310304_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

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Reason for Visit: 4D Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time:
Departure Time: / pp County: D 4PL_7;t1 Region: Vl;/e o
Farm Name: Sch12
Q K-
4-73
Owner Email:
Owner Name: 06_1
t"+
SC�,�1
Phone:
Mailing Address:
Physical Address:
Facility Contact: @�
S'
��r
Title: Phone:
Onsite Representative:
5��
�� t o GY.✓
Integrator: S MX7H F
Certified Operator:
Certification Number:
Back-up Operator:
Certification Number:
Location of Farm:
Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current Design Current
Wet Poultry Capacity Pop. Cattle C►apaeity Pop.
Layer Dairy Cow
Wean to Feeder
1
INon-Layer
I Dairy Calf
Feeder to Finish
Da' He
Farrow to Wean
Design Current D Cow
D . P,oult , Ca aci P,o Non -Dairy
Layers Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other, ,
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
U No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
5� 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
❑ No
[N NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[PNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Ej�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Ntunber: Date of Inspection: (017,9111
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ q No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
U�FNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier: Ij
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
�pNo
❑ 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
Lp No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [PNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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): C�� & � . '�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes `[�j 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? 1P
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes EP No ❑ NA ❑ NE
❑ Yes CP 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 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tr sfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspecti
22. Did the facility fail to install and maintain a rain gauge? ❑ I
Yes N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o ❑ NA ❑ NE
❑NA ONE
Page 2 of 3 214120.15 Continued

IFacqq Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the pe ? ❑ Yes r�3 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes C!pNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes k!� No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes P No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑ Yes
® No
TP
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer -to question #): Explain any YES answers and/or any additional recommendations.or any other comments 1
Use drawings of facility to better. eaplain.situations (use'additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:Z/ -7
2/4/2015

Type of Visit: O'Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
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 Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator: ��j 1
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer DairyCow
Feeder
Non -La er
DairyCalf
o Finish
rFarrowtoWean
DairyHeifer
o Feeder
Design Current D Cow
D , P�oult . Ca aci Po Non-Daio
Finish
Layers
Beef Stocker
Gilts
Non -Layers
I
I Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
keys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: 1 - 'Rcy jDateofInspectioW/2-J&//A6
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 totheintegrity 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
❑ 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
[]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
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: ` (- c3 Date of Inspection. Z y
IF
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E3 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ETNo ❑ NA ❑ NE
I
he 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?
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?
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.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ;>o ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes '�J-No ❑ NA ❑ NE
0 Yes C]-No ❑ NA ❑ NE
❑ Yes PJINo ❑ NA ❑ NE
❑ Yes [E'No ❑ NA ❑ NE
❑ Yes o
❑ Yes ;rNo
Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/inspector Signature: `v Date: GL %
Page 3 of 3 /4/1015

Type of Visit: J(;Kompliance Inspection 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:
Arrival Time:
Departure Time: County:
Region:
Farm Name:
S fil
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 Currentj2MMMM_QesignjLkourrent
ap.
Swine Capacity Pop. Wet Poultry C►apa;,,nu
Design
Cattle Capacity
airy Cow
Current
Pop.
Wean to Finish
Wean to Feeder
0
La er
Nan -La er
airy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Desirrent
D , P.oult
airy heifer
D Cow
Non -Dairy
Farrow to Finish
Layers
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes 1Z No
❑ Yes V No
❑ Yes E�No
❑ Yes LX No
❑ Yes [;VNo
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

Facitity Number:21 -3dV I Date of Insection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes ZrNo
❑ 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
(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 P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
51
❑ 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 P�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 oNo ❑ 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 C:?No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes .,,o No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;E� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes J2 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 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.
[]Yes 1' 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 e No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes j/j No
/�'
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: - Q Date of Inspection:
24. I?id.the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CZ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 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
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 file drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 2INo ❑ NA ❑ NE
[:]Yes EfNo
❑ Yes C2(No
❑ Yes eNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAVRAP? ❑ Yes P, 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 drawings of facility to better explain situations (use additional pages as necessary).
1-5
'_�/ '�- / / S- I r go
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: l
/4/2014

avi'sion of Water Resources
Facility Number - O Division of Soil and Water Canservation
Other Agency
._ -0
Type of Visit: _Q-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 0 Denied Access
Date of Visit: t
Arrival Time: eparture Time: County: /� Region:
Farm Name: j Owner Email:
Owner Name: Phone:
Mailing Address: "
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative:
C�J-e �Sj2nlg, il-
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Fop.
FLayer
Cattle
DairyCow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
DairyCalf
Daia Heifer
Feeder to Finish a
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Q—r Tj P, ult . Ca aci F,o ,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Boars
Other
Other
Non -Layers
Pullets
Beef Brood Cow
keys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 10 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ 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 No ❑ 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?
Page I of 3 V412014 Continued

Facili _Number: -
Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RfNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes JZ'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 rNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) VNo
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes ,�/I'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �Ef Shia ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
9. Does any part of the waste management system other than the waste structures require
❑Yes �10
I
❑ NA
❑ NE
maintenance or improvement?
tT
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ONo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes .]Ef No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes Zf No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes )2:fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes I/{ No
%
❑ NA
❑ NE
Required Records &_ Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes JNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes ZNo
❑ 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. 0 Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard V] Waste Analysis ❑ Soil 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of 3
❑ Yes _E�No
[:]Yes [ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412014 ConT `
ii

