310330_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

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:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design
Cattle C*opacity
Dairy Cow
Current
Pop.
We to Feeder
I
JNon-Layer I
Dairy Calf
eder to Finish
D . P,oult ,
Design
Ca aci_
Current
Pao
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes C211q'o ❑ 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 o NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑Yes LNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: 31- 9 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo 0 NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZrNo ❑ 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
FZ 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
&NS ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
0 Yes
No ❑ NA
[] NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
0 Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather Code_
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E l� ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
No ❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: Date of Inspection:
24, DW the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EfN. ❑ 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 ❑-1 o� ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No []-NX— ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
04o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑'NO
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑'Ko­
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E3-Ms❑
NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ergo`___ ❑ NA
❑ NE
Comments (refer to -questions fl Explain any YES answers.and/or.any additional recommendations or any, other comments
Use drawingsoffacility. to. better'explain�situation"s�(use ad itional pages asnecessary )
Reviewer/Inspector Name: �' �.� t i ��Y l J�1,f1 ' Phone: Tl0 7r
Reviewer/Inspector Signature: Date: & (r
Page 3 of 3 21412015

Type of Visit: 0'C pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ( Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: a(p Arrival Time: L' Departure Time: LL _ Z� County: ` UP Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop. Cattle C*apacity Pop.
Wean to Finish Layer Dai Cow
Wean to Feeder
I INon-Layer
I Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current Dry Cow
D , P,oult . C•_a aci_ P,o Non -Dairy
Layers Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other Turkey Poults
Other 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? ❑ 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 YNo
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

tacilky Number: - 27 Date of Ins ection- jm
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a D Yes La No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
N ❑ 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
hf ❑ NA
❑ NE
I & Is there a lack of properly operating waste application equipment?
❑ Yes�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ZO/
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

acili Number: - Date of Ins ection: (o
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
2b. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
No ' ❑ NA ❑ NE
r to ❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
rN
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 Io
❑ Yes No
❑ Yes No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
VN
"N❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other.comments. I
Use drawings of facility to.better explain situations (use additional pages as neeessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone
Date: J
Y4120I

Type of Visit: U 7Routine
pliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 0 Complaint O Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: 16 Arrival Time: /�Departure Time: County: _90F Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: G &&J-V oz.4i': cj'
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: _ _ l aP_5 L
Certification Number:
Longitude:
Design
Swine Capacity
Current
Pop.
Design Current Design Current
Wet Poultry C*apacity Pop. Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Design C►arrant
Dai Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Turkeys
Turkey Poults
Other
Boars
Other
Other
Discharges 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)
[] Yes
o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
go
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Vo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: IDate of Inspection: j
V
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I Structure 2
Identifier: LA 6-w�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 9'3
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [/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 LZJ 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 0NNo ❑ 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
t2. Crop Type(s):
t3. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a tack of properly operating waste application equipment?
❑ Yes
L Q '�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
La
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
rNoo
❑ 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 [Z'Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
��
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili umber: -G jl)ateoflns ection:
a:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes gNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes dNo ❑ 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 Rio ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes I 3 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 Q 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 dNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 5No ❑ NA ❑ NE
Comments (refer to.question.#): Explain any, YES answers and/or any additional recommendations or any other comments.. .
Use drawings of facility to better explain situations (use additional pages as necessary).
C ET ce'(4 O E L
Reviewer/Inspector Name: ,. O t Phone: T10 '1*
4591
Reviewer/Inspector Signature: Date: p 1
Page 3 of 3 2/4/2 J15

4
Type of Visit: d C pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Q Arrival Time: Departure Time: L-L— .z-''—� County: W PU; Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: '6RL _kK M, cL-4 eu/ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I U 5 6
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er I
El
Dat Calf
Feeder to Finish
'Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
it Ca aci P■o P.
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Tur -e s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes El o
❑ YesVr�
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facitity Number: - p Date of Inspection: bl
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I
Identifier:[)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
/No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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?
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 U 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): 1_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 0
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[JJ
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
6CJ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesYNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑Yes
Na
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
6y<0
❑ 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
YNo
❑ 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
L'J
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
Zo
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility plumber: - a Date of Inspection: 4old
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
VNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes r�No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 Reviewcr/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 �Ta ❑ NA ❑ NE
❑ Yes �No, ❑ NA ❑ NE
❑ Yes :�N/o
oNA ❑ NE
Yes ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
q'❑ NA ❑ NE
No ❑ NA ❑ NE
Comments {refer to question ft Explain any YES answers and/or any additional recommendations or., any other comments. I
Use drawines of facility .to better explain situations (use additional na2es as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Ins
Phon _isle
Date: , L
12 b 14

