310293_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qua!
II

'type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: V Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Z 2. ArrivalTime: ®p Departure Time: County: Region:
Farm Name: T+ T 1 w+rSC+M Owner Email:
Owner Name: 1 V RaY6,r Phone: cN 1D L?,- 9 I gZ3
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Cnrrent
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
Z
Non -La er
Da' Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
ET Ull
Layers
Design
Ca aci
Current
P,a
Cow
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Turkeys
Turkey Puults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [P No ❑ NA ❑ NE
❑ Yes
❑ No
V NA
❑ NE
❑ Yes
❑ No
4 NA
❑ NE
❑ Yes [:]No
[:]Yes 50 No
❑ Yes P No
NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection: 12— Z! 17
e
Waste Collection _& Treatment
4 is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes fo No ❑ NA ❑ NE
i
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No V 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?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes ® No ❑ NA ❑ NE
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 envirgnmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
VV
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
5fl No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect ILd 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): Q'
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ No
❑ NA
❑ NE
16. Did the -facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
V] No
❑ NA
❑ NE
acres determination?.
17. Does the facility lack adequate acreage for land application?
❑ Yes
E,:a No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;A No
❑ NA
❑ NE
Renuired 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 improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
M No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
12 NE
Page 2 of 3 21412015 Continued

3
i
Facility N mber: 3 1 - 2,q JDate of Inspection: 1 Z{
24. Di¢ the3Tacility fail to calibrate waste application equipment as required by the permit? ❑ Yes [5a No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Z 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 [5�jNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No X NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ No ❑ NA Jam' NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [I No ❑ NA ❑ NE
[:]Yes NDNo ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

Type of Visit: _Q�-Chmpliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: Q Koutine Q Complaint O Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
L [ q Arrival Time:
Departure Time: County:
1 1 t IV I !yL Region:
Farm Name:
�'r �( tb
_ Owner Email:
_
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design Current
Capacity Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
I] P�oultr,.
Layers
Design Current
Ca aci P;o .
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes �?No ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
�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 DWR) ❑ Yes PrNo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge? T
Page I of 3 21412014 Continued

Facility Number: Z - Date of Ins ection: It Q /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � No
a. If yes, is waste level into the structural freeboard? ❑ Yes j �No
Structure l
Identifier:
Spillway?:
❑ NA ❑ NE
❑ NA ❑ NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
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.) TT
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? Y"
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or 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 eNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ONo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E2r1Vo ❑ NA ❑ NE
acres determination? T
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes rij l�o ❑ NA ❑ NE
❑ Yes ZNo ❑ NA 0 NE
Required Records & Documents
19. Did the facility fail to have the 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 ONo ❑ 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
❑ Waste Application ElWeekly 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 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes oNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection:
24.,Pid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J� No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �}i No ❑ NA ❑ NE
the appropriate box(es) below. )''"
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [ 1] o
[:]Yes 0 No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes "PNo ❑ NA ❑ NE
❑Yes fJNo ❑NA ❑NE
❑ Yes UT14o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [—]Yes C:�No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes YNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 04o- , ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any oother comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
a 7
/C 3 i
ga
<< r 7
a, /i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: Ll
A/
12141414

