1c0 0 VZ7 .�/ zr L Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: `JCL Phone No:
Onsite Representative: �I/>�f ��i`u-��/ Integrator: /_/—'E�P��'r'
Certified Operator: 1yGTi�G�— Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = o = f Longitude: 0 ° = ` = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑Non -La er
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Otber
❑ Other
Dry Poultry
layers
Non -Layers
Pullets
Turkeys
Turkey Pouets
Other ----.."— -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current.
Cattle Capacity Population
❑ Dairy Cow
DDairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ 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 Ff No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number f�
Date of Inspection?
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ NA ❑ NE
❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 11 �ZJ
Spillway?: /va No No yA9
/ _ Designed Freeboard (in): l 9, j 5
Observed Freeboard (in): 32-
❑ Yes eNo
❑ Yes ❑ No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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 J0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes F1 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift Application Outside of Area
12. Crop type(s) /L^SCC�� �Q /�iEl�/Y1GP�O i9— C r2 ZE �'U • ��v��5���
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes gNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ;?j'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes RfNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes'0No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ,dNo
❑ 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):
ReviewerlInspector Name !� Phone: /0> 7 9!c ` 732;z
Reviewer/Inspector Signature: Date: 2
l6/Ld/V4 Lonunuea

Facility Number-1-3/ Date of Inspection Z
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
gfNo
❑ 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
ONE
Other Issues
.0
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
General Permit? (ie/ discharge, freeboard problems, over application)
`
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
Z No
❑ NA
❑ NE
Additional Comments and/or Drawings: C
4
V /7�d1,0 lip
�r ��Gp ✓y�d' �� �o i uJ��nJ / .4� n-`_ s
16- �c�' .3! C��•►�n �r
I2128,104

r Division of Water Qualit y /
Eac�lttyNumber E=—D
O Division of Soil and Water Conservation
0 Other Agency
TJpe of Visit Compliance Inspection 0 Operation ReVieW 0 Structure EJatuation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Hollow up 0 Referral 0 Emergencl 0 Other ❑ Denied Access
r
Date of Visit: Arrival Time: %4� Departure Time: 'pD County: �pL Region: O
Farm Name: /-� - Owner Email:
Owner Name: �O/2trJGl� / Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 9 Phone No:
w�AVAWA/
Onsite Representative: �I�,� Integrator: ,
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: ❑ o ❑ ❑ Longitude: ❑ ° = 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer QU ❑ Non-Layet
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
ElNon-Layers
El Pullets
❑ Turkeys
ElTurke Poults
El Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ DairyCow
❑ Dai Calf
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify D WQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes V1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes /No ❑ NA ❑ NE
❑ Yes /No ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment 7
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure2j Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 'a,�It " e2V "06 �Z �, 1 Z
oa
Spillway?: _ �O /yO G "
Designed Freeboard (in): 85 R1
Observed Freeboard (in): 90 3& Z 3 35
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes,/ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
%Window ❑ Evidence of Wind Drift Application Outside of Area
12. Crop type(s) / /�.:�'[/f I i4ZI�� i6.,., Om_,) 5a
13. Soil type(s)
r
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Oyes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes Vj No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes VNo ❑ 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):
r4�raE lVf�;o pis V-D4 Ii Os,54o ED.
8�3//a5 5axz_ 7�r V5hrv4JA0 %Jim A4_' 6(J Z rc�
ReviewerlInspector Name I r Phone: q/d- ram%-726
Reviewer/inspector Signature: ✓ Date: & 0_&
12128104 Continued

Facility Number: —Z Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropiiate box.
❑ WUP El Checklists El Design El Maps El Other
❑ Yes /No ❑ NA ❑ NE
ElYes CdNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
/No
❑NA
❑ NE
❑ Waste Application ElWeekly Freeboard ElWaste Analysis ElSoil Analysis ElWaste Transfers El Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[/No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
01,]No
ElNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA ONE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
, ,(
I[JNo
ElNA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
ElNA
ElNE
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
ONo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
X No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Aftf 6MI-40
r
04no
21)
TTfi<z f,(jZ T,-It /6�j:_22 A 5 00�NV
12128104