Type of Visit: 0 Compliance Ins ction U Operation Review 0 Structure Evaluation p Technical Assistance
Reason for Visit: 0 Routine Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Timer County: _D u __I�L.IV Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �i,� Title:
Onsite Representative: ea �- �"�
Certified Operator:
Back-up Operator:
Location of Farm.:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Latitude:
Poults
Owner Email:
Phone:
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?
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes
No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes 0 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 ❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes o
❑ NA
[3NE
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 21412011 Continued

t�. •acflit y Number: 1 -Z Date of Ins ection:
I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
21"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: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
Zo
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
d o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
7No
❑ 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
CalNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
[DNA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [} Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
tN
❑ 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
ZE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
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 ❑ t20 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge S7Nt
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [:]No ❑ NA
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA
Page 2 of 3 21412011 Continued

±acili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [] No ❑ NA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [:]No ❑ NA gNE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail 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
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑Yes <o0
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes /No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? 0 Yes
No ❑ NA ❑ NE
VNo❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.:
Use drawings of facility to better explain situations (use additional paces as necessarv).
�r
UN�1 13u=- Ta"Pvm�
QuC"S-t.�a� DEA0
Lr�AA LID3 i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
An/ n F.E&GO l7ir. c.��, Nv
CEAiv(,12— iTuC{7 kfls BEEF
a(Z- tW, 1kE
040,; A �jv 006S
U,
wA %, R
D'T-tW a"
NOT 6-0 Td
FEES ' T
Phone:
Date:
�_IA 011

#Type of Visit: 95 Co Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance 1
Reason for Visit: 0 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access I
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time: Departure Time: ® County: Region:
Title:
Owner Email:
Phone:
Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Wean to Finish
Wean to Feeder'
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Latitude:
Pullets
Turkey Poults
Other
Longitude:
y Cow
Cy alf "
y Heifer
Cow
Stocker
Feeder
Brood Cow
Dischar es and Stream Impact
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?
❑ Yes
❑ No
❑ 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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes❑
VINo
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
ElYes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: 131 -330 Date of inspection: 3
Waste Collection & Treatment
. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure ] Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (A`
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 Ef
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesVNq
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes 10
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �'
[:] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall inspectiVNo
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection:
24: Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ❑ NA ❑ 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 �Wou
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? El Yes ❑ 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 ReviewerAnspector 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 2 No, ❑ NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
rNo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes❑
FN
NA
❑ NE
❑ Yes
❑ NA
❑ NE
Comments (refer, to question #): Explain any YES answers and/or any additional. recommendations or any. other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
0/#j
Reviewer/Inspector Signature:
Page 3 of 3
Date: L41 ;�-

Type of Visit: a rRoutine
pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: i Departure Time: County: 0-N,5L0k i Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Rae1-' fft')C.Hak'• Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
1 brG (
Design Current
Swine Capacity PoPin
to Finish I ILayer
Design
I
Current
op.
Design Current
Cattle Capacity Pop.
Dairy Cow
HWean
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
C•.a acl
Current
Rio
Dry Cow
Farrow to Feeder
Farrow to Finish
D . Roul .
I Layers
Non -Dairy
lBeef Stocker
Gilts
Non -La ers
I Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
urke s
HTurkeyPoults
Other
Discharges and Stream Imnacts
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 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
❑ 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 21412011 Continued

FacilitXNumber: Date of Inspection: c.l 'L.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 56 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: LIj� ,j$fNJ
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.)
wi�o
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 environmen 1 threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[—]Yes
VNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes
No
❑ NA
D NE
maintenance or improvement?
ll
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑/1Vo
❑ 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
1N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
Y - -
❑ 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
M/N(o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�Wo
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
OZ
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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 o ❑ 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 �To ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes2No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili. Number: - O Date of inspection: `L
2<4. Did the facility fail to calibrate waste application equipment as required by the permit. ❑Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes Z[-]
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
2fNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
]/No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No C] NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ YesA
❑ NE
ENoEo]
34. Does the facility require a follow-up visit by the same agency?
❑ YesA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facilitv to better explain situations (use additional nacres as necessarv).
r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �1 �Q9 b
Date:Z/
21412011

Division of Water Quality
Facility Number O Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ( (Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: rl 5lr// 1/ I Arrival Time: a Departure Time: County: UN Region:
Farm Name:`AIL =491M EST AL& CA(- !C� .rQA& Owner Email:
Owner Name: _A(Z-NGST V ALA �1-) G P�h/one:
Mailing Address: GULAOI LLE . / C_
Physical Address:
Facility Contact: I Title: Phone No:
Onsite Representative:
Plu s?cyy-r EAct,vt Qa�CPQ_J_S't
negrat 1 n
Certified Operator: i �-� �� • r)kri ON operraat+oorlCertification Number: i �] a �L � • _ _
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = I = is Longitude: = o E--] , = «
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
^ I ❑Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharp,es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current.., , ..
Cattle Capacity Populatton,` .
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ gry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 XN o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes o ❑ NA ❑ NE
ElYes3fNo ❑ NA ❑ NE
12128104 Continued