Facili Number: - Ds ection: ZI
- -/ 4
24. Did the facility fail to calibrate waste application equipment as required by the permi . Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[]Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
(Comments (refer to question ft Explain any YES.answers and/or.any additional recommendations or any other:comments I
Use drawings of facility to better explain situations additional pages as necessary}.
1.dj
12- ];-)13
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
-�- L 61L
C V64
-Fob Wc__Z�Je
Phone: NOTC 7n
Date: ?J6,_
/4/20 4

Type of Visit: compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Q Arrival Time: Departure Time: County: _ Region:
Farm Name: ��� ILI
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: L-�p ��� ��� _ Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pap. Cattle C+apacity Pop.
Layer Dai Cow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
Design Current
aci P,o ,
DairyHeifer
Dry Cow
Non -Da'
Farrow to Wean
Farrow to Feeder
Farrow to Finish
JLayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
her
Other
WTurkeys
kePoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes )ZNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ YesNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes dNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes ff No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes ONo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 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 jam/ No
a. If yes, is waste level into the structural freeboard? [:]Yes V] No
❑ NA ❑ NE
❑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 J] 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 '0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes/ No ❑ NA ❑ NE
maintenance or improvement? - r
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? Y,
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 777ii"""''"'�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
fi�f`No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
7No
❑ 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
P�No
❑ NA
❑ NE
the appropriate box.
❑WLTP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes ZINo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil 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 C�'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [7fNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA D NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faciti Number: - d Vi
Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes E!rNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZfNo
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'0No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZNo
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
[DNA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes �] 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'drawings of facility to better explain situations (use additional pages as necessary).
3
3 /t_W//3 I'-7
"3 -e su r e '4c 5 ht e
9 1' a /A, G` s a l/r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ' ! K
Date: ! o 3
/4 OII

Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: knoutine O Complaint p Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: _2 ti�
rrival Time: Departure Time: County Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative
Certified Operator:
Title: Phone:
r l/iC? QI/ _ Integrator:�/�
Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop. Wet Poaltry
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Layer
Ell
Design Current
Ca aci P,o ,
Dairy Calf
Dairy Heifer
Dry Cow
Feeder to Finish
Ekr7yjPXMt .
I Layers
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Non -Dairy
113eef Stocker
Gilts
Non -La ers
113eef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Imuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ( No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
❑ Yes E3"No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ,dNo ❑ NA ❑ NE
❑ Yes ,ENo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - O Date of Inspection:
Waste Collection & Treatment
4 � Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes jEfNo (DNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ,E�No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
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 VNo
0 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 PVo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes grNo
❑ 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 ONo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes _6o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes E� No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 2rNo
[DNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes J!j No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes a No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes E5 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes eNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes J2'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ff 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 )EI"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 eETNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ,❑ No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: C Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the perm t? ❑ Yes No ❑ 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?
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?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
PrNo
❑ NA
❑ NE
❑ Yes
�^No
❑ NA
❑ NE
❑ Yes jo No ❑ NA ❑ NE
❑ Yes ;a No ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ONo ❑ 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 ONo ❑ 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).
5(A(2 40 3a C0,11 bra s {- o'er C 1
jP /&/M ledb jT0(E7'1__
Reviewer/Inspector Name: i3A V1 t �l l Q f1 Phone: y_r r-;?I
Reviewer/Inspector Signature:
Page 3 of 3
Date:

Type of Visit Q"Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance f
Reason for Visit_AE�rgoutine O Comptaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access I
Date of Visit: 111;13 /D� Arrival Time: Departure Time: County: Region:
Farm Name: v //O.(ll .:1_ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: ��✓ Integrator:
Certified Operator: Operator Certification Number:dd? �.
Bach -up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 =, = Longitude: = ° [--] , =
Design Current; Desrg
Capacity Population _ �wetPo�ltry �'Capaci
�.�!x.,_..r� w
Wean to Finish 10 Layer
er
Wean to Feeder - ❑ Non -Layer
Feeder to Finish Z.
Farrow to Wean
a
,__, Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Current c "
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey 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?
Cy ow
Cy alf
y Heifer
Cow
LI Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
�No
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes VNo ❑ NA ❑ NE
Page I of 3 12128104 Continued

Date of inspection
Facility Number: 3 —
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 property 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 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
❑ 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 uestion # :. Explain an YES answers and/or at► recommendations or°an other comments
(refer q ) P y Y: Y
Use drawings of facility to beiter:explain situations {use additioiial`pages: as necessary)
Reviewer/Inspector Namef Phone: yla6 7
Reviewer/Inspector Signature: Date: !l&13
Page 2 of 3
1
Continued

Facility Number: 0 00V Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n 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
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ 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
❑ No
❑ 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
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
ElYes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
.33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�300Q Q 3 7
a�-7 z
Page 3 of 3
2. 3
3 3
.-7
Jy
47
0.6 -7
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AMP 'Sa
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had ��� �•�,-t 04-
12128104