Type of Visit CF Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 1 a Tune:
Facility Number 3 Z 8 Z
Q Not Olperational O Below Threshold
Permitted [Certified C3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: _.
Farm Name• - Countyp
Owner Name:
Phone No:
Mailing Address:
Facility Contact: . ___ ... _ _ _.. __ _. _ . Title: ._ _ _ _.... Phone No: ...... ,, , .
Onsite Representative: �� T bA� L --.- Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 4 Du
Design Cm'rent NAP `d Carrent Design �Cnrrest
Swine
-
r` r
po >tion �9# =Po an: ,.Catte
Y�i
-
Non -Dairy
El
0 Gilts
t —
w..
'^'
ON
— 1'� Ltd, '.'Lem
L
can to Feeder
oa
�O �
Layer
Feeder to Parish
Nan -Layer
Farrow to Wean
�.� Other
Farrow to Feeder
to Finish
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 S
Identifier: ___.� ...._.... _ W N -2-a . Q ..._ .. .... ��...
Freeboard (inches): 3� 36 (A 3 `1
❑ Yes 13 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
2�No
❑ Yes
[�io
❑ Yes
12 No
Structure 6
12/12/03 Continued

Facility Number: 31 -- 292-1 Date of Inspection ! g a y
5. -Are there any immediate threats to the integrity of any of the structures observed? (die/ trees, severe erosion,
❑ yes
CNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
[I Yes
eNo
' 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 maintenancelimprovement?
❑ Yes
dNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ yes
[!(No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancefimprovement?
Cl Yes
No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
[Er/No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type F&5c.uv_ LG Sen-MVA
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWW)?
❑ Yes
o
9No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
❑ Yes
o
c) This facility is pended for a wettable acre determination?
❑ Yes
WNo
15. Does the receiving crop need improvement?
❑ Yes
&NO
16. Is there a lack of adequate waste application equipment?
❑ Yes
E' No
Odor Issues
dNo
17_ Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ yes
liquid level of lagoon or storage pond with no agitation?
disposed 24 hours?
[JINo
18. Are there any dead animals not of properly within
❑ Yes
19. Is there any evidence of wind drift during land application? (i.e- residue on neighboring vegetation, asphalt,
❑ Yes
ETINo
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
O No
Air Quality representative immediately.
y y�\.-•v--Y y�ts'�z �-�:�--..=��� f' :q�,�, ="--gJ �. - -
tqrq es�o3i lfl s� airy 1 E&7' 'i ifiilil9` 7 � a ca
_
,.. .. _
�idse dry of fty,to better slam{ a �txo�nal gag as wry) i ❑ Field Copy ❑ Final Notes01
p �'^ •y, 9� SY -+�_ ""4^.y"q ,yam...»«,. �` '4^..:--v.—+.-'f;..e,....--:ae-s"'"��'==
ALI
rAx)-,-&tt- b1 uaT R-re SC-.tiC V i 3 Eva PC--f;-w.E:r A" U tiT, v,/Ne+J C OvA&S UC- sua.b r'o
JQDATG {'qr�-►•r�nlc o� 4UEw �oR,n^3. C6firAct guar- t UATEtt. � (.PC, Wttoi•J& PC&Sa0.
U P DATA 71.1 f_­ Twa' wrA sT'(-- PLAOS LQ-to Of'JC, FAA t T Y UNI)ER. o►JE NtnnbEl� .
FAa-F , ANC V-C- GOV-1 s ZY4J Gaz t, An"(—
ReviewerAnspector Name
ReviewerAinspector Signature: Date: i
12112103 Condnued

Facility Number: -3 i '— 2.8x. 1 Date of Inspection f o
9equired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
922. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N;PDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes E�No
❑ Yes [TNo
❑ Yes �No
❑ Yes E3/No
❑ Yes �io
❑ Yes 040
❑ Yes E34Qo
❑ Yes rNo
❑ Yes
❑ Yes (NNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Forth ❑ Crop Yield Forth ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit .Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit J&Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: Time: i �r'
Facility Number /
Nat Operational 0 Below Threshold
M Permitted Wertified © Conditionally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: �(/�3�y11�1P �• t ci/hi� County: A, It
Owner Name: y4 1 Alk-'a In/Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Phone No:
Integrator: A& r ?
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' � �" Longitude 0 ° l�u
Discharges & Stream Impacts
t. Is any discharge observed from any part of the operation? ❑ Yes rN No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any 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
S cture 1 Stgructure 2 Structure 3 Strc�e 4 Structure 5
Identifier: —Vffl �l%it C_
Freeboard (inches): a6 54
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes %No
❑ Yes IgNo
❑ Yes 93 No
Structure 6
Continued