Facility Number: i-33cl Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: �_A�ao7U
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No
ElYes ❑ No
Structure 5
El NA El NE
El NA [I NE
Structure 6
❑ Yes )<No ❑ NA ❑ NE
❑ Yes A No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No El 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 Winddow, ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
I L-L C
�3
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
l8. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments (iefer'to'question #): Explain,any YES answers and/or any recommendations or'any other comments F pax
Use draw►ngs of facility to better explain situationsnse'additional pages
ALI
Reviewer/Inspector Name
Phone: d' �g 60 V al
Reviewer/Inspector Signatur
Date: 9//
Page 2 of 3 12128104 Continued

r
Facility Number: 3 -3 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
PkNo
❑ NA
❑ NE
the appropriate box. 0 WUP [] Checklists 0 Design 0 Maps ❑ Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
El Yes
No
❑ NA
❑ NE
`/
❑ Waste Application 0 Weekly Freeboard El Waste Analysis El Soil Analysis ❑ jhVaste Transfers tnnual
Certification
El Rainfall ❑ Stocking 0 Crop Yield 0 120 Minute Inspections [D Monthly and V
Rain Inspections E]
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?
KYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
N No
[INA
[INE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XN A
❑ 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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
Cl NE
General Permit? (ie/ discharge, Freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
tNo
ElNA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ElYes
❑ NA
❑ NE
Additional Comments and/or Drawings:
w• C,q CiZZA -r I oN
No 5LcApC C SuQ.0 E /N �C�l - CaT U EIY6E DCW15 wVo-V 3d opy S
S T->. 9(�10 9 ajorf to wqs 4P%
ATTN. AMAAVR (a a 11V6 S
�1 ICa 3 5o - aCx W (PAX)
aR-
pTtJc/: Aµ�nr�A�aArivE3
�-� c 4v gtIV4 L bAL EI
/YC_
V?_y0S
Page 3 of 3 12128104

Type of Visit Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit ZgRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: / 60 Departure Time: County: C-1 N Region:
Farm Name: i_: F)qW 6:-5 T CAGZ TGJZ A (tK", Owner Email: OwnerName: t"Z NF r cLT�R Phone: 4107Q9�r "J 1rri�p
31 _
Mailing Address: ULP U I �/VC COgs )
Physical Address:
Facility Contact: Title:
Onsite Representative: -'� XY�(
Certified Operator: ILj_ Cx&%x2yq
13
Back-up Operator:
Phone No:
Integrator: /�
Op r�" ator Certification Number: 1� a` 0Q1
Back-up Certification Number:
Location of Farm: Latitude: [�o [� 9 [� e Longitude: =° =1 [= «
Design Current
Swine C►apacity Population
❑ Wean to Finish
❑ Wean to Feeder
91 Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current
Wet Poultry Capacitti Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
urrent
P6att1!EW1WpacitFPR.o'
pulation
❑ Dairy Cow
❑ Dairy Calf I J
❑ Dai Heifer
❑ D_jyCow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ANo
ElNA
[-INE
Discharge originated at: ElStructure ElApplication Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ 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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes )4 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes I .No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility.Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo El NA [I NE
a. If yes, is waste level into the structural freeboard? [I Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAG0 01 _
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): [
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes] No [INA El NE
(ie/ large trees, severe erosion, seepage, etc.) 1
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes )Q 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 XNo ElNA [INE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes 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 ElNA ElNE
maintenance or improvement? ✓✓✓ \\\
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes f No ❑ NA
❑ NE
maintenance/improvement?
/ 1
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) sc, gez( 11)
13.
Soil type(s) M1LAUlcILC--
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 ?
❑ Ye?� No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes J,No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes }o ❑ NA
❑ NE
Comments (refer to'questran"4): Explain any YES answers and/or any :r. e.eommendations or, any othercomments :
Use drwbetter explain situat,ons(use;addttional pages as necessaryf
ReviewerMspector Name
�4
� . l j�lF S _' "` �� ` ` ' Phone: 0-_4Cj(0= 33�
Reviewer/Inspector Signature:
Date: %d
Page 2 of 3 12128104 Continued

