310283_INSPECTIONS_20171231

2 V
NORTH CAROLINA
Department of Environmental Qual

7
Type of Visit: UCO lance Inspection U Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: l'Arrival Time: f? h 1 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
C�. C'G G„
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
W an to Finish
Current
Pop.
I
Design Current
Wet Poultry Capacity Pop.
I Layer I
Design Current
C•attie Capacity Pop.
Dairy Cow
—Twean
to Feeder
1
INon-Layer
I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Design Current
D P,oul.. Ca aci P,o ,
Layers
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
1pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 [ A4_o ❑ NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
[:]Yes ❑ No
❑ Yes E;60
[:]Yes [ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - Date of inspection: 1-
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M_No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3
Identifier:
Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P40
❑ 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 ZNo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �To ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes Ej<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?
❑ Yes No ❑ NA
❑ NE
Required Records_ & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No,, ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need ' provement? If yes, check the appropriate box below.
Yes ❑ No ❑ NA
❑ NE
❑;�nfall
Application Q Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
a ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections Q 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? ❑ YesF3-No__C] NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E2<0 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesC3-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes [] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [3r A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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 the 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
E o r] NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1'� ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ❑ NE
��No
Comments (refer to question,.#); Explain any_YES answers and/or any'additional recommendations or any other comments.
Use drawinzs of facilitv to better exDlain.situations (use additional Dazes as necessarv).
5°t I
hrp�.
r per(
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
I/' `-t c 1, L- 01 n--r__ A S C C C a 14 ."e^ 4"C
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rt 60' r-1-S
cq4 1, /&c o- ems
1� 6 `" I C I e9 "e l l 19 n C c+ C r r_) 04---
G tr %
Tp_'_�k
Phone:
Date: 7
21412015

Type of Visit: (DToinptiance Inspection Operation Review O Structure Evaluation O Technical Assistance
Id Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ` Arrival Time: Departure Time: J p County: Region:
Farm Name: Q Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ��i� fl f4 (4" Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pap.
Dairy Cow
can to Feeder
1.4,0 C
on -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
IJ . P.oult , Ca aci Po
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ff'No
❑ Yes �fNo
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: '7 - Z Y 3 1 Date of Inspection: Q
Waste Collection & Treatment
-DNA
4: Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ago
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
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 environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑`No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ]"No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ENo ❑ NA ❑ NE
'16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes aN o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes tNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [7f No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [nf No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
2!. Does record keeping need improvement? If yes, check the appropriate box below.6-'Ve�so 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 Q N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NoNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - %a jDate of Inspection:
24. Did tke 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 ['_]�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
Gist structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Erles ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No DIA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [�o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes dNo ❑ 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 fNo ❑ NA ❑ NE
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 ❑ NA ❑ NE
FNo
Comments (refer'to question ft Explain any YES answers and/or any additional.recommendations or any other comments:. . ; '
Use drawings of facility to better explain situations (use additional paces as necessarv).
r y
6-\() sol /�. G (ys, f Or, F,e J 3 0
�._ Re S-j "rWP C,e S< d -4 p if _ c� �, & P ', (0,1C ern r.
Reviewer/Inspector Name: U�_L/ ! � V-� I-4' i
Reviewer/Inspector Signature:
Page 3 of 3
Phone: '1M D 7 1 G 73 r Li
Date: 11�� /Jb
21412015

zfl-i
Type of Visit: (DTompliance Inspection U Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: S" t" -1—
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
14�-s7yl
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
Z 4b
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
Dr. Pooult . C_a aci P,a ,
La ers
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
keys
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 ff No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes E 4 o ❑ NA ❑ NE
[::]Yes E`go ❑ NA ❑ NE
Page I of 3
21412011 Continued

•[Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes to ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [] NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E2,Ka
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes E]-<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ErNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Q/No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes S No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E3-KD
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or l0 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 [v] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable 6/yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ErNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3"'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
E(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.
U3Yes
❑ No
❑ NA
❑ NE
rd ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Application ❑ Weekly Freebjj;0
❑ Waste Transfers
Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield Minute Inspections ❑ Monthly and 1" Rainfall Inspections
Ej Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
CZ(No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(Ef"No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili • Number: - 2 Date of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check es ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
QT-a-il'ure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ETI or ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ffNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes L._.I 1"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 �o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ❑ ❑ 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
0,N6'- ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWIvIP?
❑ Yes
©No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
Er 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).
/6i Ha5 f\ 014 of j'C'I'9AA'" no J QA
r-ct �` i,f^� 0I 1z0 n�� nn5la- +��S qr► f AA
2
� n� 5 Ck�3e S µ J n.. 1
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t7L-c� Q�i'�►Ln�� b�flcd�C�
a- Are
���c br•�,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1. 0' r G 7 3 0 I
Date: & ! .5-
21412014

.r �J
- Division of Water Resources
Facility Nnmiler ©- .28` 3 zivQDision of Soil and Water Conservatio
Other n
N Agency
Type'of Visit: Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: AEM"outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t Arrival Time: ' e- Departure Time: County: Region: fL�.
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: ���_ Integrator:
Certified Operator: Certification Number: '791-7 G-1
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design
Wet Poultry Capacity Pop. Cattle Capacity
Layer Dairy Cow
Current
Pop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Dry Cow
Non -Dairy
Layers Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
❑ Yes ' ll� o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes dNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ONo
❑ NA
❑ NE
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)
❑ Yes JI__I No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
No
❑ Yes�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 - 1 21412014 Continued

Faceli Number: - Date of inspection: '
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
• a. If yes, is waste level into the structural freeboard? [:]Yes ('No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):("2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P�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 21"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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 1e3No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ;5,1Go
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) TT
9. Does any part of the waste management system other than the waste structures require [—]Yes 2-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes fNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes J'N`o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes .0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
M. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ETNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes �a No ❑ NA ❑ NE
❑ Yes [/] No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes ONo [DNA ❑ 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 J�TNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [:]/No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