L
Facility Number: 3 — 2j2
Date of Inspection 2 Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Anulication
❑ Yes 01 No
El Yes � No
❑ Yes allo
❑ Yes VgNo
❑ Yes bNo
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
QNo
11.
Is there evidence of over application?? ❑ Excessive P`onding ❑ PAN ❑ Hydraulic Overload
❑ Yes
& No
12.
Crop type f U +Q t�(-,-1 , &�'41Rda eGo _5;AG%l /r7'4 �h �r1rSP P�
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[KNo
14,
a) Does the facility lack adequate acreage for land application?
❑ Yes
G,No
b) Does the facility need a wettable acre determination?
❑ Yes
®No
c) This facility is pended for a wettable acre determination?
❑ Yes
[SNo
15.
Does the receiving crop need improvement?
❑ Yes
25 No
16.
is there a lack of adequate waste application equipment?
❑ Yes
�0 No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ER No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
J�LNo
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
91 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
U.No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
o
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
El No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
NNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #) Explain any YES answers and/or any recommendations or any other conimeafsc. ,
J
kUse.drawmgs of facilityto better explain situations: (use additional pages as ne(.*essary) ❑ Field Copy ❑ Final Notes
:r
o [ g6; l 5 [ sl1� .A' 1d # 3 h Pads i, z % 6t,h e. � 49/6l ' S heeds
74r1n V- keC6rjs are- f Pt f�M4� o Shy v
Reviewer/Inspector Name �— Q
Reviewer/Inspector Signature: Date: Z Zg 6S�
05103101 Continued

. r
Facility Number: 7J -"L Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes E No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes k[No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ,® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 91 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 0 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ® No
5100

Facility Number Date of Visit: O Time: DO
10 Not O erational Q Below Threshold
Permitted 13 Certified [3 Conndditionally Certified © Registered Date Last Operated or Above lThreshold:
Farm Name: !���..... Y........ /rn x� County: � ...... . .........._...._
Owner Name: ... .1. ` ,P94VM.A.......:` 11 ........................ I............................. Phone No: ................ .............. ................ .......... ... _... » » ....».
FacilityContact............................................................................... Title:................................................................ Phone No:...................................................
MailingAddress: ................ . .............................................................
Onsite Representative: , ! �� ......Y..l L..................... ................. ........ Integrator:....AWK6:'!.X':.t�.......................................... ....
Certified Operator:......................•-••...................................................................................... Operator Certification Number:..........................................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �" Longitude �• ��u
Desrgo Current Design Current _ DestgnY: Cierie�trt
Svnne Ciiaci'- .Po ulation Poultry 2 Cii aii ._Po uktlon Cattle Cs act ;`TPo elation .
Wean to Feeder ❑ Layer I ❑ Dairy
❑ Feeder to Finish -= ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish TotalDes CS Ci
❑Gilts pa ty
❑ Boars Total SSLW
Number of in
❑ Subsurface Drains Present C� Lagoon Area .
yHolding Ponds / Sollid Traps . ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
Spray Field Area I
❑ Yes .ffNo
❑ Yes ❑ No
❑ Yes ❑ No
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
❑ Yes ❑ No
❑ Yes 8 No
❑ Yes J No
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes RrNo
S�tr)uc urie 1 jS�trru�c/ture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ••-... (�{� ......[.................. f1{/./f7� ...................stl �j. ............... 2���.................
....................................
..........................
..........
Freeboard (inches):
5/00 Continued on back

Facility Number: !g Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes j2TNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes .0 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes JYNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 0 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
11. Is there evidence of over rplication? 1❑ Excessive Ponding ❑ PAN ❑Hydraulic Overload ❑ Yes XNo
12. Crop tyl� /I1lf z1/9
13. Do the receiving crops differ with those designated in the Certified Animal
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Plan (CAWMP)? ❑ Yes r No
❑ Yes
PNo
❑ Yes
VNo
❑ Yes
ONO
❑ Yes
FNo
❑ Yes
(� No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Q•viQlatMns:oi dtfeiencies -wgrp po(ed jJ06ng tbis'vis}tt - Yoo wili•l�ee¢iye Rio #'ui-tit�r'
corresporidei c' e: a�tit this visit` ....................................
Welo
s necessary) , w
�FGrJ S r7Q
❑ Yes LNo
❑ Yes XNo
❑ Yes ErNo
❑ Yes AEOL
❑ Yes ZNo
❑ Yes O No
❑ Yes ONO
❑ Yes Zrl4o
❑ Yes 2rNo
7b/ 64 M
KIP �r,E�ER P ,�-l�T AVO M UtJ rr4 lea4p5' eoot
.�F Ivy C�i�✓ate GoCfIT! �h�1'i Cgi0) 7 5—Dd o ZZI�
&t*_;rr*E �V Nxr pa,6_
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Q 5/00

Facility Number: —Zg Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes .b No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes O No
28. Is there any evidence of wind drift during land application? (Le, residue on neighboring vegetation, asphalt, ❑ Yes Ko
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Z<o
[Additional CoTn eats and/or ravings: s _ - -
N07-,F5 a4eleW
tr
IZI
�a. 14, ,�96
�-
` .X
a
5100