,r
Facility Number: 3 Date of Inspection f�
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists
0 Design 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 'ANo
❑ Yes %No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes XNo ElNA ElNE
ElWaste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑vaste Transfers❑,snual Certification
0 Rainfall [:3Stocking E]Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections E]Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
4' C--T GC:% OX 4'> S6'ON 4S � Ccv/
C-�e-r W,41Goau Pu b tiow A-S ZOW AS po55 r &_E
❑ Yes
I�No
❑ NA
❑ NE
❑ Yes
X 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
ANo
❑ NA
❑ NE
❑ Yes
No
❑ NA
[I NE
El yes
No
❑ NA
❑ NE
12128104

Type of Visit lD Compliance Inspection ()Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit oRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: LI A/ Region:
Farm Name: AQNF ST Ca27T.4L VAtL(A Owner Email:
Owner Name: 7= R Q-/V E_S TT CA `'L E R Phone:
Mailing Address: 1`'�NN ���t�� AU ►Ltd �f VC I �'
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: JS JUA/ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o =' = 1i Longitude: = o =' =
oil
Design Current.
Design Current Design ffin
❑ Wean to Finish
❑ La er
❑Non -La er
4/
Dry Poultry
El Layers
Non -Layers
El Pullets
❑ Turkeys
❑ Turkey Poults
El Other
❑ Dairy Cow
❑ Wean to Feeder
Feeder to Finish
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
El Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Otber
❑ Other
Discharges & 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
[I No
❑ 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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�KlNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
o
❑ NA
ElNE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: `31 —�j3C� Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): X- 5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1ANo ❑ 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 ElNA ElNE
through a waste management or closure plan? I
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 ElNA ❑ NE
maintenance or improvement? 1 �
Waste ApDlication
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 IYJ No ❑ NA El NE
❑ Excessive Ponding ❑ Hydraulic Overload [I Frozen Ground El Heavy Metals (Cu, Zn, etc.) V�
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) se �ee__R�
13. Soil type(s) A LA, f R I � ui w_: ^
14,
V
Da the receiving craps differ from those designated in the CAWMP?
El Yes
o
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[XNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
acre determination?❑ Yes
ONO
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[ KNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
$ No
❑ NA
❑ NE
.. -
da.- .., -- r,:. .. .-<.��'w..'�' '.w;-,.e..x•_. ...'a::,.._aw+b .. ....z.°='_: n.._e ,._'aT�.Y,. 'S.•s.......�...
._dl�'-.�.6'l�Ls -_... ac - baAB i'
• r • .
a Jag1Qol J. 9
jj/PLIO 1.11
So10g l.q
Reviewertinspector Name I HOQAW 1 I Phone:
Reviewer/Inspector Signature: Date: S Slog
Page 2 of 3 12128104 Continued

1 L
Facility Number: j 33 Date of Inspection?
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes '0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropirate box. Q WUP 0 Checklists El Design 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA El NE
0 Waste Application El Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ V paste Transfers
✓✓✓✓✓✓ ❑ llinuai Certification
0 Rainfall 0 Stocking El Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 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
10
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
No
El 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
kN A
❑ 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
R
El NA
El NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
jJ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
AN.
❑ NA
❑ NE
Additional Comments and/or Drawings:
GgU2Qg i ION DLAJ& i HIS 46A2
1n1 e), mS 15 INUAl-j - 1T1S (Y I V�J�fl��57�nIDt�1/� j SAT
�l
ti- 5�oAj 1-5 TNT C�1� Fo"�N�S F19UL-►i - HiS olC
Ciao 1S v FEU D
pcu-� �)�- S 1
LE tCtk
To e (n�� - uJ pS 0 C TZC i A�
F�E�DS NrE� nl`upA
p"T QED
Page 3 of 3 12128104

Division of Water Quality
[Facility Number j 33a O Division of Soil and Water Conservation
— Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 5 CJFi Arrival Time: �� Departure Time: County: r / " Region:
Farm Naive: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: r Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = = 6 = Longitude: 0 ° = t = «
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle CapacityPopulahow
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish N j
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other Ii
❑ La er
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:.-.:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of 3
❑ Yes I%No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes � No
ElNA
ElNE
❑ Yes 9No
❑ NA
❑ NE
12128104 Continued

F1
racility umber:3 Date of Inspection's,l�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ANo ❑ 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: t, 14(�,�`
Spillway?:
Designed Freeboard (in): l9• S
Observed Freeboard (in): 199,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 9No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0SNo ❑ 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? �f Yes [--]No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ' r] No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ' No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
l4. 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 9No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ONo
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): .
`�. Co,NT1NQ E wa(Zrc 1114r alA( U'F-E
W19 Q-- A L-I-rTLE f,f(QF JQA1 CYN
/ A`51 fl 6—
N CK t Al Ca W j f3 t LLLt �u s aAl or y E
r F i�1 +� !� � 5 (L-LCofL� o F 1 T
5
k11
Reviewer/Inspector Name t jv
I Phone: 9 90 --} 9 & 'T3
Reviewer/Inspector Signature:
Date: 5113 6 t,
Page 2 of 12128104 Continued