Lin
'Division of Water Quality
Nurriber 3 3CU Q Division of Soil and Water Conservation
Q:Other Agency - <.
Type of Visit 4Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ denied Access
Date of Visit: Arrival Time: Departure Time: County: �� Region:
Farm Name: /f d�O .EL - _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �" Title:
Onsite Representative: c-7O cSA/Gf
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ` = Longitude: = ° = ` "
Design Current Design Current- -Design Cum
�rvide CapacityPopulation -,Wet Poultry ..: Capacity Population , : ` Cattle :Capacity ,P�opi la
Wean to Finish 10 Laver
Wean to Feeder j,'. ❑ Non-Laye
Feeder to Finish
Farrow to Wean I Dry Poultry
Farrow to Feeder
❑ Layers
Farrow to Finish
ELJ Boars I I I..
>- Other
❑ Other - -- -- --
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures::..
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
,A
❑ 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 Number: N Date of Inspection r
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 ❑ No ❑ NA ❑ NE
the appropriate box. ❑ Vap ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate bo below. ElYes ElNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ElWaste Analysi ❑ S Analysis ❑ Waste Transfers ElAnnual Certification
nfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspectio ❑ thly and I" 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?
0Did the facility fail to calibrate waste application equipment as required by the permit?
P25 id the facility fail to conduct a sludge survey as required by the permit?
6. 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
.2'1'es
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
� N CoY,,V ce tlb�uty"\ -�� OLOO&
d o CV/
Page 3 of 3 12128104

Faciliity Number:3 1 — 4 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
St7ture 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 types)
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 #a): 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):
Reviewer/Inspector Name I Phone:
we
Reviewer/Inspector Signature: Date: f-ZyLd 6
Page 2 of3 121N104 Continued

Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit p4outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: p O Arrival Time: - o Departure Time: County:
Farm Name: c �i U6 NK ;9!' Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
� r i
Onsite Representative:( )/SG
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Phone:
Phone No:
Integrator•
Operator Certificatio umber:
Back-up Certification Number:
Region:
Latitude: = 0 = Longitude: = ° = 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
Non -
Other
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?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dgg Calf
❑
Dairy Heifei
EFDry
Cow
❑
Non -Dairy
❑
Beef Stockei
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:0i
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 El"No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J2<o ❑ 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): pZ
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes oETNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes -,2-0'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 12rNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require ❑ Yes P-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XfN o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2rNo ❑ 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 AccSEtable Crop Window ❑ FXidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) 15.ArAy"a
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes AfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes )2No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,❑
Yes allo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes i`J NNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes eJ No
❑ NA
❑ NE
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: `< Date: Q'
I2,128104 Continued

Facility Number:3. —130 Date of Inspection ff
Re uired Records & Docume is
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ;?I No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below, XYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
.FZRainfall ❑ 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?
Oyes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ZINA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
,p NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
ZI NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
gNo
❑ 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
ONo
❑ 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
2rNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 t.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
)2<o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
'No
❑ NA
❑ NE
Additional Comments and/or Drawings:
d! 4- ol�d pjWe, In 6 t fc{i rn uc, s., v vx e�.c
Mi -arm • CCt %P-er
U J/��raM
12128104

(Type of Visit UCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit f0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: WIN MA Tune: -Gi7
ILf Not Operational O Below Threshold
,.,,ffPermitted,ef[ Certified Conditionally Certified © Registered Date Last Opera or Above Threshold:
Farm Name: _ _ .. _ __. _ County:
Owner Name:
?Mailing Address:
'Phone No:
Facility Contact: — 7 C ... Title: _ ��y Ph —one No: _
Onsite Representative: 1 Integrator. /!//C1
Certified Operator. Operator Certification Number:
Location of Farm;
Calw-ine J2Wouttry ❑ Cattle ❑ Horse Latitude Longitude �• �' �"
Discharges &• Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ,ONO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a_ if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes j2No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes , Q-Mo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes ,Ej'Ro
Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103
Continued

Facility Number: �j �� ' Date of Inspection t
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes,, rNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ETNo
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 maintenancefunprovement? ❑ Yes �?o
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes .-UNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ,allo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes JZ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ yeso
❑ Excessive Pomp ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper #nd/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes „Z"NO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [;ft
b) Does the facility need a wettable acre determination? ❑ Yes ErNo
c) This facility is pended for a wettable acre determination? ❑ Yes E5'No
15. Does the receiving crop need improvement? ❑ Yes )D-No
16. Is there a lack of adequate waste application equipment? ❑ Yes PNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes
liquid level of lagoon or storage pond with no agitation? jaN
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes .ffNo
I9. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0'No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes J:�Wo
Air Quality representative immediately.
Comore tagon) an]'=YE�`answers and/or any or anyctheCooats.
L1se drawings o£l acdy�to better ealsrn �. (ae,addttt�si Pal �) ❑ Field Copy ❑ Final Notes
d .
�
f �[ L� �✓ � �Cl� ! //vW t� / � v ! �! � ! �i [..L/ Gar �
-
7
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: l
12112103 Continued