.r
16 Routine O Comnl
Follow-up of
Facility Number $ 2-
Permitted © Certified 0 Conditionally Certified
Farm Name:......if......... ...............................
Owner Name:
Facility Contact:
ection 0 Follow-up of DSWC review 0 Other
ir. ire
Date of Inspection
Time of Inspection ®24 hr. (hh:mm)
© Registered E3Not O erational Date Last Operated:
County:....... ........ .11...'::. .
Phone No. ..... !d�.A ...... T.............
Title: ....................................
................ Phone No: ...................................................
MailingAddress: ................................................................................................................
Onsite Representative: Ix
Certified Operator:
Location of Farm:
.................................................................................. ........... I..............
Intel;rator:........ t ..............................................
Operator Certification Number:,,,,,....,,
Latitude 0 & 44 Longitude ` ` 64
Design'- - Current
Swine
Ca act Population
WeantoFeeder
IQ Gp
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Destgn Current
Poultry Capacity: : Pooulation Cattle Capact Po ulation
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy _
❑ Other
,Total Design CapacYty
Total'SSLW
Number of Lagoons ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holding Ponds/Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes P(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 gaUrnin?
d. Does discharge bypass a lagoon systcm' (Ii' yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Wo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [XNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: p 1 IDD ra-- k o ! W t s a-
1 rreboard inches `� N "� u
( ) .................7.........._............."'............._...._.-............................. :..1..........................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �(No
seepage, etc.)
3/23/99 Continued on back

Facility Number: —5S-5- Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes )q'No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Oyes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? )<Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? PLYes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there eviden of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes 2(No
16. Is there a lack of adequate waste application equipment? ❑ Yes O No
Rcuuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes 19No
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 Wo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes t<No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes jX No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes Z No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
' (ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
9No
24. Does facility require a follow-up visit by same agency?
❑ Yes
XVo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
0: Cio yiolaOdris'oir deficiencies mere noted• during 4his;visit. • Y;oir will•reeeiye do uii-th,Er;
corredpondenee' about: thi :visit:
Comm(r ents efer to gttestignl#)c -Explain any ,YES.answers-and/or any recommendit�ons or`any'other comments:=,
Use :drawings of--:facility,;to better ek6lain situations (use additional -pages as necessary)
Reviewer/Inspector Name
Reviewer/Inspector Signature:
t,.
S�3940-
Date:

1

Facility Number: 3 — }. Date of Inspection �Q V
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
WYes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
KNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
El Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
O(No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
qNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
ONo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
ff No
Additional Comments °an or -Drawings::.QLk
� t
e

o��� w ArFR pG
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Norwood Dail
Double D Farms
407 Maready Road
Chinquapin NC 28521
zg�
Michael F. Easley, Governor
William G. Ross Jr.. Secretary
North Carolina Department of Environment and Natural Resources
August 5, 2003
Alan W. Klimek, P. E., Director
Division of Water Quality
Subject: Application for National Pollution Discharge Elimination System (NPDES) General Permit
Facility -Number 31 - 282
Dear Norwood Dail:
The Division of Water Quality (Division) has been required by the U.S. Environmental Protection
Agency (EPA) to develop a NPDES permit program for animal waste management systems. The
Division has developed a general NPDES permit similar to the state Non -Discharge General Permit that
this facility is currently permitted under. Coverage under the General NPDES permit will be required by
all facilities that are at, or above, the federal threshold numbers of animals listed below, as well as any
facilities that have had a discharge to waters of the state since January 1, 2001:
Federal Threshold Animal Numbers:
2500 Swine greater than 55 pounds in weight
10,000 Swine less than 55 pounds in weight
700 Mature (milking cows or any cows that have calved) Dairy Cattle
1000 Beef Cattle in confinement
30,000 Poultry with a liquid waste management system
55,000 Turkeys
125,000 Chickens other than a liquid waste management system
82,000 Laying Hens other than a liquid waste management system
According to our records this facility meets the federal threshold for a NPDES permit. If you are
currently operating at a population above the threshold numbers please sign and submit the enclosed
NPDES Short Form B — Existing Facility. Please carefully follow the instructions on the form.
If you are currently operating this facility at a population below the federal threshold you may choose to
submit the enclosed "NPDES Short Form B — Existing Facility" for the design capacity of the system as
it is currently permitted. You may also choose to request a new Certificate of Coverage under the State
Non -Discharge Permit at a population below the federal threshold. Should you choose this option,
please submit the enclosed "Request for Modification to Existing Certificate of Coverage for State Non -
Discharge Permit" application and updated WUP reflecting the population change. Please note that if
you are issued a modified Certificate of Coverage for a lesser population, any future increases in
population would require a new permit from the Division prior to increasing the animal population.
Non -Discharge Permitting Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
Customer Service Center
An Equal Opportunity Action Employer
NCDENR
Internet httpJ/h2o_enr.nc.state.us/ndpu
Telephone [phone] Fax [phone]
Telephone [phone]
50% recycled/10% post -consumer paper