titer -
ivtsion of,W Quality -� f� ,
Far�;LtyNumber OrDivisian of Soil and Water Gonseruatloi
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit,,,trRoutine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: lj Departure Time: County: Region
Farm Name: eZ Nu r��eT Owner Email:
Owner Name:
Mailing Address:
Physical Address:
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: [= c [= 1 Longitude: = ° = . = i!
Design Current AD'es�gn Current "�: Design ' Curt enta
r ,..
Swine Capacity WFopulation Wet PoultryCapacityty Population; Cattle ,GapacityFP�opulatian
❑ Wean to Finish
El Wean to Feeder
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
[� Gilts
❑ Boars
N
M:.
Dry Poultry
LJ Non-L
❑ Pullets
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder '
❑ Beef Brood Co
,__, ....,.�,>
W Other^ ❑ Turkey Poults
❑ Other ❑ Other N ml
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?
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
❑ Yes o ❑ NA ElNE
❑ YesPjNo ElNA ElNE
ElYes ❑ No ❑ NA ❑ NE
Page 1 of 3
12128104 Continued
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit,,,trRoutine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: lj Departure Time: County: Region
Farm Name: eZ Nu r��eT Owner Email:
Owner Name:
Mailing Address:
Physical Address:
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: [= c [= 1 Longitude: = ° = . = i!
Design Current AD'es�gn Current "�: Design ' Curt enta
r ,..
Swine Capacity WFopulation Wet PoultryCapacityty Population; Cattle ,GapacityFP�opulatian
❑ Wean to Finish
El Wean to Feeder
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
[� Gilts
❑ Boars
N
M:.
Dry Poultry
LJ Non-L
❑ Pullets
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder '
❑ Beef Brood Co
,__, ....,.�,>
W Other^ ❑ Turkey Poults
❑ Other ❑ Other N ml
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?
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
❑ Yes o ❑ NA ElNE
❑ YesPjNo ElNA ElNE
ElYes ❑ No ❑ NA ❑ NE
Page 1 of 3
12128104 Continued
N
M:.
Dry Poultry
LJ Non-L
❑ Pullets
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder '
❑ Beef Brood Co
,__, ....,.�,>
W Other^ ❑ Turkey Poults
❑ Other ❑ Other N ml
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?
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
❑ Yes o ❑ NA ElNE
❑ YesPjNo ElNA ElNE
ElYes ❑ No ❑ NA ❑ NE
Page 1 of 3
12128104 Continued
,__, ....,.�,>
W Other^ ❑ Turkey Poults
❑ Other ❑ Other N ml
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?
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
❑ Yes o ❑ NA ElNE
❑ YesPjNo ElNA ElNE
ElYes ❑ No ❑ NA ❑ NE
Page 1 of 3
12128104 Continued

Facility Number: -
Date of Ins ectioa:
W to Co ection & Treatment
4. fs storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesA5No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ZNo ❑ NA ❑ NE
Structurf, 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
El Yes lam/ No
❑Other: `T
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA. ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste T nsfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of 3
❑ Yes o ❑ NA ❑ NE
❑ Yes No [DNA ❑ NE
21412011 Continued /�

[Facility Number: - Date of Inspection:
2I. Did the facility fail to calibrate waste application equipment as required by the permit's ❑Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [7rNo
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? ❑ YesETNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes,,ZNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes,,J;;;rNo ❑ NA ❑ NE
❑ Yes,,�No ❑ NA ❑ NE
❑ Yes TNo ❑ NA ❑ NE
❑ Yes �io ❑ NA ❑ NE
❑ Yes ��'' No ❑ NA ❑ NE
(Comments {refer to question ft Explain,any YES answers and/or, any additional recommendations or any other comments
Use drawings of .facili to better explain situations use additional pages as necessary).
g t3' .. p ( p g
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Cp r-11-M ,(- 1-ee�rls kd�'ynaf'
Phone:
Date:
1J4 011

IType of Visit EKompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit-O'koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /� Arrival Time: Departure Time: County:
Farm Name: Q� ef` 7 , j �',��� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator: /zy
Operator C tification Number:
Back-up Certification Number:
Region: z.�.�SW,
Latitude: =1 o =1 Longitude: [� ° =1 = u
esign Current
1C._DqiF.)aity
SHM
Design Current
Swine Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish I
Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
Beef Feeder
[I Boars
El Pullets
❑ Beef Brood Co
❑ Turke s
Other,
❑ Other
❑Turke Puul0ts
❑ Other
NumStructures:
ber of
1
Discharizes & 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 L?fNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
0 No
❑ Yes
WrNo
❑ NA
❑ NE
❑ Yes
J9No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: e JDate of Inspection,
Waite Collection & Treatment
44. ITorage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
r-71 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):
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
?I 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
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[—]Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or 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] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [—]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yesr f No ❑ NA ❑ NE
Page 2 of 3 21412011 Condnued