-.ie i
Facility Number: - I Date of Inspection: r
,213
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No
02�.,
sthe facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E� No
Other Issues
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
/❑'No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[� No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
r
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better exvlaW situations (use additional oases as necessarv).
Reviewer/Inspector Name
Reviewer/inspector Signature:
Page 3 of 3
V
All
r
Or�rdw r
T
Phone: 1
Date: ?
4

Type of Visit: —C'Compiiance Inspectiou 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 2rRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /;to/j,3j Arrival Time: Departure Time: County: / Region:
Farm Name �, _ 1 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Q
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: /),I�
or
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
airy Cow
Wean to Feeder
Non -Layer
airy Calf
Feeder to Finish
Design Current
D , P,oult . Ga aci_ >E;o .
Layers
airy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Li—ot—her
Turkeys
Turkey Poults
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q'No [DNA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes-fn-No •❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [7[-No ❑ NA ❑ NE
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 ,e'Rio
❑ Yes ❑E Vo
❑ Yes hlo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

JF261ity Number: - Date of Cns ection:
Waste Collection & Treatment
41Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes J'No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes �No
❑ NA
❑ NE
Stru�ctu�reJ 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ff No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes J'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',[�JNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes _ffrNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes .ff 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 �io ❑ 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 ❑ Yes ,_-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes,,4D-No ❑ NA ❑ NE
❑ Yeses ]-No ❑ NA ❑ NE
Rem[ uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes -No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes,,Q.4+Fo ❑ 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—ED.No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes—Ea'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �R N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection:
14. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes EINo
25.- the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ef No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes CfNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Otherlssues
1/7
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
EZ 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
E�f 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
0 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
[2rNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
V No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ZNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
12r No
❑ NA ❑ NE
Comments.(refer to question ft Explain any YES answers and/or any additional recommendations or any other comments..
Use drawings of facility to better explain situations (use additional pages as necessary).
`/zr//n d- %7e(G&
lobkL�Wezl
Reviewer/Inspector Name:
ReviewerMspector Signature:
Page 3 of 3
A , A leaj 2 0 jo I e
Q5 '550"-7 ers
/ICJ - S S`Q "Do o y
Phone: �lU� %�
Date: 6/Zo X3
121412011

y
-1Mivision of Water Quality ,
F
�. Division of Soil and Water Conservation"'
Other Agency a
n
rM�M.."
Facytiy�Number �g
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit�outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ' Ar0.
riv Time: eparture Time: :d� County: /� Region:
el
Farm Name: r' Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: / VD��_
Title:
Onsite Representative: ��iS'
Certified Operator:
Back-up Operator:
Location of Farm:
- � I
wine � � MC
_] Wean to Finish
] Wean to Feeder
] Feeder to Finish
] Farrow to Wean
] Farrow to Feeder
] Farrow to Finish
] Gilts
] Boars
Phone:
Phone No:
Integrator:
Operator Certification Number)
SZV/��D
Back-up Certification Number:
Latitude: 0 c = ( = it Longitude: 0 ° 0 6 0 S,
n Current~ r ` Desrgo Current .•`
city Population .W _. Wet Poultry Capacity Population n Caul
Layer
U
DairyCow
Non -Layer
❑
DailyCalf
❑
Dai Heifer
❑
D Cow
❑
Non
Layers
.;
-Dairy
❑
Beef Stocker
Non -Layers
V`
❑
Beef Feeder
Pullets
❑
Beef Brood
❑ Turkev Poults
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0"No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
❑No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
ElNA
❑ NE
❑ Yes
[ZNo
❑ NA
❑ NE
Page I of 3 I2/28104 Continued

FacHity Number: - Date of Inspection:
24. laid the -facility fail to calibrate waste application equipment as required by the pe o ❑ Yes ONo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �:kNo ❑ 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
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes jZrNo ❑ 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 ZfNo ❑ 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) 7�"�
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [ZNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �TNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Z No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ON. ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any.other comments.,:.'-'&
Use drawings of facility to better explain situations (use additional pages as necessary)..
Z 1 a PGVA 3e-6 cA hl S r p ea se Csa 11 r' 9/07k7
w N
Zee 5 04/t
oc S o ?, V
�0 4 9-0/0 / o lD - s1
�a
ReviewerAnspector Name: A V 1(15!
Reviewer/Inspector Signature: A� l �
Page 3 of 3
Phone: &7_
�� 7
Date:
W20

Facility Number: - Date of Ins ection:
-Waste Collection & Treatment
less
Yes
No
NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) than adequate?
❑
Z
❑
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
77�
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
P 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
(6No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
J�rNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2fNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
10 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Excessive 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 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes V` No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [ZNo ❑ NA ONE
❑ Yes Z�No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ff No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate bo ,fYes ❑ No
❑ Waste Application ❑ Weekly Freeboard ZrWaste AnalysisAE, it Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑Crop Yield ❑ 120 Minute Inspections Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E5 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Z] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Division of Water. Quality,
lyaC�llty;Ntimber v r. �O.DIvkj,6 of Soil andWater Conservation
O::OttlEr:AgenCy* e _'
Type of Visit ,0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit YJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 8 Arrival Time: t✓%Departure Time: County: Region: Zz�
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative:. Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0=` 0" Longitude: 0 o= r
A
,:2737/
Design Curient ° Current
_Design
uie Capacity 'Population Wet Poult _Capacity l-opulatioin Cattle
�,
�Laver
Wean to Finish
❑
Dairy Cow
Wean to Feeder
;:Q ❑Non -Layer
❑Dairy
Calf
Feeder to Finish
= ak�"�' �'« ❑ Dairy Heifer
Farrow to Wean"* �� "„ "
DryPoultryy
❑ D Cow
Farrow to Feeder
t , �. .._ ' ': ❑ Non -Dairy
��
❑ La ers
'
Farrow to Finish
❑ Beef Stocker
Gilts
❑ Non -Layers
❑Beef Feeder
Boars
El Pullets
❑Beef Brood
-" ❑ Turkeys
a
Turke Foults
w
Other`
❑ Other
wNumbe of§:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
VNo
❑ Yes
,dNo
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan? '
❑ Yes ZNo
❑ Yes ZNo
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ NE
❑ Yes
�2No
❑ NA
❑ Yes
[;Ko
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
,Z'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes ;'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes .fNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes J2'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 'UNo
❑ 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 ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes P-I<o
❑ NA
❑ NE
,Comments (refer tb question.#) Explain. any YES'answesrs and/or any recommendations ©r any other comments" TL
'Use iirawings` of facility to better ezplain situations (use additional pages as necessary):-Aeb
116FCI��ea­l
Reviewer/Inspector Name ev l?. -;
C ;a <„ Phone: — —7
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12&8104 Continued