L;
Facility Number: — Date of Inspection ! O
Remuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps
p El Other
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
N No
❑ NA
❑ NE
❑ Waste Application El 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
bgNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
XNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
14 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
4NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes JO No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
UNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
CAVrGIC t<nrocw CF #N TH'Atr
/46 E-D5 -TID
�� �ol�►CL D S N E i 7i? SAC Ri d
J7 (La W� I F00k 70 A NUMI E RE E p%A T �A € tQN Att- L tC CQ 4�I�
x
Page 3 of 3 12128104

�(R
Division of Water Quality
Facility Number j O Division of Soil and Water Conservation
Q Other Agency
Type of Visit )9 compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit f6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / 0 Arrival Time: 3; Departure Time: r 7� -/t/ Region:
Farm Name: , %� 657- r,-Owner Email:
Owner Name: �/ gny5� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone No:
Integrator:���
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: =' =' = Longitude: = ° [�] ' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
E]DryCow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ ]VE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

j
Facility Number: I- 0
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ,, f
Spillway?: ,VU
Designed Freeboard (in): Z -7,5
Observed Freeboard (in): 5la
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ElNE
(ic/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes IVINo ❑ NA ❑ NE
through a waste management or closure plan?
❑ Yes )gNo
❑ Yes ❑ No
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? j�Yes ElNo ❑ NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes
(Not No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) "```�s��ss��/
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ElNA ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J�J)No ❑ NA ❑ NE
maintenance/improvement? ////////
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window /❑ Evidence/oaf Wi Drift ❑ Application Outside of Area
12. Crop type(s) A�� S�.
13. Soil type(s) /Y
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
/ No
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes�,(No
El
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
JLJ No
/4
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes,
o
❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment? s
ElYes
jKo
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other codiments.
Use drawings of facility to better explain situations. (use additional pages as necessary): .
`,� �o���z.-��rf % GC/��,� �•1 =5 �.�Gz Sl���� �� Ss Q��n/s �l�'
�wf-✓,EOf
Reviewer/Inspector Name l 6 Phone: /0 -- 9�
Reviewer/Inspector Signature: Date: EJ
12128104 Continued

Facility Number: Date of Inspection / D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ;oNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes / Z No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard El Waste Analysis ❑ Soil Analysis [I Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i"
Rain Inspections Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
,(❑
❑ Yes 1[J No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes /❑ No ONA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes A No ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes )dNo ❑ NA
ElNE
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.,111NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
!!
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
ElNA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
,_,{
El Yes /J No
❑ NA
El NE
33.
Does facility require afollow-up visit by same agency?
Ell Yes I
El NA
❑ NE
Additional Comments and/or Drawings:
f'
gzl'
12128104

O.Division of Water Quality
Facility Number :O Division of Soil and Water Conservation
-- — O Other Agency
Type of Visit 16Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Fallow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ��® Depa'rture Time: unty:
Farm Name: �Al�i�l �S? f1IrQ %� / /�[P/Yl Owner Email
Owner Name- '_/417_ 7 r1— 7 29r Phnne:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �/�l2r�fS� /�—E;
Certified Operator:
Back-up Operator:
Location of Farm:
Region: /
o
Phone No
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ='
= Longitude: = o = =
Design. Current.: Design Current Design Current.
Swine Capacity Population Wet Poultry Capacity Population . Cattle Capacity 1',opulation''
�U Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other —
❑ Layer
1❑ Non -Layer
Dry. Poultry
❑ Layers
❑ Non -Layers
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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
El Yes P No ❑NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes PfNo ❑ NA ❑ NE
❑ Yes PlNo ❑ NA ❑ NE
12128104 Continued

Facility Number: — D Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes )ZfNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA 9NE
❑ Yes ❑ No ❑ NA PdNE
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? [I 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 Q�NE
maintenance or improvement? /
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA O�NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NANE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 1Q% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes J[d No El NA El NE
15. Does the receiving crop and/or land application site need improvement? El /�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ❑ No ❑ NAff NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NAFfNE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ZNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessa
ry).
^1�✓`��'9��i✓ Aas✓r< 16-0-e f c.s� �c �,PF . Se';✓r �i/ e14110 �odE 1�,✓
r
- 4,47 C IMF �n� 0 �ln� c�C//��i-1 J-Gl�'! zi`1G- �O c.J OeOP F ,6 r ,
IReviewer/InspectorName — — Phone �U �t//Z I
Reviewer/Inspector Signature: Date:
Page 2 of 3 " 11/281,64 Continued