Facility Number: - Date of Inspection: Q
24.4Did thMacility fail to calibrate waste application equipment as required by the permit? ❑ Yes �3No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E J 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 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 � No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Comments (refer to question #k Exnlain any YES answers and/or any additional recommer.
Use drawings of faeility to better ex
3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
situations (use additional pages as necessary).
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes—.10 F11-No ❑ NA ❑ NE
[:]Yes EfNo ❑ NA ❑ NE
❑ Yes ,FfNo ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
2fNo
❑ NA
❑ NE
❑ Yes
ff No
❑ NA
❑ NE
tateons or any::otner•eon
Phone:
Date:
Date: 6
2/4/20 I

Factlxty Nud berg
�
sion of Water Quality
sion of Soil and: Water Conserval
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: c3 I Arrival Time: Departure Time: County: Region: [ -�
Farm Name: SL Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: 1,6
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = e 0.' = « Longitude: = o =
Design Current Design Current,,_,'.,w
Design Current
Swine �«.y
Ca aci Po Mahon Wet Poult Capacity dPopulatron
typ ry
Cattle " Ca aei Po ulation
ty
4 g
P �
M p �p
❑ Layer
- ❑ Non -La er
.
t .
;Dry Poultry ;.
ry
Y
4
..
"Other
y
k
.�,
M .:�
❑ Other
�w
t
1Vumber of.Structures`
r
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
-
❑ Gilts
❑ Boars
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Points
❑ Other
❑ Dai Cow
❑ Dai Calf
❑ Dairy Heifer
❑ D Cow
❑Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ZNO
❑ Yes A!fNo
❑ NA
❑ NE
❑ Yes ;TNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: Date of Inspection
Waste Coilection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: � _ .._
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [VNo ❑ NA ❑ NE
❑ Yes • Rio ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 'P No ❑ NA ❑ NE
❑ Yes ; 'No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes JO No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ONo ❑ 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 ''No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes C'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
0. Soil type(s)
l4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
;;rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
V,No
❑ NA
❑ NE
l7. Does the facility lack adequate acreage for land application?
❑ Yes
ff No
❑ NA
❑ NE
1.8. Is there a lack of properly operating waste application equipment?
❑ Yes
Plo
❑ NA
❑ NE
Comments (refei-'to question:#): Explain any YES answers and/ any' men or anv otherrcomnients:
Use..drawriigs of facility to better explain situations (use, additional pages as necessary)
Reviewer/Inspector Name _AlK Phone: - _7
Reviewer/Inspector Signature: 11C Date: 3 %
Page 2 of 3 12a004 ' Continued

Facility Number: — Date of Inspection
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;jTNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Fel No ❑ NA ❑ NE
the appropriate 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;'No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[,�`No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
g�qo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C2rNo
❑ 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
ZNo
❑ 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
PfNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
UNo
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
;aNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
J
/J iwk oce:�t�t
harry
11117110
l- S�
-7 16; //0
�130110
1, -7
�s —lo
/1// 716
Page 3 of 3 12128104

Type of Visit Q.Campliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit u 'ne 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: .' Departure Time: County: ag L Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phon''' a No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 Longitude: = ° =' = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
El Wean to Finish ❑ La er
❑ Wean to Feeder ILI Non -Layer I I
❑ Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers
El Gilts Non -Layers
❑ Pullets
❑ Boars ❑ Turkeys
Other ❑ Turkey Poults
Design
Cattle Capacity
Current
Population
❑Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
ElBeef Brood Co
Number of Structures:
❑ Other
[]Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes gNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
V_No
❑ Yes
�No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility, NumlI i E3.� Date of Inspection 1 C�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E3 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes o ❑ NA ❑ NE
St7cture 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
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes C}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 [;I?No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PMo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes O'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 9090 ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P4qo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[,2�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
mments (refer'to question #) �Explatu,any YES answers and/or airy recommendatiod5 or any other comments.
... ���„
tuisedrawmgs�yof facifitytaibetter'explainksttuahons.�(use addtttonal°pagesas ncessary)�
..- a �'io;�=a'.�•ww-s.a».<F�='Rzr'�'""-�..'�".'.�."'iM,..7�,#%�y��*„_�.,....�T"�'^F..�`-Y'""v,yi`k�..3�.i9=
Y"COAZ
I
T
Reviewerllnspector Name Phone: —4)
�r%Q r3 p
Reviewer/Inspector Signature: Date: /:P- P
Page 2 of 3 12128104 Continued