Please submit one of the enclosed applications within 60 days from receipt of this letter. If you choose
to submit tha "Request fnr Mnrlifii stir— to Evicti— C—tfor nt t N " a
_,_ .�. � J UJI%.ati> of Co-CvverayG 1L Le IN UII-U1 11dI1J. C
Permit" application you must include an updated WUP. If you are unable to obtain an updated WUP
you should submit the "NPDES Short Form B — Existing Facility" for your current permitted population
and request a permit modification at a later date when you have obtained a new WUP. Failure to
submit the application as required may subject your facility to a civil penalty and other enforcement
actions for each day the facility is operated following the due date of the application.
If you have any questions about the NDPES permit, the enclosed applications, or any related matter
please feel free to contact Duane Leith at 919-733-5083 extension 370.
M. Paul Sherman, P.E.
Cc: Duplin Soil and Water Conservation District
Wilmington Regional Office, Division of Water Quality
Permit File NCA231282
Permit Application File NCA231282

Division of Soil and:Water•ConservaonQperation Resew N
Division of Sod and -,'"Tate; -Co` Compliance Inspec4on
Division of Water Quality 'Compliance Inspection W
Y
- ,Other Ageney OperationReview` _ f w -
Routine 0 Complaint 0 Follow-up of DWO inspection 0 Follow-up of DSWC review 0 Other
Facility Number EMD—EMIEI Date of Inspection 5 `T
Time of Inspection I ME24 hr. {hh:mm)
Permitted [3 Certifi d 13 Conditionaliv Certified [3 Registered JE3 Not Operational Date Last Operated:
y ^..........................
Farm Name: Q ... County: -.... 1.................................................
Owner Name: .. .... ........................... Phone No:.............--.....
.......................... .. l .......-.............-.............. \yr �� p -/760
1Facility Contact:.e
MailingAddress:......................,.............................^............................................................... ...................*....-............................. ...-..................... ..........................
Onsste Representative:.... e1 - ........ Integrator:......
.. �..�........................................................�.....?.............................................
Certified Operator:................................................................................................................ Operator Certification Number: ............................. _...........
Location of Farm:
....................:..............._1..--..--.--.....-....-..........-...................................---...........-•---......................-...........-..........................................-..-..-.-..-...-.....-.
Latitude . 0 f �•� Longitude • ° 44
Design Current De'sign� Current ;- Design Current,,
.aoacity Population: Capacity Eonulation . `" Cattle _ -Capacity Population
Wean to Feeder
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts{
f l Boars
Number of Lagoons
4101ding Ponds / Solid Traps
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
it. If discharge is observed, was the conveyance man-made.'? ❑Yes ❑ No
b, If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? Cl Yes &No
3. Were there any 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 storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure I Structure 2 Structurerr3 Structure 4 Structure 5
Identifier: ��Da {{ S k m�W4 L W �\ a'
Freeboard (inches): ............t...........-...................1............... 3�. .... ..-....i...
5.'Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
Structure 6
❑ Yes bNo
Continued on back
3/23/99

i
er

Facility Number: — �Q�] Date of Inspection
-- 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenarice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of o W application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�4.viUlatidris :Or- &ficlenries -*QrC Voted- dim iltg tbis'vlslt; - Y:oi► will •feceiye rid fufth&
..................................
COrresj)ofidenceUt. .al)Othis Vlslt.'.'.'.'.'...'.'.'.'.'.'.'.'.'.'.'.'.'.'. .'.'.'.'.'.'.'.'.'.'.'.'.'.'.'I
[:]Yes XNo
❑ Yes 0 No
❑ Yes [(No
XYes gNo
❑ Yes VNo
❑ Yes t4 No
❑ Yes N(No
❑ Yes 4Wqo
❑ Yes 5�rNo
Ayes ❑ No
❑ Yes K No
❑ Yes P(No
❑ Yes XNo
XYes ❑ No
❑ Yes � No
❑ Yes O No
❑ Yes J9 No
❑ Yes KNo
❑ Yes t� No
❑ Yes 14 No
❑ Yes (gNo
_ -...-
Comments ("refer tq,;question #): Ezplaio any YES answers and/or'any recommendations oFany`other comments:
-. _.
Use drawings of facilitv. to --better explain situa4oias . {use addition alpages as.necessary)
cz
r-�� � .� � r,-.�.,� � ►-fit � � ►--��_
j L7
ei� A,
Reviewer/Inspector Name __'
Reviewer/Inspector Signature:
c=39s'3�C 0 �. _aC
Date: 1
.^ 3123/99