tV
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [:]Yes L3<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box.
❑ WLTP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ST(Vaste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking Crop Yield IV 120 Minute Inspections V11onthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
VD7id
id the facility fail to have an actively certified operator in charge?
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?
(Additional Comments and/or Drawings: ^
❑ Yes J2 to
❑ NA
❑ NE
❑ Yes ;2-iq0
❑ NA
❑ NE
❑ Yes j:3-No
❑ NA
❑ NE
❑ Yes ZNO
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes [:]No ❑ NA _4Ej NE
❑ Yes jRNo ❑ NA ❑ NI?.
❑ Yes r No ❑ NA ❑ NE
❑ Yes 0 No
❑ Yes No
❑ Yes No
❑ Yes J No
El NA El NE
El NA ❑NE
El NA El NE
El NA El NE
Aencl _k kk goe'_7
eLo�s
lVe_e� h,
.lase,
Page 3 of 3 C"J�Gi �`Q/� CCe;g5e *-- /� {��S' . 12,128104

;iP A
On.-',ofWaterFQuahtyr
4
Facility NuinNe 3 D.Dtv1ston of SoilKand Water Conservation t
Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visitoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Timer Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:ALOAr-/�7 Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of farm: Latitude: [= o = A = Longitude:
'."Design Cnrrenf ��` _°Design Current
Design Current
Swtire " Capac►ty Population Wet Poultry C p �l ypoplatiO"
JCattle, :Cap�a` ckty Population
i
❑
Wean to Finish ❑ La er' El Dairy Cow
Cow
Calf
El Dairy Heifer
❑
❑
El Beef Stocker
❑ Beef Feeder
El Beef Brood Co
Discharges & Stream Impacts
Discharges & Stream Impacts
N

Facility Number: — Date of Inspection
Waste Collection & Treatment
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 2fNo ❑ NA ❑ NE
Structte 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ZI
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes fiTNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes PNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes JRTNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes A No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PrNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I 0 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 L'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 4:� 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 O-No ❑ NA ❑ NE
❑ Yes 12Ko ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers anctior any•recommendati©nsM any other,.commenu.
Use drawings of facilityt,o. better explain situations (use'additinecessi y).
Reviewer/Inspector Name Phone:
6 le
Reviewer/Inspector Signature: Date:
O
1V28104' Continued

Fatility Number: Date of Inspection !J
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
PfWaste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
'El No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[,-,-VNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
3 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
6No
❑ 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
EfNo
❑ 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
eNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
dNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
/Yoy 'mil
�,/i/o ui4:S�e Ana/yJ/1 � CoUG✓ �2�Q`� fJ �
o 1vd
,yes s1ua'Se, .sc���y rX��41- '<On//�q �s �141- 19&c7'_
12a8/04

.0-division of Water Quality
Facility Number 0 Division of Soil. and Water Conservation
-- - 0 Other Agency
Type of Visit j:)<6mpliance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit P-Routine O Complaint O Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: % Arrival Time: Departure Time: �� County: Region:
Farm Name: f✓f_ $ _ _ Owner Email:
Owner Name: CJ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = S = Longitude: = ° = i = ,A
Design Current
.Swine Capacity Population
J❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
Other
❑ Other
Design Current .
Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
❑ 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?
;1
❑ Yes ❑ 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 dumber: Date of Inspection �7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
4,u "i Gc)P ceS
"1
�Y
Cav�ic w � A �.-�./y S/s. 4,�I 76 �
cc, f ��CCccc ^4(y Sal
=n de fA"k yPc-, a c r cpy
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: 17 0
12.128104 Continued

-1ivision of Water Quality
Facility_ Number,;. 3 ZJODivision of Soil and Water Conservation
�____ -_ ._ 'Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit,)OrRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 1 % `�(% Departure Time: County: 04,W1 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: G!/
Certified Operator:
Back-up Operator:
Location of Farm:
Qt
Phone No:
Integrator: ia,2/1
Operator Certification Number:
Back-up Certification Number:
Latitude: [= c 0 ` Longitude: 00 "
Design Current
tier
Desig> Current-°=
ine;: Capacity. 'Population
Wet Poultry Capacity Populatiot
Wean to Finish
i'
�
❑ Layer
`Wean to Feeder
_
,
❑ Non -Layer
Feeder to Finish
Farrow to Wean
Dry Poultry
Farrow to Feeder
❑ Layers
Farrow to Finish
❑ Non -Layers
=
Gilts
❑ Pullets
Boars
❑ Turkeys
— — - -- - —
El Turkey Pouits
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current •:1
Cattle Capacity .Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
f
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
Ei
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
�No
[I NA
❑ NE
❑ Yes
,B`No
❑ NA
❑ NE
❑ Yes
P&
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L.
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 'L2'go ❑ NA [I NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Q'�o ❑ 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,_L]'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes )EVNo ❑ 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [;]VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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) 1/1 - / I f
13. Soil type(s) _ a / ci /ter,
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 ®'Mio ❑ NA ❑ NE
t6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 9 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):
AReviewer/Inspector Name —22 -- — — -- Phone: !/� �
Reviewer/Inspector Signature: Date: le�f
Page 2 of 3 12 8104 Continued