Facility Number: — Date of Inspection F 7 �' p
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 C�NE
the appropriate box. ❑ WUP ❑ Checklists /
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
❑ NA A 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
A 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 0No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes //�No
El
❑ NE
and report the mortality rates that were higher than normal?
J
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ONo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
'P�No
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ONo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes N No
❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
�t7 c,c� CiP4i� �z� yU„
7�C� was ✓Jin �yUzfT,"0 p `9SO
�i��F��lG l�li/�it/y/�?Pzi✓� �„/ �rt, 1��,,� .vu714
IVD
Page 3 of 3
12128104

Hog waste is being discharged under gathering rain clouds. Note where
circle of spray crosses over a ditched area. Ditches in most all sprayfields
are directly connected to streams and other public trust waters.
Lower Neuse Riverkeeper _
Flight 3h1107 2:30 to 4:t5-PM-<
N34 55 658 W077 44 657'�
A

(Type of Visit 21 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Qf Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date o€ Visit: /00 121 Arrival Time: r�0,i�9 Departure Time: 2' aunty: Region:
Farm Name: Owner Email:
Owner Name: _ /lni5 _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative
Certified Operator:��
Back-up Operator:
Location of Farm:
Title:
Phone No:
ntegrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = , = " Longitude: = ° = ` = "
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry C**opacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
ajRj
❑ DairyHeifer
El Farrow to Wean
Dry Poultry
❑ D Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑ Pullets
❑ Beef Feeder
❑ Beef Brood Co
❑ Boars
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
gumr of Structures: Lul
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ YesXNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes/ElNo
❑ YesIVo
❑ NA
❑ NE
❑ Yes PVo
❑ NA
❑ NE
12/28104
Continued

't
Facility Number: — Date of Inspection ! O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ?No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ WE
Structure 5 Structure 6
❑ Yes 'VNo ❑ NA ❑ NE
❑ Yes ['No ❑ NA ❑ WE
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 ❑ WE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ WE
(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 [:]WE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ WE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ WE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Ace table Crop Window Evidence of Wi Drift ❑ Appli ation Outsi a of Area
12. Crop type(s) 4s r 1�t� i9lk, t/ '�5,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
V(No ❑ NA ❑ WE
No Cl NA ❑ WE
No ❑ NA ❑ NE
No ❑ NA ❑ WE
No ❑ NA ❑ WE
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):
ZOOS to .� Sf�� ! ftf' �i�,4�TifO �`�O.P_,05 (O
1¢7' 91 o) 35� - Zook
All
Reviewer/Inspector Name Phone: La
Reviewer/Inspector Signature: Date:
Pape 2 of 1212hloe Continued

Facility Number; :3301 Date of inspection
Reduired 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 ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? 1f yes, check the appropriate box below.
Vf Yes
❑ No
❑ NA
❑ NE
❑ Waste Application A Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
Rainfall'0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
to No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
�9NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VfNo
❑ 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
O 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
❑ Yes
O No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewerfinspector 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:
D � D
Page 3 of 3 12128104

�. Zlii.'sion
ion of Water Quality
Number of Soil and Water Conservation
- —
•• Agency
Type of Visit i2e ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit -Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (P/,
Farm Name: �^
Owner Name:
Mailing Address:
Physical Address:
y
Arrival Time: Departure Time: County:
Owner Email:
Facility Contact: Title:
Onsite Representative: /1/0 (7,14 �W 5Z ZL
Certified Operator:
Back-up Operator:
Location of Farm:
Design
s S. _ Capacil
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
w. ❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = e = ' ❑ Longitude: ❑ ° ❑ ' ❑
Current Design- Current
y,population Wet Poultry Capacity. Population
❑ Laver
❑ Non -Layer
�----� Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Design Current
Cattle" Capacity Population-
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ''No []NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
[--]'No
❑ NA
❑ NE
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
lQ No
❑ NA
❑ NE
12128104 Continued

Facility Number: �.— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�INo ❑ 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: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
O 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
d No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[:]Yes
T] 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
ETNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #f): 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):
ule2 r.
C G✓l laC / V j I�l a/ u/e Cc e! 5: 14 le r
0 X
Reviewer/inspector Name Phone.
Reviewer/Inspector Signature: Date: /
Page 2 of 1212R/O4 Continued