• 1`
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Facility Number: 3 —�,�'� Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of property within 24 hours?
❑ Yes
PYNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
XNo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
1'No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
WNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
'Yes
�No
3/23/99

i;�

C
Facility Number a a Date of Inspection
Titre of Inspection � 124 hr. (hh:tnm)
[I Permitted © ertified © Conditionally Certified [3 Registered [3 Not Operational Date Last Operated:
FarmName: ................................................. .... County: ....... !............................ .-.....................
Owner Name:.. ......,tl..f%i/��` .. �L Phone No: ...........................................•'..................................
Facility Contact: ............. ........................... Title:.......................................-.............-.-........ Phone No:
Mailing Address:
Onsite Representative:........................................................................................................... Integrator: ..... in�t
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude Longitude
Design Current ; ° Design Current Design Current
Swine Capacity Population: Poult
ty p _rY . Capacity _Population , Cattle Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
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 tnan-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, Dues discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: � !�
Freeboard (inches): ...............;.f..................._.........-................................................................................................
."
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.}
3/23/99 Continued on back
k

Facility Number: — Date of Inspection®
6.-Are there structures on -site wliiA are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level X
elevation markings? Yes ❑ No
Waste Annlication
la.
Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
12.
Croptype
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reuuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, 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
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
U.Ni) violaEititi:s.0- deficiencies were noted• during this -visit' • Y:o4 witl•reeeiye lio further
cori•esporidei�ce: abhut: this visit:.: .
Co' ffi_ nts (refer to question'. #)—Explain any YES answers and/or Any recommen(Iations. orany other comments:
a:
Ijse, deawings of.fAcilityAb better explain situations (use additional pages as; necessary).,y}
AL
hile
rr
re- s4
e, - su a�
Reviewer/Inspector Name f -
Reviewer/Inspector Signature: _,iA. AlTV Date:
3/23/99

m
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-� 14 C00N
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:1V
Embankment Sliding?
(Check One, Describe if Yes)
Lagoon Dike Inspection Report
1 e2 9
"I 01F VP
o�d Names of Inspectors
Freeboard, Feet C�
eyCr5CTop Width, Feet
rl _ t
` Downstream Slope, xH:1V
Yes No
Seepage? Yes_ No- - ...; L' DJC
(Check One, Describe if Yes)
"—A
Erosion? Yes X No
(Check One, Describe if Yes) 1 1 (1 f
(?fx 4 C n O
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
�C t r ly <6 0
jGr e o �S
Yes 4 No If Yes, Depth of Overtopping, Feet
Yes No
Yes No t
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes
Other Comments J i �e _ ice, ' C_ w/ -So
No
c �r..
v.- j �al C_
ono �5 � c s ec, 5/1 /°,, Po -

Lagoon Dike Inspection Report
Name of Farm/Facility
Location of Farm/FaciIity
Owner's Name, Address
and Telephone Number
Date of Inspection 5 Names of Inspectors r,-A,�N CJ✓
L/, -C
Structural Height, Feet 6 Freeboard, Feet
Lagoon Surface Area, Acres �ee_ revs, S.0 ^ Top Width, Feet 0
Upstream Slope,xH:IV Downstream Slope, xH:1V .
Embankment Sliding? Yes' No
(Check One, Describe if Yes)
Seepage? Yes � No_ - . GL ��[Z,� r 1`n e (r
(Check One, Describe if Yes)
L.>c i/ K ., 4 c.,
Erosion? Yes No
(Check One, Describe if Yes)
I 1 j
Condition of Pr V S D J 41 Q a C/_
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes :A - No
Engineering Study Needed? Y Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments / � Q We /-� G C S U
P1__f,e
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3
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Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH:1V
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Lagoon Dike Inspection Report .d
8eiv��
>rrC Or—,ri� I
Follow -Up Inspection Needed?
Engineering Study Needed?
15 Names of Inspectors (fA AJV V
Freeboard, Feet
r'evc. $ e Top Width, Feet
Downstream Slope, xH:IV oC.
Yes No
n 1.
1
Yes No-.. L. x 5C2>%. Lr, ,L c LA-0
Yes K No
0 0 j 7, / ( cz 1-o c//, J /),'A e— '
Yes A No If Yes, Depth of Overtopping, Feet
Yes C No
Yes No ;
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
1 \ 1
Other Comments r d e A o 4 v re 'F Q J
/' n ! 10— �

Lagoon Dike Inspection Report _qc?l
Name of Farm/Facility UL
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Names of Inspectors
;c, k
Structural Height, Feet S / Freeboard, Feet
Lagoon Surface Area, Acres e �Top Width, Feet l
Upstream Slope,xH:IV . S 1 Downstream Slope, xH:IV
Embankment Sliding? Yes No
(Check One, Describe if Yes)
Seepage? Yes No D CG'� I , n e
(Check One, Describe if Yes)
Erosion? Yes No
(Check One, Describe if Yes)
Vegetative Cover `f
(Grass, Trees)
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes Y-­—No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments 1 J t
�/ /S
1.��
L �''� S
o
CX
kOCrA I
/� d�
PCJ
r

[2Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
10 Routine O Complaint O Follow-up of DWO inspection O Follow-up of OSWC review O Other I
Date of Inspection jgjq
Facility Number
Time of Inspection .rtd 24 hr. (hh:mm)
0 Registered ® Certified © Applied for Permit [3 Permitted 10 Not O erational Date Last Operated:
Farm Name:
.......... `.✓..e:'6ia......... b....... �:t!:&x.............................................................. Count y:.....4lr..............................................•..................
Owner Name: ... N.t r.!_%-j..........�a.............................................................................. Phone No: � 14. . 32311......... J.. � ................
Facility Contact: ..... .....�ai................................. Title: -- ..---... Phone No: .............
MailingAddress:...... zpZ........ r_...Q+E1ln,Y...... "t.......................................................... ..... + G y► lii....5............................................... Z 511...........
Onsite Representative: .... l-tom.. - 4
..±:.. .... �+.�....................................................................... Integrator:....... �(.�1t1r�.............................
} f
Certified Operator:..----... !st�h5�1.... + :......... a.` ..................................................... Operator Certification Number:.. AL33.........................
Location of Farm:
:. Q►t'�1s....1. ......P.11...... P. 9st.... �....G....... ► ......i. i%.. ?...........r+► s..... .............................................................. �.... r-a off.. ............. �
.................. .................... ........--.---......--.. .............................
Latitude �' ®� �3 Longitude �• �®"
Design Current Design Current Design Current
Swore , Capacity Populationi, Poultry _ " Capacity Population Cattle CapacityE. Populattan .,
EQ Wean to Feeder
tU aoD
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer ❑ i
❑ Non -Layer I❑ Ni
,H
❑ Other
Total Design Cal
Total S
00 " {
,u, Oo0
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes I9 No
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify 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)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoonstholding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes 53 No
❑ Yes No
❑ Yes] No
❑ Yes 10 No
❑ Yes 50 No
❑ Yes [Z No
❑ Yes 1ANo
❑ Yes No
❑ Yes No
Continued on back

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Facility Numher: ' 3i —
8. Are there lagoons or storage ponds on site which need
to be properly closed?
❑ Yes ® No
Structures (I.a2ootts.Holdina Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less
than adequate?
❑ Yes ki No
Structure I Structure ?
Structure 3 Structure 4
Structure 5 Structure 6
Identifier: iiJ ..�..........................W.�.:L......................D.
....
.........................Q-DAn.............
.... .......................
Freeboard (ft)=..........Z.................................. -L:............
........ ..�:�......I.......... .e7-G..............
........................
10. Is seepage observed from any of the structures'?
❑ Yes i8 No
I I.
Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes
® No
12..
Do any of the structures need maintenance/improvement'?
Yes
❑ No
(If any of questions 9-I2 was answered yes, and the situation poses
an immediate pubtic health or environmental threat, notify D1VQ)
13.
Do any of the structures lack adequate: minimum or maximum liquid level markers"
❑ Yes
55 No
Waste Application
14.
Is there physical evidence of over application'?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15.
Crop type .......... k!-................... we.P>tiJ.a........................ .............-Sh!�s,.i�...t;YL. n................................
...............................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)"
❑ Yes
ONo
17.
Does the facility have a lack of adequate acreage for land application?
h
❑ Yes
.® No
18.
Does the receiving crop need improvement?
❑ Yes
No
19..Is
there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
®Ne
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative"
❑ Yes
0 No
22.
r
Does record keeping need improvement?
(� Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste :Management Plan readily available?
❑ Yes
® No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
I@ No
25.
Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
❑ No
03 No.violations or de dencie's.were note'd-during this.visit. lou.wiil receive no further
correspondence about this.visif.,:
Cotitments':(refer to question ##): ;Explain any YES -answers and/or'any recommendations or any other 6'.m:tnents l?
Use drawings of facility to better explain situations..(use additional pages as necestiary ),.
(�- q W S 0e 1 ar alb -Cora( �&50-*Is sWA l-,,e ttstdtJ. iv, it, C�tn, (A,r,6- d�i/vav,, av`
,aAtcx+ t�l•{ Z Sin.o��� �e2-. rrpa�r[e. ,
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t0. r-ki I �rl l'q � • tLi �l v, l Oath v�. Urw_ � UVY[Lt M &I Por eN t� - V ve 0--
7/25/97
Reviewer/Ins ector Name
p
Reviewer/Inspector Signature:— 1 Date: 'a,