Facility Number: — Date of Inspection C
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, chec the appropriate box below. Yes ❑ No ElNA ElNE
ElWaste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
ARainfall ❑ Stocking f Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �3 No ❑ 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
❑ NA
❑ NE
❑ Yes
[INo
(P
[INA
ElNE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
Y No
❑ NA
❑ NE
❑ Yes ❑,No
/[/�
❑ NA
El NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes JZNo
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ;dNo ❑ NA ❑ NE
Additional Comments and/or Drawings:
lof�• /
ernQ fur, � 5 { era
�ecvr� (a i n �, L 1 6 (� bc> ` �a rn S
S
_ crof ieW CY• O')o -Fa f r'vkwf vm
Ly s [ s
p laryr1k) /U C10,5wg
fur�►�1V,dat,- ivc a- Y,d
Page 3 of 3 12128104

0
Type of Visit -0 Compliance Inspection. 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I 8&LI—Arrival Time: . [ Departure Time: County: i'%1_ Region: .
01
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: � Title:
Onsite Representative:%a7/�,,.1` / t &L
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = f = Longitude: = o = , =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
/ 1❑ La er
.0 Non -Layer
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ 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?
❑ Yes _ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 Vo
❑ NA
❑ NE
❑ Yes
'OONo
❑ NA
❑ NE
12128104 Continued

[Facility Number: — Date of Inspection -7
Required, ecords & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes J�Vo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes „ 'No
❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
Yes ❑ No
❑ NA ❑ NE
❑ Waste Application Weekly Freeboard „Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
[Rainfall ❑ Stocking ❑ Crop Yield El120 Minute Inspections Monthly and V Rain
Inspections ❑
Weather Code
.D 22.Did the facility fail to install and maintain a rain gauge?
❑ Yes AE No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
LRIgA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 2 No
❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ;;No
❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes 2 No
❑ 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 XNo
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes .eNo
❑ 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 [: 1Mo
❑ 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 P o
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
Did Reviewer/Inspector fail discuss
❑ Yes ; To
❑ NA ❑ NE
32. to review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA ❑ NE
Additional Comments and/or Drawings:
z'
� rq
6Y"_ a p6ovp-d � � + TrN-�(A1 0� fAtV
�a\ 1n `0130a ! Yr5 Pe C.k-1-dY,
T(eC.s-e Coe SU 'VeLlf-'e.. �(�����
•�c5
Y-'_ , S , a-.' -
12128104

of Visit 0 Con)pliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Q Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 3 O Tune: 0
O Not O erational Q Below Threshold
0 Permitted © Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ...... ....... &Q-.1axly...... ....County:........��.................. ............ ....................
OwnerName: . ........ ................................... .... ........ ............... .......................... ... Phone No:................
Mailing Address:..-._ .. ....... ........................ ...............
_ ._. �._. �� ...................... �. _ �� �..._ �....�....... _.. ... .W _._.- ..
Facility Contact: ....... W ..... ....
M..T...i.tl.e...:.........._..__...._ Phone No:
Onsite Representative: ......... si-bfiier aySIntegrator:.__...
.M-wYl)
�� .. ...... .. ......
Certified Operator:.............. _ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 1 46 Longitude • & is
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes /No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ NoWO,
2. Is there evidence of past discharge from any part of the operation? ❑ Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
.......... ...................... .......................... ... ... ....... ............ .............................................. ......
Freeboard (inches): Z�
I2/I2103 Continued

Facility Number: 3 — 2. Date of Inspection 30
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes d N
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or El Yes;N/o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?❑ Yes ;
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 maintenance/improvement? ❑ Yes /NNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yesg�No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type C, S L
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Ng�
14. a) Does the facility lack adequate acreage for land application? ❑ Yes L�J'N/
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes 60
15. Does the receiving crop need improvement? ❑ Yes iN
16. Is there a lack of adequate waste application equipment? ❑ Yes 0
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑L] Zxo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
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 �Zo
Air Quality representative immediately.
�Commeirts {ice#er ta:q�atu-�} Fa�plmn any YF.S asaswers auad/or a� r�on�ueada�biis or aiey other` camments.,_Tw ��-
`Use dra►vuegs of facihty to better explara sit�trons' {� addrt,<ongl pages as mecessary) � ❑Field Copy ❑ Final Notes i- ,_
t
._ _ •T. .._ _i' 4, _`S,. � � -'»� -..mod --£ -`. '� -"4Aewms.-'-w<^ b_use^^�'-^^^e-wry»m"+®+^'.4^Y-'g.'?A. <
\NUP ALUDW3 F-fL euMPmo& art UAsf- c+� op 13vt flans t•r&r IAAJJE. ACA-Ef
QR- FX c4- D o R• PU LL,,5 - SUG4-E ST N (L V J W UQ SAW 67-) A GR E PU LLIS ,
CABLE- FuL LVJ v5AM AAA L `? S T5 SAWL�6
filp-M T�j 6.0 ah 5 ►a
Reviewer/Inspector Name
Reviewer/Inspector Signature:
2 (> Ec ic._ ?E atvd1 1SIti6 .
Date:
1!./L6/V3 l.OAAI ue"

. Facirty Number: 3
Date of Inspection 3�
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ 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?
(ie/ 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?
NTPDES 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?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
E Yes ❑No
❑ Yes No
❑ Yes No
❑ Yes 911<0
❑ Yes
❑ Yes ONo
❑ Yes LTNo
❑ Yes CKo
❑ Yes 01<0
❑ Yes [` Flo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Type of Visit 16Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit (D. Routine 0 Complaint 0 Fallow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: l i QZ Time: �r
Facilih� Number 3
Not Operational QBelow Threshold
® Permitted ®.Certified [3 Conditionally Certified ❑ Registered Date bast Operated or Above Threshold:
Farm Name: f 5 (��/ _ __ County: _ 110l,`n
Owner Name: Phone No:
Mailing Address:
Facility Contact: Title: Phone JNo:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' D u Longitude 0 01
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a_ If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any pan 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 �kNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: 3i — 2g-j Date of Inspection 1 3i 2
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [&No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes [K�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 5�LNO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ®.No
9" Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes PNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [KNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes Elm
12. Crop type n
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 or other 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 AW W?
❑ Yes &No
❑ Yes 10 No
❑ Yes [--]No
❑ Yes ❑ No
❑ Yes PNo
❑ Yes P No
❑ Yes W No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
[1 No
EPLNo
No
No
�[ No
f No
No
® No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cammeots.(refer_to' uestion # a Ex iarrl any YES anarvers_attd/or"an recommendations or sap:ntiier commentx,
p y Y -
q ) _
ag� plain srtnat<oas."(ase additional pages as necessary) -• , i❑----- _
Use drawl s of fc�tty ta. better `ex Field Cat�v ❑ Final Notes
for s - in `0,;ki Cr0®W
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: l 3l
05103101 �r Continued