Facility Number: r 1/1
Date of Inspection
Reituired 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?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes fiNO
❑ Yes .0 'No
❑ Yes 2Ko
❑ Yes Ano
25^ Did the facility fail to have a actively certified operator in charge?
❑ Yes e2No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
.-ErNo
27. Did Reviewer/Inspector fail to discuss review/x aspection with on -site representative?
❑ Yes EJAo
2$_ Does facility require a follow-up visit by same agency?
❑ Yes 01�o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes . TN' o
NPDES Permitted Facilities
30. Is the facility covered under a NPDFS Permit? (If no, skip questions 31-35)
❑ Yes SNo
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 NPDFS required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no farther correspondence about this visit.
le11. fe
12112103

Facility Number Date of Visit: C� Time:
rO Not Operational 0 Below Threshold
® Permitted 0 Certified ©Conditionally Certified 0 Registered Date Last Operated or
Above Threshold:
Farm Name: I o Ind f 3 County:
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
l `% /
Onsite Representative: � OG %f4D /L�✓ Integrator: /
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude 0 t
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes X 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 ISNo
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Jallo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: %
Freeboard (inches): 32
05103101 Continued

Facility Number: -3 — �[
Date of Inspection 5'
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 Apolication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type 0,/p/rnk/�!� Ley ) /yr4 Ak PPIR'Yee,4
❑ Yes R[No
❑ Yes 14 No
❑ Yes &0 No
❑ Yes RLNo
❑ Yes [9 No
❑ Yes N No
❑ Yes 53-No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes (9 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes JSNo
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes JKI No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
99-No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
R9 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
Da No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
R No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
EENo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ER No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
M No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
No violations or deficiencies were noted during this visit. You will receive no further correspondence shout this visit.
Commentsl.(refer<to' que holy! Explain any YES answers and/or any recommendations or any other comments. ;
u c r
Use drawings of facility to better ezplam srtnatsons. (use additional pages as necessary): Field Copy ❑ Final Notes �
`'
...ru .
/1/Di,,' .41Ps i -fd
Reviewer/inspector Name ^
Reviewer/Inspector Signature: Date: Z A77*'Z
05103101 V Continued

Facility Number: — Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
FNo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
E;-No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
M 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
ONo
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
M No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
PrNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
® No
' .
Mona Comments and/or raveng • s•
AL
05103101

r - Dtvtsron of Water —Quality ~ -s
s Q _Division of Soil and Water Conservat,oq"
: - tfier Agency }
X Oo - -
_ t -
Type of Visit 10 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 Uate or visit: Time: E�= Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Permitted ❑ CCCertified © Conditionally Certified ❑ Registered Date Last Operated o'rAbove MTh%reshold: ...............
FarmName: ......6-r .._................................................. Countv:... �1T1r. ,[!•...................... ........ .............
Owner Name:.........` .o.................... a, , Phone No: .....................
FacilityContact:.............................................................................. Title: ................................................................ Phone No:
MailingAddress:......................................................................................................................................................................................................... ..........................
Onsite Representative: Q`f�/ ....................... ., ,. , Integrator:
......................................
Certified Operator:
Location 'of Farm:
,. Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��� Longitude �•
��
Design' Current Design Current Design . Current
Swine ; Ca Po alafioa. Poultry Ca aci Po elation Cattle Ca
;:Po " lion
gi Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
t-
r:v Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish Total Design Capsclty
Gilts
- Boars Total w.;
�s
lygimher of 1Gagpp>tu
c
❑ Subsurface Drains Present
i.ag—n Area
❑ Spray Feld Area
❑ No Liquid Waste Management System
=
�xgHolduug Pttudf / Sohd Ttraps ,
:,.
L _:
Discharges & Stream Im acLs
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 P No
b. If discharge is observed. did it reach Water of die State'? (if yes, notify DWQ)
❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/inin?
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 P No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure
Identifier: .................................... ...............................................................................................................................................
....................................
Freeboard (inches): 3�
S/00
Continued on back

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures obsery? (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 maintenance/improvement?
11. Is there eviden9p of over application? ❑ Excessive
12- Crop type -- �
13. Do the receiving crops differ with those designated in the Clerti
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?
❑ PAN ❑ Hydraulic Overload
Animal Waste Management Plan (CAWMP)?
Reguired 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?
yioiaioi .ojr• i 010'e 4ci -*o a Pofe# Owing Ns:visit; - Yoo wiii •t- eeeiye do fut1hglr
cori-es• deuce. 2"i this visit.
Comtra nts (refer to question #) .Ezplsun any, YES answers sudlor any. recamtnendaizaas orLany othercomane
Use d riw*� of fa cility,ta lietter'i iplain siftA ous.,(use addrtiott . pages as necessary)
EVER CDC, � � ��,�� E s� �, � 1��IR
❑ Yes No
❑ Yes #`0
❑ Yes [/No
❑ Yes P No
❑ Yes yj No
❑ Yes i j No
❑ Yes �No
❑ Yes
PfNo _
❑ Yes
V`No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
PfNo
❑ Yes
0 No
�dyesjjr
❑ Yes
F(No
❑ Yes
o
❑ Yes
fNo
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
�No
&vim& 116
Reviewer/Inspector Name
Reviewer/Inspector Signature: /WQZQ� / WZ_,, Date: /7_/h/400/ 900

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes RrNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �Io
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 IdNa
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 N
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Yes 7No
do - onmients an or wings:: .N
MJI-14-> G 5 / v-, -o p
ZVV4G�O 1,&
lt�,. �J LG�'J�C�D CloaL�
M-re
S/00