Facility_Number: '3 Date of Inspectiony�
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
❑'No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
21�o
❑ NA
❑ NE
the appropirate box.
❑ WUP El Checklists El Design El 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 ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
�lVrNo
NNo
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�L
R IVo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O-No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
GRT90
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,.,�
2 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
V No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O-No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
dNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
UTNo
ElNA
[INE
33.
Does facility require a follow-up visit by same agency?
ElYes
E?No
❑ NA
❑ NE
Addthottal,Co-nrtments and/or:Draw�ngs
I
Page 3 of 3 I2,28104

IType of Visit 01-Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit _.QAoutine O complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number o? Date of Visit: I
,O- ermitted43tertified © Conditionally Certified 13 Registered
l
Farm Name: __ s,. } LA r� <%e�
Owner Name:
Mailing Address:
Tune: s7�.
Not
Date Last Operated or Above Threshold: _.
County: tLn -. ......
_.. 'Phone No: _
Facility Contact: ___ .... --Title: Phone No:
Onsite Representative:.n ��.� ��p.(' _ Integrator. W��
Certified Operator:
Location of Farm:
Operator Certification Number.
0swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 &4 Longitude • '
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes _ETNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes -EINO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes •E]&
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes J2.?6
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:_,�L�
Freeboard (inches): c
12112103 Continued

Facility Number. — Q' Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
1 seepage, etc.)
,,01�o
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes .431' 0
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes .PTO
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes . rf4o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes ,21;ro
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelrmprovement?
❑ Yes ZrNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes ElNo
❑ Excessive Ponding [3 PAN E] Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
M. Crop type .ZLc�, so �eadiz,&i gL� a
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 �ONO
b) Does the facility need a wettable acre determination?
❑ Yes A2No
c) This facility is pended for a wettable acre determination?
❑ Yes ,[allo
I5. Does the receiving crop need improvement?
❑ Yes ❑INN
16. Is there a lack of adequate waste application equipment?
❑ Yes _[3.lo
Odor issues
IT Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes E3Ro
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes O'So
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes .21Rb
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 _DTo
Air Quality representative immediately.
� �J;
�f2cr�0rT�ih ec�
�eCpYa�.f Q�'2 //ea�
Reviewer/Inspector Name
ReviewerAnspector Signature:
❑ Feld Copy ❑ Final Notes
6��2e' d-- c.✓el;
Date: lQ//Jx'lt:52
12112103 Continued

Facility Number: Date of Inspection /� G
Rgguired' Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ,QNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iet WUP, checklists, design, maps, etc.) ❑ Yes IET<o
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes�O No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes .E!rNo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ,ETRo
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes E3No
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative? ❑ Yes ZrNo
28. Does facility require a follow-up visit by some agency? ❑ Yes 2Mo
29_ Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes PNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes ,8'go
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

=, 1 D[vision of Water Quality
'{ r _: �yrl Y� �. �. DiAseon of Soil and Water Conservation ff
F O' Other Agency_ 1 y r'c
Type of Visit 3&Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit ISRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: ?� TJ Tiine: j !'� Printed on: 7/21/2000
.,.. 0 Not Operational O Below Threshold
MPermitted k.Certified
(j ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ...................
Farm Name: T� l.. ilt (ax�dv"�/ County: �I/....................................... ........................
`.....(............................................................................
Owner Name:
!�e n Z Phone No:.......... ................5........................................................................... .............................. .................
�1...
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative ........ i.l.: MJpK............ ....................•..................................... Integrator.......,<111LriP 1. —
Certified Operator: ................................................... ............................................................. Operator Certification Number:...........
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude * �� ��� Longitude
Design Current Design Current Desrgn Cartc�t
4.'._._ Ca iii Po elation Poultry Ca p aci - Population Cattle . Ca :.Po illation
Wean to Feeder 2l0(xf ❑ Layer PO
DairyFeeder to Finish ❑ Non-LayerNon-0airy
Farrow to Wean
- Farrow to Feeder ❑Other
Farrow to Finish Total Design Capacity
Gilts
qRFBoars Total. W- -
Subsurface ains Present ❑ Lag^�+n Area Spray Field Area
' N��Dr
merof Lagoons ; .: ._ .
Ponds /;Scdtd Traps . ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: [I Lagoon El Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes N No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes rallo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .... ............................... .........................................................
il
Freeboard (inches): 3f
5100 Continued on back