Facility Number: 31 — hate of Inspection T 3
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes M-CPio
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? © Yes §9 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �4 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 P�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 ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional Cominents and/or Drawings:,
05103101

ODlvision of Water,QuaLty
r
0 Division of. Soil and: Water tonservation
0 Oth Age cy_ . -
eir n r= e
•z _
-
of Visit oCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit AO Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
F- Facility Number Date of Visit:
X1 Permitted ❑ Certified © Conditionally Certified ❑ Registered
Farm Name: ....... ._:. ... ..'. .1... .Si�.��.........4.................
Owner Name:..... w,q„ N r .L �t t S
.............................................................................................
Facility Contact: ..............................................................................Title:
Mailing Address:
Onsite Representative: J!UA.I.A.9...... ;V V ► .5
Certified Operator; ....................................
Location'of Farm:
dl Time: �Printed on: 7/21/2000
Not Operational 0 Below Threshold
Date Last Operated or Above Threshold: .........................
County: ..... !_.1...11 f..1!.h..
Phone No:
.................................... Phone No:...............
Integrator:. M..�.^.... �!.... .............
Operator Certification Number: __...
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 64 Longitude • 4 f4
Design Current
Capacity Population
Wean to Feeder
_ Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Dcs�g�n _ Ct treat=-
PoUjtry Capacity PopulationCattle Ca' : -Po ulation
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
TotaI:SSM
Nor pi_Lagaons 10 Subsurface Drains Present Lague Area ❑ Spray Field Area
HoidiiagP©nds L Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts -
1. Is any discharge observed from any part of the operation? ❑ Yes 91�0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Iwo
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes rNo
c. If discharge is observed. what is the estimated flow in gal/min? 61
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes j No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................If.........................................................................................................................
Freeboard (inches): 2
5100 Continued on back

Facility Number: 71 Date of inspection Printed on: 7/21/2000
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 Application
10. Are there any buffers that need main tenancelimpro vement ?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type C0'- --, W ,,ce, i , <" L :.,t,,,.l
13. Do the receiving crops differ with those designated ih 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?
❑ Yes VNo
❑ Yes 'R(No
❑ Yes 36 No
❑ Yes YfNo
❑ Yes A No
❑ Yes KNo
❑ Yes Po
❑ Yes IM
❑ Yes No
❑ Yes M No
❑ Yes No
❑ Yes No
❑ Yes TTT] No
❑ Yes )2 No
❑ Yes 'ONO
El XNo
❑ Yes XNo
❑ Yes gNo
❑ Yes )/ No
❑ Yes fNo
❑ Yes A No
❑ Yes XNo
.... yi....... defieie>ic{es were ngtea during #his:visit! Yoi� will receive Rio furthgr
correspo Bence: about: this visit
Comments-(r",efer to question #) Explain any YES answers and/or any_recommendations or any other cominents
Use:drawings of facility to better explain situations (use additional pages aspeces
sai3')
;.s well AW . Lu ker.A �,r��� :t 2s ��► �,'s� �h� �,ti/�1�.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date
AL
5100

Facility Number: 3) — 2 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 properly within 24 hours?
❑ Yes
�No
28.
Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt,
❑ Yes
;TNo
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
;jrNo
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
j No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Additional —Comments andor rawings:. _� ,' ; ,
w

Dtvtsion of Water Quality
r Division of, Soil and Water Conservation
f
,
At
Type
FacilityContact: .................................................................__.......... Title: ................................................................ Phone No:
Mailing Address:
Onsite Representative: .... 01Jq.P..'_',.... I .. . integrator:
Certified Operator:................................................................................................................ Operator Certification Number: ..........................................
Location'of Farm:
L i
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ��` �«
Design Current
Canacity Pcnulation
Wean to Feeder
21,DQ
j1Q
` Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design
Current
Poultry C
PopulationCatlte ..:-.. -,..
❑ Layer I
I
❑ Dairy
❑ Non -Layer
❑ Non -Dairy
❑ Other
Total Design Capacity
ToUISSLW - '
Desigiit . Caffeit
Ntastber of `Lagoons' Subsurface D-sins Present 10 Lagoon Area 10 Spray Field Area
Ilk
°P4nds'`f Soltd Trnps ❑ No Liquid Waste Management System
Discha ges & Stream I. mpacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
Discharge originated at: [ILagoon [ISpray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed_ what is the estimated flow in gal/ruin?
d. Dues discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
1 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
91 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
D9 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:.........._.__I!.....................................................................
Freeboard (inches): `3
5100
Continued on back

Facility Number: '3( —3 Date of inspection Printed on:
7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 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
elevation markings? ❑ Yes (A No
Waste application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes CS No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
® No
12.
Crop type (-Ze-4 - 62
_
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
P9 No
b) Does the facility need a wettable acre determination?
❑ Yes
0 No
c) This facility is pended for a wettable acre determination?
❑ Yes
E( No
15.
Does the receiving crop need improvement?
❑ Yes
j No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oel 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 Rcviewer/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?
iitionjs or• def:pde.nc;es were noted- iiitring �bis:visit. • Yon wiii•t & iW Rio ruether
coriespori�ence. abuu this visit . :::::: . .:....::.:::
............
.
AAe,l keep a eery Q f we" Al Ae AoAd reAw w, r«ards.
A�",* S`>zi (- Aurdy
4rc Ilk
❑ Yes P No
❑ Yes
® No
Yes
&No
❑ Yes
91 No
❑ Yes
® No
❑ Yes ® No
❑ Yes ® No
❑ Yes t4 No
❑ Yes ® No
Reviewer/Inspector NameZr
Reviewer/Inspector Signature: Date: �,�Z71ff Z 5/00