_Dtvistgn of Water Quality
xx
Q Drvisron of Siiei and' Water Conservation
_tom Q Older Agency 1
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 1KRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
"ate of Visit: '� �--CA Tiine: G d Printed on: 7/21/2000
'j
5 Not ojperational Q Below Threshold
Permitted e
Conditionally Certified © Registered Date Last Operated or Above Threshold: .......................
Farm Name:...........................................[......................-............................. �..-.1 ........
v `^G '� ....................... County:........... .................
Owner Name: ................................... . ............. Phone No:
.........................................................................
Facility Contact: .............................................................................. Title Phone No:
Mailing Address: _ ................. ..........................
...................................................... ............................................................
Onsite Representative.._.. " :. C?................................................. Integrator:.....--..............................................
Certified Operator: .................... .....................................................................................•--.... Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude ' 4 «
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder QQ ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer 10 Non -Dairy
❑ Farr6v to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons JE1 Subsurface Drains Present ❑ Lag-nn Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste vlanagement System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed; was the conveyance mail -made? ❑ Yes ❑ No
h. If discharge is observed. did it reach Water of the State'' (If yes, notify DWQ) ❑ Yes ❑ No
c. If dischar,�e is observed. what is the estimated flow in galhyiin?
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 WNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes D<No
Structure I Structure 2 Structure 5 Structure 4 Structure 5 Structure 5
Identifier: ............................................................... .
Freeboard (inches):
5100 Continued on back

}
vy
Facility Number: — -_�6 Date of Inspection 0 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 NfNo
(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
t< No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
)KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
.1�?'No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
k No
11. Is there eviden q. of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
ElYes
JXNo
12. Crop
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
U'No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
&NO
b) Does the facility need a wettable acre determination?
9Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
�f No
16. Is there a lack of adequate waste application equipment?
❑ Yes
bfNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
kNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
XYes
ONo
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
N'No
21- Did the facility fail to have a actively certified operator in charge?
❑ Yes
M No
22- Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application) ElYes (TNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 4No
24. Does facility require a follow-up visit by same agency? ❑ Yes 19No
25, Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes KNo
0: is
-yi61Mi6lis:ot. aeficWncies were n6fed- during �his:visit; • You wiil•reeeiye tio: rui-ther • : -
- : - corres op ri�ence a�otiti this visit............ ......... . ......... .
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):
sit,-�,�
SZ;, �
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5100

t
y Facility Number:1 -3a(j Date of inspection Gti 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 atlor below ❑ Yes No'
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes )Z(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 j® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes /PfNo
Additional'Comments an _ orDrawings: -
1
5100

Facility Number Date of Inspection 9/29/99
Time of Inspection- ® 24 hr. (hh:mm)
0 Permitted 0 Certified p Conditionally Certified t3 Registered 113 Not Zlperationa Date Last Operated:
Farm Name: Sholar l................ ....... County: Duplin WiRO
Owner Name: Dwight ................................... SjMLV ......................................................... Phone No: 285-20.74 ................................
Facility Contact: ...............................................................................Title: Phone No:
Mailing Address: 585.1.ighthaurae.Rd............................................................................. W.Allace.AC ........................................................... Z846.6 ..............
Onsite Representative: . ................................................................................................... Integrator:Murphy...F.atmdy.Farms......................
Certified Operator:due.0...................................... shofar........
Location of Farm:
Operator Certification Number:12982...................
Latitude ®• ®� ®�= Longitude ©• ®4 F )
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation? Yes [7 No
Discharge originated at: p Lagoon p Spray Field p Other
a. If discharge is observed, was the conveyance man-made? p Yes p No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) Yes p 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) p Yes []No
2. Is there evidence of past discharge from any part of the operation? p Yes p No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes p No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? p Spillway p Yes []No
Structure I' Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
..........................................................
Freeboard(inches): ...............3.1..............................42............................................................. ...............................................................................................
5_ Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes []No
3/23/99 seepage, etc.) Continued on back

hacility Number: 31-304 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 ❑ 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?
p 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?
p Yes
p No
Waste Application
10. Are there any buffers that need maintenance/improvement?
[]Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
p Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
p Yes
p No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
p Yes
❑ 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?
p Yes
❑ 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
[]No
19_
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
p No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
p No
21.
Did the facility fail to have a actively certified operator in charge?
p Yes
p No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
Cl:N.o:vit*tA;on,s:or.defIci noires.were.anted.during.thisvisi't:.Yau.wvili.xereiVtz no further.;:
........ ........... ... ...... .. .. .....I.....
:: �eorxcspaddence. aboirf this:visit::::::::: • : • : • : • : • : • ::::::: ::::::::::::::
cane Flovd Assessment
freeboard in lagoon # 1 and #2. Dike walls are intact.
non-DSW: (Lagoon#1) Minor enbankment sliding in non -vegetative areas. Lagoon is lined and is not saturated. Minor
ion in non -vegetative areas on inside of lagoon #1 slope. Very good vegetative cover all around dike wall. Dike wall in tact
not saturated with sufficient freeboard. No further recommendations at this time. Work on vegetation of inside slopes in
Reviewer/Inspector Name Greet]McVicker Brian Gannon{DSW) , ,-
Reviewer/Inspector Signature: Date:

',e s5
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:IV
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Lagoon Dike Inspection Report 4 a
so
Names of Inspectors C 14�i 6N
T� c�CL��
Freeboard, Feet
Yes No
Yes No
Erosion? Yes No
(Check One, Describe if Yes)
Top Width, Feet
Downstream Slope, x1-1:1V
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes No
Is Darn Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments

--;l

j.=_`:';:'i�- `�,�.}ff Gam. ��t..So-`:-f::G.=:_'-::..tt;,::._::i:::1-sr_�..�:``_., r..-_---•-_..�_, -•t `E' L:.� :5ti `4=....c: r.. . r....ti-......:{4f:
�h
Lagogo4`e In !t
eon Report,
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date Inspection
b 9
of
Names of Inspectors
Structural Height, Feet
�[�
Freeboard, Feet
Lagoon Surface Area, Acres
Se d' r_ 4
Top Width, Feet
Z
Upstream S1ope,xH: IV
}'
Downstream Slope,
xH: I V
Embankment Sliding?
Yes i- No=-
-&—
(Check One, Describe if Yes)
p
U ec t4] e c� �✓ Pr 5 a
,
r� 5 �� ��6%� P .
Seepage? Yes %C No �Q- rt �� �,� h O
(Check One, Describe if Yes) J v i
Erosion? Yes �� Norte _ --e /�S
(Check One, Describe if Yes) 1 n r
Condition of
Vegetative Cover
(Grass, Trees) ve, j
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes -/-- No
Is Dam Jurisdictional to the Dam Safety Law of 1961
7? Yes No
Other Comments ► �4C WC, / l _ 1 r� � � L � C � �y�o �_
Q) Ct) A
4(( � l
l�G S i {� r l►✓v� k Q, U e S,

`l':'T- ., sir,,.._ � �✓ - � '
r to 0
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH:1V
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Lagoon Dike Inspection Report °ic;/
glo 13 64
S o L> ��ae �fi Ira -
1 r + '
�"s I o i�_� .. %100 r
A I l< Cq(o) n S
Names of Inspectors {r 14 OAI
CV rCk—
Freeboard, Feet
Top Width, Feet
Yes No
Yes No
Erosion? Yes No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Downstream Slope, xH:1V
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments

- -.. �Y�1--�-•S•�.. f_.�.L ri..1�i S'�.-�..wr..�.l ��_�v'J-,:C'. _.....,..... er.-.Y�s Y..t .�._ _i..4.1 _.s-.tx-.�_. rr_ ...... h'.'.S `.`f�Fw
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:1V
Embankment Sliding?
(Check One, Describe if Yes)
Lagoqo'Ge In e on Report ` j^
bT 9 ! Names of Inspectors CAVA,10
l U _ Freeboard, Feet (7
e- Top Width, Feet _ — ---
' Downstream Slope, xH:1V
Yes No �, - — �� r-_ l ` L)zl
UP4. wej �rr5 0� �•• Sc�c �16Pe
Seepage? Yes No D ►� h r
(Check One, Describe if Yes)
Erosion? Yes No L !o 1 v--- a.,
(Check One, Describe if Yes) I /
U t f.� P r e c G [ fl
,f J�
Condition of W, / - 60
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes J� No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 196] 7?
m
Other Coments A, re W a,
4 LG 5 414A_ -e_
Yesr No
1, r r r .-% j /^ a

Division of Sail and Water_Canserviii - Operation Review
<
Yl [3Division of Soil and Water°Conservation - Coiaphance Inspection t,
ian of Water Quality-- Caatpliamce �nspectinn
Other Agency Qperatio;n Review"< _.
0 Routine 0 Complaint 0 Follow-up of DW2 inspection 0 Follow -tip of DSWC review 0 Other
Facility Number a Date of Inspection
-, Time of Inspection 24 hr. (hh:mm)
13 Permitted Certified © Conditionally Certified 0 Registered [3 Not Operational I Date Last Operated:
Farm Name: - .. .� %.�,Z/T%" J. �G/ .. ...................... county: ...... Z...51..eu1 Q........ .................. ...
Owner Name:........, � .. ...�tl�ilf G /'t 1.....'.�]IY.pLl�` ................ Phone No: .-...' lQ....-... hl. T.•..................
Facility Contact: .......... .t '% 7.11 ~..................................... Title: ..................... ........................................... Phone No:
Mailing Address: ...... .. .7.. .. �, - .. ..�...... &........ ......1ILl,C.,} k4: e_ .....Nl�....................... M..V&4
......... ....
Onsite Representative :......... dQ�t......?ISt......... Integrator:........:f.........................................
Certified Operator: .....,.rJ�......t4."..............� f{................................. Operator Certification Number/:....1. j ...........
Location of Farm: j
x�crm.........,r�.,rv�ra�l�........ emu........... ........... r�rf/..... JVVV_ .....srn�.....:., ..-...� z.�.. {.., pa r......:.............
13
Latitude [M' ' Eb4:1" Longitude =' Eff' 1U:1"
Design Current -_ Design Current F: `: Design Curient,
'Swine` Capacity Population.rPoultry ,Capacity,. Population Capacity ` Po ulation
Cattle
Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish : ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ ❑Farrow to Feeder Other _ . -
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLI AZ
W�
Number -of Lagoons [:]Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
Holding Poii& / Solid Traps ❑ 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. Dues discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 0 ..jr..
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes
❑ No
❑ Yes
No
❑ Yes
No
❑ Yes KNO
Structure 6
❑ Yes 0 No
Continued on back
3/23/99