1~acility Number: .3 — 3 Date of Inspection j./ D� 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 maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
[ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
BNo
12. Crop type �PSGK� ta�/AZG� �l7lhi1 SOY j
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ZLNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
jg No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
9No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
Ej No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
Og No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
IgNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
�1 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
D9 No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
CK No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
MNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[)�No
fo violations or• deficiencies -were noted• diwirig this'visit; • Y.oii VlVt. eeeiye tid further
correspofidenee: abaut: this visit.... ........ - . .... ' . .
/V6le r )at9 :5244 110t aJt pQG t� �iu - Li as hold y'2e�Er
re6u!-k6 zkCl— as 4- e4-'
rQ4 ek 1� e orrl &Z-0r tf vl-- c.�17f` 40�
Reviewer/Inspector Name
.p_ �/i,:. o. -,. �s _a .-. ... a'•�,, s_�.�4s,W°.c�,a�[.i.a;z`�� .cPr_�ia. ..�,�.Fs :�a
Reviewer/Inspector Signature: _ Date: SAM

Facility Number: — 3 Date of Inspection J z� Printed on: 7/21/2000
Odor Issues `7T'
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 23.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 29 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 5 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 J� 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 X No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 9No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Ci�No
5/00

Routine 0 Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review 0 Other
Facility Number Date of Inspection to -
Time of Inspection ®24 hr. (hh:mm)
p Permitted Certified E3 Conditionally Certified 13 Registered 113 Not Operational Date Last Operated:
..........................
Farm Name: ... ...1.....\............`h Y County:........... . ti..��,. ...............
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
MailingAddress:.......................................................................................................................................................................................................... ..........................
Onsite Representative: .................... ...............................................
p ....0 L'L .i..................................................... Integrator: t ' 1..
Certified Operator: ..................................:............................................................................. Operator Certification Numb(er:..........................................
Location of Farm:
Latitude ' 6 44 Longitude ' ' "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
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 O�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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard (inches): ....... ...............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes P4No
seepage, etc.)
3/23/99 Continued on back

acility` Number: 2&— Date of Inspection
�7
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
P(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
Of No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
(�(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
J 'No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
to No
11. Is there evidenc f over applicat' ? ❑ Excessive Ponding ❑ PAN
❑ Yes
ONo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
P'No
b) Does the facility need a wettable acre determination?
❑ Yes
ONO
c) This facility is pended for a wettable acre determination?
❑ Yes
Wo
15. Does the receiving crop need improvement?
❑ Yes
JWNo
16. Is there'a lack of adequate waste application equipment?
❑ Yes
'gNo
Required Records & Documents
17., Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
9No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
XNo
(ie/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
KNo
20 Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
KNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes XNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes gNo
24. Does facility require a follow-up visit by same agency? ❑ Yes J�(No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes Q(No

Facility Number:3t — 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
Wes
❑ 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
N, No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
J 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
FNo
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
f 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
M-ditionall CqMments: and/or ° raw�n s:

D7.:Divysion of.Snil and Water'Conseivat<on .Operation Review ,
D Division of S©il and Water Conservation CotnpErance Inspeet�on
CI,I)Msioa of Water Quality Compliance inspection
Other Age ncy; Operafa on Rev�ewsrf
z.
Routine 0 Complaint Q Follow-up of DWQ inspection Q Follow-uE of DSWC review Q Other
Facility Number Date of Inspection
Time of inspection Q 24 hr. (hh:mm)
© Permitted )4 Certified 0 Conditionally Certified [3 Registered E3 Not O erational Date Last Operated:
Farm Name: �.. v ✓ SUS CountY:... ..-.... �l.h.......................................................
........>!n...................................................................
Owner Name:.... ................. .............. Phone No:........................
FacilityContact: ....................... Title:................................................................ Phone Na:...................................................
MailingAddress:.......................................................................................................................................................................................................... ..........................
Onsite Representative: , "et.— �Integrator....... (!sue
..... .......................................................................... .....
Certified Operator: ........ 1-11-1-1. .................................. ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude Longitude �• �� C��:
Design Current ; :: Design ' _ Current Design - 'Current
Swine;tPulaCapacity Po =ulaaonr= -Capacity Po ulahon Pou
Wean to Feeder QC60 ❑Layer _ ❑Dairy
❑ Feeder to Finish ❑ Non -Layer El
[] Farrow to Wean =-
ElFarrow to Feeder ❑Other
❑ Farrow to Finish Total Deign Capacity,
❑ Gilts,
- ,_ -
❑ Boars Total'>SSLW
Number of Lagoons- . ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
Holdink>Pofi& / Sohd:Traps W ❑ No Liquid Waste Management System
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 ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes VNo
3. Were there any adverse impacts or potential adverse impacts to the Waters -of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches):........................................................................................................................................... ..
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes XNo
Continued on buck
3/23/99