Facility Number: 3� — 3 Date of Inspection Printed on: 7/21/2000
Udor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes PK No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes CSNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes I} No
5/00

tsion of DxvWat er uahty
�'
o D1VLSion�of Sbel and Wafer ConservaLon
Y k
r ;
x
Q Other A enc a
Tci =
.F
k�E-r 'i._r
Type of Visit ($f Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit � Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: I� -�� Time:� Printed on: 7/21/2000
3 Z
Q Not O erational Q Below Threshold
0 Permitted A Certified © ConditionallyCertified [3 Registered
{� j k I g / Date Last Operated or Above Threshold: .........................
Farm Name: ......P;,.; ...11y...'....1 %fl �: r.. ..U.lA4A'�i .!�.I.S.L.SL l) County: ........... Dvpl . o..............................................
Owner Name J ji Phone No
Facility Contact:
Mailing Address.
Title:
Onsite Representative:...............................................
Certified Operator:....... - + /..... .,.......... D.Coj.i�.........
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
w
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �# �� �'° Longitude �• �� �46
Design Current
Swine CaoadtV Ponulation
Wean to Feeder
`Z(006
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I 1 1[] Dairy
❑ Non -Layer I I JE1 Non -Dairy
❑ Other
Total Design Capacity O O
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System .
Discharges & Stream Impact4
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed; was the conveyance man-made? El Yes No
h. If dischan-ic k observed. did it reach Water of the State'? (if yes, notify DWQ) El Yes IV No
c. if dischars•e is observed. what is the estimated flow in gal/ruin?
cl. Does discharge bypass a lagoon system'' (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment INO
4. Is storage capacity (freeboard plus storm storage) less than adequate? ElSpillway ElYes
Structure I Structure 2 Structure - Structure 4 Structure S Structure 6
Identifier:........-4.L............................................................................ ...--- ............................................
Freehoard (inches):
5/00 Continued on back

i
Facility Number: .31 Date of Inspection -0a Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes j No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes � 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
$. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes qNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ElYes qNo
12. Crop type C:drn Qhta 4 —S,. f lnz „ . -
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?
0. o vWatigris'or dk!& ncies mere noted, &Witig this:visit: Y:ou will-teeeive Rio futthe' r
correspondence about: this visit
❑ Yes WNo
4 ❑ Yes No
[f Yes ❑ No
❑ Yes ❑ No
❑ Yes VNo .
❑ Yes No
❑ Yes No
❑ Yes to
Ix Yes ❑ No
❑ Yes f� No
❑ Yes �No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes) No
Comments (refer to.gluestion #): 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):
let- KA.Lp cam(rcr►� 50-I r 4 an f+tc. L)PdJe_ 0"Ie 4nat_IysI 5 ( s�1ould A A.atone- cLva,��cilcf. )'ontplp le -Al rcp;teA rat rma�ror7 on rrr an rc_pori5.
t,1-.1 w �� O.t,Ci t r+�rvta.�-ior� , D►"scusS �+ Sol i ,j,L&O-e-V,
Reviewer/Inspector Name ,3
Reviewer/Inspector Signature: 171*1� _ Date:%/ f a-ts 5100

Facility Number: Date of Inspection - -00 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or hplow
❑ Yes
[ No'
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
�No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
�No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
INO
31.
Do the animals feed storage bins fail to have appropriate cover?
ElYes
32,
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
, �
'kNo
S/00

y
3 Division of Soil and Water:`Conser-vahon -:Operation Review
z
©:Division of Soil and Water Conservattan Compiianee Inspection
1
` Division of Water Quality Cornpiiance Inspection r
Other Aged 0 erahon Revyew- F
CI' g Y ; P
Routine O Complaint Q Follow-u of DNVQ inspection Q Follow-up of DS`VC review Q Other
Facility Number Date of Inspection Time of Inspection ® 24 hr. (hh:mm)
Permitted Certified [3 Conditionally Certified © Registered JE3 Not Operational Date Last Operated:
Farm Name: mil"_.`. �^-....aJti.�.?....... .... County:...........-.... ..1��
93-
Owner Name: . Phone No:..............0. r.-....4. �i..•.........
FacilityContact: ................ .......................................................... Title:................................................................ Phone No:..............
MailingAddress: ............................................................. .....
Onsite Representative:..Q...-..... Integrator:,.......'..^`.......................................
........................................................ ............
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
.ocatio of F• rm:
�b
:.. .... .:....... .... ^..!�. s......... 4...............................................................I.,?. ............"'"' t" .....................................................................
'R...13 .................................................................................................................................................................................................................................. .
Latitude =1 =11 Longitude
- - _- Desi Ctiirrent Design
Design Current... gn
Current
Swine-.,.- _. __
.Capacity Po ulation l gulf Capacity, Population Cattle
t Y-._ _- Capacity
Po ulattan
P
Wean to Feeder Ci0 _ ❑Layer ❑Dairy
-
= ❑ Feeder to Finish ° ❑ Non -Layer I I ❑ Non -Dairy
❑ Farrow to Wean - = _ rt
❑ Farrow to Feeder J❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts, ' -
❑ Boars - _ -: Total- LW
�Nnmber of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
HoldtngPonds / Solid Traps ❑ No Liquid Waste Management System
_ W
`
--
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
tv(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 gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
�rNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
19No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
O 'No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure
6
Identifier:
Freeboard(inches): ....................... ...... I ............ ........ ......................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, [] Yes XNo
seepage, etc.)
3/23/99 Continued on brick