State of North Carolina
Department of Environment, �CE"IVED
Health and Natural Resources • • .
Division of Water Quality SEP 2 9 1997 IIA4
A -Oft
James B. Hunt, Jr., Governor BY
Wayne McDevitt, Secretary p E H N F=I
A. Preston Howard, Jr., P.E., Director
September 25, 1997
.MEMORANDUM
TO: Wilmington Regional Water Quality Supervisor
FROM: Sue Homewood 4
SUBJECT: Notification of Facility Number Change
The following changes have been made to the Animal Operations Database. Please make
appropriate changes in your files.
Facility numbers 31-282, 31-377 and 31-673 were combined under one facility number; 31-
282. Facility numbers 31-377 and 31-673 were deleted from the animal operations
database.
Facility numbers 31-676 and 31-677 were combined under one facility number; 31-676.
Facility number 31-677 was deleted from the animal operations database.
If you have any comments or questions please feel free to call me at [phone] ext 502.
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

Date of Inspection Ilr
Facility Number Z.
Time of Inspection 00 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review 3 L
(� Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: ...._ ...._........ _......._..... __......_..... _............�..........._ ..... _
Farm Name: _ .�tii� .._.h...12.1 als.._t....... ......__...._._............. _..... County: _..i..1117)ir,... ......... .... .... . _ ...
Land Owner Name: ....xf�51.... D►1 __.� ................... ........... Phone No: .....................................
� t - 1 4$— 5511
Facility Conctact:. D.. i�Itsi .. :... ... Title: .....t��. Phone No.
Mailing Address: . ( �42�5 ._ _.... ..... �.... .._...�.._ .................... r)q jl�tl�. ! ...._...... .... �i__......
Onsite Representative:....... 04 � r 1
�r....... .....n.....;I..............__....... _..... ........_. Int tor:._..---- ....----- _------ ._..-----
......
Certified Operator:!?.:!A . ...... ......... .......:..... .._..... ....., Operator Certification Number:-110.,—,..... .........
Location of Farm: r
..... Fla. ...... L, .......0 .2—.v!Lt(,c.s._.. . Fou,
Latitude �• ®u Longitude ©• ®�'
Type of Operation and Design Capacity
DesignCurrent ;Design= Current S`[festgn CuiTent -
�Swrne Ca acr P�o ulatioplfry .. Ca a`citvvPo s' ilationn Cattlek Ca acf Pa alation
„ �$1Wean to Feeder D EEO]La er x< O D
❑Feeder to Finish ❑ Non -La er In Non -Dairy
Farrow to Wean �-
Farrow to Feeder �Y TvtalDeszgnCapaeity tjZp
171 Farrow to Finish ,gyp =j� L1� 3
�.
AxM :. :. a SS O IV
FP _:.,3''"'";:#',a;. .. ,.0 e.,. ...ss- ._.. •, 3'�'- :9 'fir"
Sf
IR
Tv `#
Number of Lagoons 1 Holdtng�Ponds 2- ❑ Subsurface Drains Present
4
Lagoon Area Spray Field Area
T
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water`? (If yes, notify 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)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
[:]Yes ® No
❑ Yes 0 No
❑ Yes 9LNo
❑ Yes JA No
❑ Yes 0 No
❑ Yes %No
❑ Yes 19 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes M No
Continued on back

Facility Number:Z.71..
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La`oon-and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ....... .................. ...... -.... C:M!L s l........ 6KlCls?
❑ Yes
P No
❑ Yes
%No
❑ Yes
rXiNo
Yes
® No
Structure 5 Structure 6
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilittees Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
Firn}am'nnu YFC ancwerc`anri/nrand rPrnn
3ther cottiments:
❑ Yes ;3 No
❑ Yes �&No
❑ Yes 09 No
❑ Yes EgNo
❑ Yes ONO
❑ Yes IRINo
❑ Yes No
❑ Yes ® No
❑ Yes JA No
❑ Yes 1$ No
❑ Yes Ca No
❑ Yes [,No
❑ Yes CR No
J, Yes ❑ No
4up 1\J,n t)m6r' aw) field VnVm r-
Reviewer/Inspector Name x.. 'p<k, ,•
Reviewer/Inspector Signature: Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97