Facility Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require 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 maintenance/improvement?
11. Is there evidence of over application? ❑
t2. Crop type
ve Ponding ❑ PAN
§er PPL_
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?
Cl
Yes KJ No
❑ Yes No
❑ Yes No
❑ Yes _ 9 No
❑ Yes _ No
❑ Yes No
❑ Yes J No
❑ Yes fJ No
❑ Yes No
❑ Yes No
❑ Yes V No
❑ Yes -0 No
❑ Yes 9 No
❑ Yes No
❑ Yes No
❑ Yes `� No
❑ Yes No
❑ Yes 0 No
❑ Yes ANo
❑ Yes $TNo
❑ Yes kNo
Ni .-6glatigris'or• d0ficie.ncies were noted. during Ois'visit: • Y:oik will r'eeeiye d futthgf
correspondeiree. about. this visit....
Comments (refer to question #} Explain any YES answers and/or any recommendations or aoy other comments'"
Usc ;Akawings of facility to explain; situatinons (use iiit tional.pages; as necessary)
FRAM C.ea,e_S -4-4pD I AL
Reviewer/Inspector Name t
ReviewerlInspector Signature: ,( jG /J1�„ Date: / t Z3 IM
3/23/99

Facility Number: — Q 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
KNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
XNo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
XNo
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
fA[No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
'K No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
XYes
❑ No
tiona . omments-an or, rangs:_
y
3?-' Govtt'- FILL
3/23199

Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
10tRoutine O Com taint O Follow-u of DWins ection O Follow-u of DSWC review 0 Other
Date of Inspection I
Facility Number
Time of Inspection q : 24 hr. (hh:mm)
U Registered M Certified [3 Applied for Permit [3 Permitted 113 Not Operational Date Last Operated:........
FarmName: ............:.5.64x..... #3........F"-w .............................................................. County:.... NOY%....................
OwnerName:........ .......... SILLC+r....................................................................... Phone No:..�1 fU 2iS-..Za�'�...........................................
FacilityContact:.............................................................................. Title:................................................................ Phone No: ...................................................
S
Mailing Address: ..... &J!S..... 1.ri .�leus ....c�.......................................................... .....(a..��S.i...lalL............................................... ..i? $'tG.Lt.........
OrtsiteRepresentative: ....... ...!�.r.................... ..... Iniegrator:.....(�pr.��,�
......
Certified Operator.............................................................................. z......... Operator Certification Number :........... I ... .... L[1..............
Location of Farm:
x tca' � ....i] j...6.........&J%Z1+.Q:7..h5...... i'a.. y........................... �
. .... ........ ......................... I.........................
Latitude • 4 66 Longitude • 4 46
Design , ;Current Design
ie Capacity. Popula on ` Poultry Capacity
[$� Wean to Feeder
2 (,Go
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
lurrent
ipulation
Cattle
❑ Da,r3
❑ Nan -
Total Design Caj
f;
�' Tota1:S
I
j❑ Subsurface Drains Present E[o Lagoon Area ❑ Spray Field Area
ij
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. 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 [V 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?
op
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
Ul No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
® No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
MNo
7/25/97
Continued on back

'I•'acility Number: —
3 3c
8. Are there lagoons or .storage ponds on site which need to be properly closed? ❑ Yes No
Structures (Lagoons,Iiolding fonds 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): .............. .... I...............................
10. Is seepage observed from any of the structures? [D Ye., ® 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/inilwovement7
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.
i
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
91 No
Waste
Application
14.
Is there physical evidence of over application?
❑ Yes
XI No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
_
15.
Crop type ............ C. tCn...............s tC-A.............'ka.j rr,,......... ................ .....................................
..............................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
rS No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
[4 No
18.
Does the receiving crop need improvement?
Yes
IN No
19.
_Is there a lack of available waste application equipment?
❑ Yes
R] No
20.
Does facility require a follow-up visit by same agency?
Yes
❑ No
21.
Did Revi ewerA nspector 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
Do 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
No.violations or deficiencies Were noted•du�ring' this.visit.- .You Will receive no ftirttier
: correspondence aliottt this,visit:...
Comments'(refer to.question #.}: Explain any YES answers and/or any recotmtnendations or any other comments.
Use drawings of ftcilit_v to better explain situations. (use additional pages as nccessarv}R.
q. Ins lr. �agoc:� . Layor {tvcl 5�ovjd �e low" + V%7rJ
itctr ` i=boejr
Ytno�vly'lttX]'•
1 - l r. � ` j � g
1�• &rGS On o:t ThvuC W�t� 3�pulal �De�l�U WTl'� C(G�y r K$t�er�Qzl{ c7�`K atcAS S�t1rj �JA 1`��G�Pl�!
�m uoa :r d,fu-s;an-skovtd 6e- im4reveJ i-a ".*wve r"a1,w4cr.
Z.Z. Ut;.sve �..c� Sts Sin t} IO2 V?t J-ttl • �Q rLtd67}s fN� V P&r sltlatlld be ot, st k .
2.4. Ow aft: c+`on of t.1 �ea. or Meld # of g 1bs/ac.
3"--
7/25/97
s N
Reviewer/inspector Name16� lib
Reviewer/Inspector Signature: Date:'/��

Routine O Complaint O Follow-up of DWQ ins ection Q Follow-up of DSWC review O Other
Date of Inspection -I Z
Facility Number 3i
Time of Inspection t; 04 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ElApplied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
[Certified ❑ Permitted Jor Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: ,......
Farm Name:......... 3 _._. ..... - •.._ ..... ._.. County: ..... .... ......... ......fit._ .
Land Owner Marne:...._..��RS�......_.„.5`!4.�C.............._.................................._......_ Phone No:.��. �:'..,T�...`z.�.............. _.......
_............
Facility Conctact:........ �!1!� a'�...._ ... _�....q.........._.. Title:._ ............. +......{� ....._ Phone No: .... _........
Mailing Address:._ _S115'_L�,, 4 5 ,....L�1� _.._.._..........__.. ._...... !°I.1LA.G� ... t..N�.�....:..... ... 4.....-......
OnsiteRepresentative: ..... .AO-C.... . Integrator: ._....�.
Certified Operator:.... QZ•„ „•••,� tiQ.SJIk�... ..., Operator Certification Number...�1�
Location of Farm:
...... .. ..18.�`1.1�.. �a........ir .. .�...... ��......,.�.r..nn......aS.....�1,.�..r.:i .....tl.r ...._�' �... �.... .' 4
Latitude •©; p(, 44 Longitude '1-� • ©�
Type of Operation and Design Capacity
-E=ro Dest Current
z DCSIgn Lilrrellt$ � "A � DeSlgn' Current * k.- .Wattle e � �"N
Swrue '
_ Ca "'aci Po uiaiian � 'nut Y -_ Ca aci Po `ulatian ._ , .<Ca aei <:Po ulation
Wean to Feeder 4aC � :�❑ � � ❑ Da'
❑ Feeder to Finish ❑Nan La erg` ❑ Non-puiTy
Farrow to Wean z ` �� F.�� Farrow to Feeder Total Design Capacity goo
Farrow to Finish
-i4
dcoa a �
W k
Other
Tota! -
.;-x���=
Numberof,agoons 1 HoldtngEPoiads' ❑ Subsurface Drains Present
�q��� ❑ Lagoon Area �=n ❑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/inin?
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?
❑ Yes ,® No
❑ Yes R No
❑ Yes 7r' No
❑ Yes RNo
❑ Yes [&No
❑ Yes Q� No
❑ Yes �O No
❑ Yes [N No
Continued on back

Ea=eilw4umber:..3.1...... 30!
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 Hoidina Pondsi
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4
A Z
14. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Wastg 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 .... �.fl ....... .._........ ......... ........... ..... _..... ..MO ._ ....
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes W No
Structure 5 Structure 6
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
1.7. 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?
24. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Fagilities OUIv
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 RNo
® Yes ® No
19 Yes ❑ No
❑ Yes Qp No
❑ Yes j� No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes tZ No
baYes ❑ No
❑ Yes JO No
❑ Yes a No
❑ Yes 10 No
Yes ❑ No
Comments (refer to question #) Ezplam any Yl;$'-answers andlor;any recommendations or any other comments
Use`drawings,'of facility to better explain situations ;'(use ad&tional pages as necessary} E o =�
,ni�'�' Pt S�v�iti be -ex f�cJ —w�' ;etia 1� jayon o+,d 4, eroded awQT
&e-
t6cc �J-L � Vsmseecl[c). ama. shMJ be. rtseeJtd- il%ltitr✓ wd1 o+ '�, Lam
°�
gZ.
S �a,1 tl foe ,r&c� e�] � � Gf hj .
r
S �r-an� records 51�.0>313 6e. rccort)cc] on LRQ-t : rri�rk�on 1or-r+� emc _40Vs
01+.3 6_-a�iora 56A 6e McOded,
` y I
�c CAM V � to y C_ Mntl S�� V a a -I W O lj m P tpe (JuL l f'rcgG� Corm e�f!•
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: -I IZA7
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
F
Facility No. 313 a
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: dam- , 1995
Time: _J?
Farm Na
Mailing
County:
Integratc
On Site 1
Physical
Type of Operation: Swine l/ Poultry Cattle
Design Capacity: 0- fin Number of Animals on Site: iV
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:06" Longitude:_° 2 8" " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)dPor No Actual Freeboard:_Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o Was any erosion observed? or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: s_ I- _ f zf'a4 !U: Q ix .-Mecgt�
74(
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? 6s or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ord§�
Is animal waste land applied or spray irrigated within 25 Feet of a US Map Blue Line? Yes 06
Is animal waste discharged,into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes L'/ If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or 0
_� t fl 3 C -
-11
Inspector Name
Signature
cc: Facility Assessment Unit
If
Use Attachments if Needed.