Facility Number: 3 - 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
XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
O(No
8. Does any part of the waste management system other than waste structures require maintenance improvement?
❑ Yes
Z No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
)j�No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
M No
11. Is there evidence of over application? ❑ Excessive Podding ❑ PAN
❑ Yes
E"No
12. Crop type 1 j_ G
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
O�No
14- a) Does the facility lack adequate acreage for land application?
❑ Yes
[�(No
b) Does the facility need a wettable acre determination?
❑ Yes
RNo
c) This facility is pended for a wettable acre determination?
M/Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
KNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
IV
Renuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
bdNo
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
E$No
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
M No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
CO No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
El Yes
PONo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
13 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
O(No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
FyNo
N.O.. i6latigris;oir deficiencies were n6ted diWi ig ihis;visit' • ;Y;oik will-Teceiye dd further •;
corresporidtenc, e. abaut this.visit:. .. .... .. _ _
Comments -(refer to question #f) '-Explain any.YES answers and/or any -reeomme6daiions o6a—nzy'other comments: -�
Use;drawings offacility 1p,better explain situations (use ges additional paas?necessairy)
._ .. - .
1 j
77.
pq.
6c�lkl:;� "4-\ Y��4.
5- <3 VN t,,� -L
Reviewer/Inspector Name ' - - Y
�
Reviewer/Inspector Signature: Date:
3123/99

Facility Number:-3 ` '7�
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
k,es
❑ 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
XNo
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
W
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
MNo
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 permanentltemporary cover?
KYes
❑ No
itional,.,omments`and/or Drawinw_
3/23/99

[3 Division of Soil and Water Conservation 13 Other Agency
Eg Division of Water Quality
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection � = D 24 hr. (hh:MM)
[3 Registered 19 Certified 13 Applied for Permit [3 Permitted 10 Not O erational Date Last Operated: ..........................
I
County:...:411-e! ................................. . J.. .........
Farm Name: ..... t
..
Owner Name: .......... ..P .... ..A'..S ............................................... Phone No: __j .............
FacilityContact: .............................................................................. Title: ................................................................ Phone No: ...................................................
Mailing Address:................ .... 94 ....... ... wclr_ j
.... Aj .. C, .................... . ........ ...
Onsite Reprcsentative:..WJL.1.A,.t1y .... T41JIS ... lntegrator:..".,J.-yC..F F. . .............................. . ....... I .............
Certified ... 11_...................................... Operator Certification N ber—Al...Q..Z..1 .......
Location of Farm:
5i#A ...... a E ...... 1�..........1...0p.... 7 lal� ..... 0-1 ... 14-441Ps ..... 414Q_ A
. . ................. . .............................................................................. .................................................... V
Latitude 0 Od 4 9 C Longitude & =11 Eyo 11
N 'D
�s Current Mt Desin "Wh
Somme s Capacity P latiori Pof& oiiiiiitv __Xcp fi­ ittle U&
wn,9-C
[ZLWean to Feeder ?,(ptFV 0`1E] Layer I0 Dairy
El Feeder to Finish I0 Non -Layer 1 110 4Non-Dairy
........... �
0 Farrow to Wean
AE] Other
0 Farrow to Feeder
Nis
.. .. ....... ...
❑ Farrow to Fin
ish On, -Total Gapacl<ty
0 Gilts
El Boars f'T i ifa- 1,,,,
€Number of '­Wfids 0 Area
s. Field
Subsurface Drains Present IFfLagoon Area spray
Lagoons 1-P.
g.:
mv❑ No Liquid Waste Management System
- - e
Zm
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Lagoon 0 Spray Field [I 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 dischargeL_
is observed, what is the estimated flow in -aUmin?
A. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
OYes -ONo
0 Yes CKNo
El Yes No
0 Yes No
A
0 Yes Eff No
❑ Yes 19 No
❑ Yes No
0 Yes No
0 Yes 0 No
0 Yes RNo
Continued on back

Faeility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
�WNo
Structures (Lagoons,Iloldit Dads, Flush Pits, etc.)
9, is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
allo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: f...1_5
Freeboard(lt):....................................................................................................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes
No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12, Do any of the structures need maintenance/improvement?
❑ Yes
LNo
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
I'No
NVaste 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 ...................................................................... .... ..
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
RNo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
BNo
18. Does the receiving crop need improvement?
❑ Yes
O No
19. Is there a lack of available waste application equipment?
❑ Yes
ER No
20. Does facility require a follow-up visit by same agency?
❑ Yes
KNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
91 No
22. Does record keeping need improvement?
91 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
® No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
allo
No.vitilations•or deficieiicies.were ntited-during this:visit., Your_A i&eive,_it61 rth:er-:
: cofO*)tid6hete ab:out this'visit:-
G©ym nts (refer to question #) Explain any YES answers andlof.any r�ommenda#ions or any other cainmenis
drarviitgsytif
Ilse facthtyto bette explaui sttuat�ons (use addEttonal pttges asnecessairy}
.. ^
US e P Art) cL-4 -t- �a.�.. �o c o 1-, vN
L r e cal c v[ u_ jr 2 co rd 1 R q -1 -} r° t e..A w -� lsra � Pl v. d— i,-ct f i a�
L
So { a a �l f !` E. C ,G V4-1 ✓, f_2_.0 o ' {-1. r e c ce c v l-�-0- [ a ✓S
ov. o end , y . 4 S 1b s o� v% q, A.- q e,.� c a �-e,Y n. [ ` -,�• 3e- v t
W% 1 d v i �. C v Ldc ,E­i try { p V e-w t v r-� l� d v L� C v� 11.a�iv� `a i�a b Lt-✓ n S
7/25/97
Reviewer/Inspector Name �' i
c F A$��
Reviewer/Inspector Signature: a rkA Qlll- Pate:
v 4
v