Facility Number: 3 -9731 (late of hispection
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 �lication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑} Excessive Ponding ❑ PAN
.12, Crop type _ LL CG
r'
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?
(le/ WUP, checklists, design, maps, etc.)
19_ Does record keeping need improvement? (e/ 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: d yiola�igris;or defciecies were pQfee7 dta ing this:visit:- ;Y;Oil will -receive iio #'ucther
. ctirresponc#ence. about this .visit. . ... . . . _
❑ Yes gNo
❑ Yes P(No
❑ Yes J'No
❑ Yes W No
❑ Yes No
❑ Yes �'J No
❑ Yes Z No
❑ Yes 5�No
❑ Yes �?No
15�ycs ❑ No
❑ Yes WNo
❑ Yes N'No
❑ Yes 0 No
❑ Yes KNo
❑ Yes KNo
❑ Yes M No
❑ Yes XNo
❑ Yes KNo
❑ Yes ,C�rNo
❑ Yes No
❑ Yes No
Con mentsl(refer to questiott #}: Explainiany YES answers,and/or airy recommendations or.any other comments:!
U1�se�drawsi�ng`-� of facril�itv_ tLo �Le�= ec,e`sfiayetter explainsituse additional srpagesasn
g_ _LA,((
ble
ly
-r� Q
Reviewer/Inspector Name 1 �C�+� • = . - _ ' -�3
lReviewer/InspectorSignature-.�� Date: �; q
3/23/99

Facility Number: bate of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below 9Yes ❑ 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 KN0
28. is there any evidence of wind drift during land application? (i.e, residue on neighboring vegetation, asphalt, ❑ Yes N 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 KNo
M Were any major maintenance problems with the ventilation fan(s) noted? (he, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 14No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes P, No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
3/23/99

[3Division of Soil and Water Conservation [:] Other Agency
M Division of Water Quality
10. Routine 0 Complaint 0 Follow-up of DWO inspection 0 FollOW-UD of DSWC review 0 Other I
LFacility Number 3D—��� 1
13 Registered C1 Certified 13 Applied for Permit C1 Permitted
FarmName: .......... Ail ..... . . . . ..............................................................
OwnerName: 10 0_4 ... E4ril ..... .... .... ... ... .............................................
Facility Contact:
................... Title: .........
Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Lla,Not 22crational I Date Last Operated: ..........................
....... County: 4kh .... ........................... ..................... ..
.., ..... Phone No. .......................................
MailingAddress:......: ... &.1 ...... (A.".1 ................... I ...... I ..............................................
Onsite Representative: ..... h1A \i& .... �",\L.w .. ........................................................
Certified Operator:........................................................
Location of Farm:
..... I ...... Phone No:
..... ckVkxYU.r.F\V . ...... tj.!�� ................................. .... ?. U, ?,. f .........
Integrator: t r, yy...........................................................
e 3 I�K
Operator Certification Number .........k.................................
C:
.... ar .... 15K.A.UA., - .01 ...................................................................
............................................. ...... I .................................. - — — — ---------- I ...................... .... ............................................................ * ....................... . ......
Latitude Longitude
-Designi C1,
urrent !Desig
n Cprren tDesign
CurrTnt
Swine DacitvP6iiiiatiorPoulfryC2DaCitV. PODula ton Cattle Capacity -onulati
Wean to Feeder
_ZCroo
El Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
0 Gilts
Boars
I0 Dairy
10 Non-Dairyj
-1
ZE0
General
1. Are there any buffers that need maintenance/improvement? 0 Yes V9 No
2. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Lagoon [I Spray Field [] Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
1�
d. Does discharge bypass a lagoon system'? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? .
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes q No
El Yes [21 No
❑ Yes No
. m F
El Yes U] No
El Yes
El No
El Yes
No
QU:Yes
❑ No
❑ Yes
MNo
0 Yes
[)I No
Continued on back