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint Q Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: 1 j 4.
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County:
Facility Contact: Ti le:
Onsite Representative: (f
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator
Operator Certification Number:
Back-up Certification Number:
Region: W�g
Location of Farm: Latitude: ❑ o ❑ ' ❑ Longitude: = ° 0 6 ❑
64
Design @urgent
Design Current
Design
Current
Swine CapacityPopulaton
WetPoultry Capacity Population
Cattle Capacity
Population
❑ an to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
❑ Non -La et
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifej
❑ Farrow to Wean
Dry Roultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
IEJ Other
Number of. Structures:
❑ Other I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
J21 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 DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
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)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
)ZINo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 3 — Date of Inspection LaL�LeZiJ
Waste Collection & Treatment
4' Is st ro age capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes ONO ❑ NA ❑ NE
El Yes El No ❑NA El NE
Structure 5 Structure 6
Identifier: f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a
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 AD 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 „2No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes J'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 .rNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes []-To
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[]Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) "s-/
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ' 3No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ONO
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes ,EPqo
❑ NA
❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes ONO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes UNo
❑ NA
❑ NE
Reviewer/Inspector Name Phone: X
ReviewerlInspector Signature: Date: Q
12,128104 Continued

Facility Number: — Date of Inspection 3
Required Records & Documents
19, Didithe facility fail to have Certificate of Coverage & Permit readily available? `Zyes 404o ❑ NA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo El NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 21Sles ❑ No ❑ NA ❑ NE
❑ Waste Application Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
PIR'ainfall ❑ Stocking Otrop Yield ❑ 120 Minute Inspections Monthly and 1" Rain Inspections OWeather 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 ;ZNA ❑ 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
[2 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
VNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VrNo
❑ 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
VNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
VrNo
❑ 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
0, No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
�No
❑ NA
❑ NE
Additional Comments and/or Drawings: _
PCGi'� '� UC! CaY1s?
% Gael 1501)Xe_
ef 4��IZWd
It- t 'vil/&l Q om' iAch
Coe
_Tns A? 11 a rafter "c' all
/ Tot
06
Q�C�Yj-1 G A7 e f H r7� moo! C`C
~/fir SV
0
12128104

L
Type of Visit j2rtompliance Inspection 0 Operation Review 0 Lagoon Evaluation i
Reason for Visit erRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number �^ Date of visit: Time;
Not (Operational O Below Threshold
PermittedO3�06 r ifiied [3 Conditionally ertifed E3 Registered Date Last Operated ..
or Above Threshold: .........
Farm Name: ...C.a.(��"1'l�.S .. '.. C "'.t�!J....,- County:..._L. 4P_C1........._ .. .. .
Owner Name: ----------- ------------------------------ -__--- ____- Phone No:
Mailing Address:
Faciiity Contact: .. _........... ......—__..._.._.-- Title:.._ --- -- Phone No:
Onsite Representative: j^A(, G.5 ..,r� ._._.... Integrator: !! r (�(,�
.. ,.. . �.
Certified Operator:.................................._....._...._..................._ ......... Operator Certification Number:..........................................
Location of Farm: -
JQ4ine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' & 61 Longitude • 4 64
�Desagn`
Currents Design
-,_ �--,
Current s £ Design Current
rt
Swuxe
Y
Cattle
`flan Pop'ahon;Ca`aci
,, , Ca-aci
l'oY Poultry 1 „Ca
a- r zI'o elation
,Wea
Layer'
=PO
p Dairy
Non -Layer
❑Non -Dairy
_ a -
S
Other
- i-
git Capac><ty-
'G
Boars
Discharaes & 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'? [I Yes [I 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 ;21 �10
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �io
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? [I Spillway ❑ Yes � Ali
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ........ �............_._.................................................__......._ ._�_._.._.�.
Freeboard (inches):
12112103 Continued

Facility Number: — Date of Inspection
t5. `ASb there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes J2.90
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑yes �'No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes Pr90
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes �No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes RKo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes 2<o
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes -0-No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving craps differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14. a) Does the facility lack adequate acreage for land application?
[:]Yes 211 o
b) Does the facility need a wettable acre determination?
❑ Yes 2N-6
c) This facility is pended for a wettable acre determination?
❑ Yes Llfo
15. Does the receiving crop need improvement?
❑ Yes Ergo'
16. Is there a lack of adequate waste application equipment?
❑ Yes EM6
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ yes .E'Ro
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes L fro
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes J; iab
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 gldo
Air Quality representative immediately.
;Comments (refergnest,on #)Explaraa answer aadl orange other ' &p
.LS �mmendaUoas
'Use drawings of=facilrtyabo better exptarn sttaation�..(uststidthonai pages as a�essaxryl�� Field Co Final Notes � �° «
.. .T .«. :4...,..�Y??:. �:.«Y ' ..N ..... �z - N_� °�. � ^^' -.rd� v"'...-a.9"�._p'-;L..�a, ..:L�:v�w'>'"'_1�.'.�2a ss."•:!.0
Invx,}'
y
d'�r-#�L. ..r.. �'''^a.wr14 S^w�-yw r"" '�aaiT �:.��4.:'� � '�"'p-`�.'� k✓ � � "-T.t�«
Reviewer/Inspector Name
��
Reviewer/Inspector Signature: Date: 66M7
12112103 Continued