'®Division of Soil and Water Conservation Other Agen c
Y
»:..> ❑ ..
Dw�sion of Water Quality
® Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection 11/10/97
Facility Number 31 283
Time of Inspection 1150 24 hr. (hh:mm)
❑ Registered 0 Certified [3 Applied for Permit 93 Permitted 0 Not Operational I Date Last Operated:
Farm Name: Pi CA County: ftupUa ...............................................
OwnerName: Walter .................................... Davis.............................................:...............: Phone No: 210 293 48.QI.------.............--------...............................
Facility Contact: W..ayac.D.ayil.................................................. Title:. yjmr................................................. Phone No:
MailingAddress: 1iat...2.Bax.228......................................................................................... W. .w aw..N.C.......................................................... 2S39.s .............
Onsite Representative: Ed.Lamitpr.................................................................................. Integrator: 1. t;.r by..Fait) ly..Exrj kS...........................
Certified Operator: Walle]r..W............................... Raxia.................... ............................. _ Operator Certification Number; .1803,9.............................
Location of Farm:
Q.e..nuxkh.side...f.�ti..13.�0..a.pp.rax.......uail..x.pasx.itQ.th......as...,uf....iittt..xs�etxQx#.kYatlt.SR.X�........................
Latitude 35 • 00 ' 50 " Longitude 78 ' 01 ' 46
M Wean to Feeder
2600
2600
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
LEE]
❑ Boars
General
1. Are there any buffers that need maintenance/improvement? []Yes M No
2. Is any discharge observed from any part of the operation? ❑ Yes M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? [] Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify D WQ)
i
_ ❑Yes ©No
3. Is there evidence of past discharge from any part of the operation? []Yes M No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes M No
5. Does any part of the waste management system (other than lagoonAolding ponds) require []Yes M No
maintenance/improvement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes M No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes M No
7/25/97 =

Facility Number: 317283
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Structures (La oons,Holdin2 Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft):..............2.5............... .. - ...........................................................................................................................................
...................................
10. Is seepage observed from any of the structures?
❑ Yes
® No
11. Is erosion, or any other threats to the integrity of any of the strictures observed?
❑ Yes
No
12. Do any of the structures need maintenance/improvement?
❑ Yes
® No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
Z 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..Small..Cgairt.(Whc.at..Barlt�,y...........................................
N "o, Oats
16. Do the receiving crops d er with lose designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
19 No
17. Does the facility have a lack of adequate acreage for land application?'
❑ 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
® No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
9 No
22. Does record keeping need improvement?
Z Yes
❑ No
For Certified or Permitted Facilities Onlv
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
❑ No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
�l�ib-vialatibns' or:d'e%Eeneies.were-noted'during t4iS.Visit.' Void wiltrikeive no farther• -
.:cvrrespontlence a>aauf this.vasiti .. .....
done with Ed Lassiter at owner request. I
2) Need waste sample within 60 days of irrigation. Need to use WUP recommendations on records to assure there is no over
pplication. Also should verify that WUP matches what is being irrigated on (acres/fields/tracts).
3 & 24) Need certification for farm & copy of design.
to till out emergency action plan. Need to fill out odor, insect, and mortality checklists. A T.S. at Duplin SWCD or Murphy can
7/25/97
Reviewer/inspector Name4hn 11+"t#�I;cratcl
Reviewer/Inspector Signature: Date:

"Et..........
10 Routine 0 Complaint 0 Follow-up of DW2 inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
— ---- - Time of Inspection Ui 24 hr. (hh:mm)
Total Time (in fraction of hours
I@ Registered 0 Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on ReviewFarm Status: 19Certified [I Permitted I or Inspection (includes travel and processing)
El Not Operational Date Last Operated:
Farm Name: As —I-) .... . ....... County:.-D..uf.h'..k'* . ...... . AQ-L L.
Land Owner -- — ---- . .... . Phone No: ... . ...... . ..... —..
Facility Contact: Title: Phone No: . .....
Mailing Address: ---- — ---- - - ---- - - ----- - ------
Onsite Representative: ... Integrator: _AA V.x.-f . . .... . .... ....... . . . .... . ........ Certified Operator: .... . .... ........ .. . ..... Operator Certification �Tmber: --- --- - ---- -
Location of Form:
Latitude 0 4 0" Longitude
Type of Operation and Design Capacitv
w. i n
Designg" Current Design Current
"ation
ap iiwpop����CkpgeitV2.P6 oulL '-C Po nation
WDSC
Wean to Feeder
toonDa'
0 Feeder to Finish
❑ Non -La eT Q Non Da I
Farrow to Wean
Farrow to Feeder
g"
I.Mesign'Au'a
C1 L-t.L
Farrow to Finish.
Finish
0 Other
M. ........... ..
S-K
WA
4NEEM 10 Subsurface Drains Present
'
-A 10 Lagoon AreEa]' Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Lagoon 0 Spray field 0 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 lagoons/holding ponds) require
4/30/97 maintenance/improvement?
[I Yes &No
D Yes R No
[I Yes 91 No
[]Yes 19 No
❑ Yes
12 No
❑ Yes
No
❑ Yes
No
❑ Yes
No
Continued on back

Facility Number: ..31...... —.
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 (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure i Structure 2 Structure 3 Structure 4
4>. �....... ..
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes ELNo
❑ Yes JR No
❑ Yes 0 No
❑ Yes 29 No
Structure 5 Structure 6
❑ Yes Ea No
❑ Yes IN No -
12.
Do any of the structures need maintenance/improvement?
❑ Yes
® No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
C9 No
V4'aste APolic� ation
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 ,C-o'!.t^ .... —...... ..... r,........... ..... kuLh.ett.t...............--•-.-....................---..................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
0 No
18.
Does the receiving crop need improvement?
❑ Yes
®No
19,
Is there a lack of available waste application equipment?
❑ Yes
E& No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
14 No
FoLCertifed_'acilities
Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
19 No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®.No
24.
Does record keeping need improvement?
0 Yes
❑ No
, nsesador.any eomenaons aramComments{refer to queshos eEw/h.
Use drawingsof facihty to Better explain situations use aiidrtional.pages`as necessary):
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HO
;� My
Reviewer/Inspector Name s a
E. a ..':_ a nr gam: ,� x - •,.• -:u : „'``
Reviewer/Inspector Signature: IL Date: r. I J Z.q
cc: Division of waxer Quauty, water Quartty Seaton, racutry Assessment unit 4/3U/Y I