Facility ti umber: — Z
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (Laagoons,tloldini Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure I Structure ? Structure 3 Structure 4 Structure. 5
Structure 6
Identifier:
Freeboard(ft): (............ ..... ................... ............ ....................... ............ ............. ....................... ................. ....................................
...................
10.
Is Seepage observed from any of the structures?
[1 Yes
(@ No
11.
Is erosion, or any other threats to the integrity of any of the structures observed'?
El Yes
[�j No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
03 No
(If any of questions 9-1.2 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
IN 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 e .. iC S .......................4I...... __........... -................ .... ...... .................. .................................. ........................
............ `..............................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
Od 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
[3 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
[M No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
] No
22.
_ r
Does record keeping need improvement?
❑ Yes
No
For Certified or Permitted Facilities Only
,
23.
Does the facility fail to have a copy of the Animal Waste :Management Plan readily available?
❑ Yes
[� No
24.
Were any additional problems noted which cause noncompliance of the Certified AWNIP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit"
❑ Yes
S] No
[3 No.violations or deficiencies were noted- during this: visit..You.will receive no further .
• correspotidence ab:oitt Phis.visit.- . � � . � .. � ... . � � � : � .. .. . � _ . � � .. , : � . ... • � . ,
Cointnents (refer to.guestion #) ,Explain any,Yl:S answers and/or any recommeiridatrnns or aRy'o her�comments^ A�
Use`drawings of facility to Netter explain situations. (use additional. pages as,neeessary} _ `
.._
5. Lbw o r�� ► �. c�t� # 3 L slujMr} be 1� 1 �rade�zt e jej.
��• [ ih kscut— f `CW sV m)W !f 1-,t dTej.
7
7/25/97
Reviewer/Inspector Name - ' :7 � ILA-)n'AA "t_' U `
_
Reviewer/inspector Signature: Date:

UNITED STATES NATURAL RESOURCES P. O. BOX 277
DEPARTMENT OF CONSERVATION KENANSVILLE, NC 28349
AGRICULTURE SERVICE 910-296-2120
July 28, 1997
Mr Brian I_ Wrenn
DEHNR
Wilmington Regional Office
Division of Water Quality
127 Cardinal Drive Extension
Wilmington, NC 28405-3845
Dear Mr Wrenn:
JUL " 1 1997
BY:
This letter is being forwared to you in reference to the matter of updating the
waste plan for J&T Farm facility number 31-293. 1 have completed a plan based
on the irrigation design submitted by Mr. Billy Hall. I have also included the corn
field on the southeast side of the farm in the plan.
If you need any additional information on this farm please give me a call.
Sincerely,
e
/�v /46W4
BilllyW. Houston
District Technician
cc: Eugene Parker

Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection F WT4­1 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review 0
M Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:..... .. ..... .... .. _ ...._.... ?.....-.... .W. ...�_ ....
FarmName: __...x� .... NUrssa..... .................... .._.... _.... ..._............. County: f. '! °L... ........ .... .....__.
Land Owner Name:... �5 _...�c .... ..... ...... Phone No: ......................... __..
Facility Conctact:...Eu0t— . 8, f ... .._..... _.... Title: _ ... ... _ ...._ Phone` No:... �.��?).j aR.�lgZ.... _........
Mailing Address: .Q.x .� 4 ...... _.... _ ..:._ .........._. .... ..._..�lfY�,11.L+.pi:i[�.. !�
Onsite Representative:...... L —ty" -ac6(,A._ at . .....
- Integrator !�
Certified .... C t _......._ .....__.. Operator Certification Number: Z
Location of Farm:
,..Fa�rn�._...1..�Q��.r`..P...+��....K�....:.^►.ti5........ ....... __...... ........... I ............. ......._..... .......... .... �}'
Latitude Longitude
Type of Operation and Design Capacity
, , Des Current e � ` r .3
gnDesi nCurrent A Dest n Current
�S+�n©Ca aci sPo ulatiun �_` °ul y: � Ca aci_lPo nlatron_ v�.Cattfe�ST�� Ca�aci �Po�elat,oa
❑ Wean to Feeder pix ' ❑ La er D
❑ Feeder to Finish [] Non -Layer ❑ Non-DaiTv
Farrow to Wean
Farrow to Feeder tau. Design Capacity da
Farrow to Finish .��;��� ,
F Total SSLW�
. ❑ Other
fr �$•9 s'$.'�:"�'�%:'-.4�:�-� ,�:.��:. :.r.�A :ibw.-4;ac ...�� ::.< �G...F.'iw�?�. .., r3�li"..�;';k ��ai:.. ::ff�err. �`::c-:�� �T'.�
Number ofLagoons !Holding Ponds��
s
❑ Subsurface Drams Present
: ❑ Lagoon Area ❑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. ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes $0 No
❑ Yes JVNo
❑ Yes P No
❑ Yes No
❑ Yes No
❑ Yes [%No
❑ Yes 0 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
EA Yes ❑ No
Continued on back

Facility Number:......
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?
Structurgs (Lagoons and/g Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (fI): Structure 1 Structure 2 Structure 3 Structure 4
S
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 B No
❑ Yes ® No
❑ Yes 52 No
❑ Yes B No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste ,Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ?L ......- ...... - ..... ..... ....._ ... _....... .......................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
FonCertified Faciljties Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes ® No
❑ Yes 13 No
I@ Yes OBNo
❑ Yes E4 No
❑ Yes 13 No
❑ Yes 0 No
❑ Yes (.NNo
❑ Yes ® No
❑ Yes [%No
❑ Yes (? No
❑ Yes & No
❑ Yes UNo
❑ Yes 19 No
(,% Yes ❑ No
Comments (refer to gerestion'.Ezplam any YES answers and/or any recommendations or any other tse.
Use drawings.of facility,to better explain situations {use adilrtianal pages as necessary) b
. �' ...}}x
S Q berm shmui e. r i- G.�pvti.V ..`� �v,(o}rdn
IZ,' Ne. �"VVL 01� irf+'3A� Sr1tw- 66Aj lne
2-4. 5" 'r«ods 5.wd 6e- � � by 5P� k'elJ � ova ky�,�,� � raref—
Afrt �, wash s;� si,N sae v da4j- A CL"ks{- dor r^or+J% des Sa,[
� �.l�.fy � � y
iVNstc,,` dJAJ odor e&4TOt sIOU1J
a
cc: uivtston of water vttamy, water &Iuaruy aectron, Pacrttty Assesstnent Unit 4/3U/50 /

Site Requires Immediate Attention:
Facility No. 3 —ZI3
DIVISION OF ENVIRONMENTAL MANAGEMENT
LOT OPERATIONS SITE VISITATION RECORD
. #a_j7
4 iDATE: , 1995
!6W
Time:
Farm Name/Owner:s� a r 5 e r U
Mailing Address: ✓3 S
County: u
Integrator: Phone:
On Site Representative: Phone: ��Q —
Physical Address/Location: AVC-5-9 L lv —�
Cgto) zoo _.
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
'�DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:"I TjLongitude: 7° Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of l Foot + 25 TFt.
hour storm event
(approximately 1 Foot + 7 inches) e or No Actual Freeboard: Inches
Was any seepage observed from the la oon(s)? Yes or No Was any erosion observed? Yes or No
• Is adequate land available for ra pro No Is the cover cro de u te? 'ego No
4 P y /_ p a 4
0
Crop(s) being utilized: o c ZI oZ2 3,Sl7vJ
Does the facility meet SCS minimum setback criteria? 260 Feet from Dwellings? e or No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes olo
Is animal waste discharged into waters o e state by man-made ditch, flushing system, or other
similar man-made devices? Yes or o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with ver crop)? Yes or No
Utio* Comments: © o S f
A
jIn
r,
41
cc: Facility Assessment Unit Use Attachments if Needed.