Facility Number: _ Date of Inspection 4'
d Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes,,O'Ro
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes E No
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ,Ofio
❑ 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 ,2No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes J;No
26. Fail to notify regional DWQ of emergency.situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes EMo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes 4E No
28. Does facility require a follow-up visit by same agency?
❑ Yes 4ET&o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes J:M
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes LkNo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form [:]Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Division of WaterQuality<.
zF Di*
.0'Wowof Soil and Water Conservation:'
�Ot11er�A eRc - _ ~
}c 0 y 3,Mf
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit jj�-Ftoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: QZ Time: 2 /lt Printed on: 7/21/2000
Facility Number / � —j[
- - - .. NNot Operational Q Below Threshold
aPermitted aCertified 13 Conditionally Certified © Registered Date Last Operated -or Above Threshold: .........................
Farm Name: G►' o 6.e.... / Countv:........_..k�li.....
........................................................
.....n........................................ !....................
Owner Name: LCr" rn o71'r�PvPhone No:.......................................................................................
........................................... .................... ..............................................
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative: ...... 1, .147het� Integrator: �Q! A �/
Certified Operator: ................................................... ................................................... ......... Operator Certification Number:.........................................
Location 'of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• ��°°
F Design . Current Design Current De0o
: Current
�. ' Ca ac'ty Pa ulatiion Poultry Ca aci Po ulation Cattle Ca
ci Po elation
Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish ❑Non -Layer ❑ Non -Dairy
ra Farrow to Wean
= ❑ Farrow to Feeder Other
Farrow to Finish Total Design Capacity
Gilts
Boars Total.SSLW =.
Nam;
Subsurface Drains Present IVIIA
Area 10Spray
Field Area
Ho1dg Poails ! Soi>Ed Traps
No Liquid Waste Management System
Discharges & Stream I_.mpacis
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation?
❑ Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PjNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier.....................................................................................................................................................................................
Freeboard (inches):
5/00 Continued on back

Facility Number: 3 -33D Date of Inspection z2
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 AnDlication
❑ Yes ® No
❑ Yes 1,�Z No
❑ Yes 12 No
❑ Yes lO No
❑ Yes ® No
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? El
Excessive Pondiing El PAN El Hydraulic Overload ❑ Yes ® No
12. Crop type � 07 — — riff KG1G L ?1.4-7GJ
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes WNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes R No
b) Does the facility need a wettable acre determination? ❑ Yes [4 No
c) This facility is pended for a wettable acre determination? ❑ Yes 12 No
15.
Does the receiving crop need improvement?
❑ Yes
P 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 or other Permit readily available?
❑ Yes
W 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
® 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
� 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
BNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments:( efer toquestion#) r Eapl na y YES aiiswersand/or ant recommendations ©ry o antlseromments '
i c.. , la,1
Use drawings of facility toebettmexplain situations; (use addittonal:pages as necessary) = # ❑Feld Copy ❑Final Notes ._
- a,. .:
II
Vile,' oj,ie�a,41 oyd L���on Ze✓el �'e.fl�k�s w/'7i/f owe✓
w
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Z
v
05103101 Continued

-r.
Facility Number: - Date of inspection Z / Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 0 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 [allo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Callo
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 CRNo
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 nNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 99 No
Additional omments and/orDrawings: _
J
5100

VeDivLsion of Water Quality
0_Division of Soil and Water Conservation.
O Oth nicy:`
-._ er-Age
Type of Visit ocompliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit eRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3! Date of Visit: 1 01 Time: 30 Printed on: 7/21/2000
0 Not Operational 0 Below Threshold
0 Permitted [3 Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
n FB1 r '^'�
Farm Name �� cS CA 4 ..................................... County:..........V ...'..`....................................................
Owner Name: .................. r K C 5�.....0 i-[ C''........................................ Phone No:
Facility Contact: ...........................................
Title:
Phone No:
:flailing Address:..........................................................................................................................................................................................................
Onsite Representative: Cnf Inte rator• VT-- j fa.r.r' "S
'...................................... g....... "l...
Certified Operator:................................................................................................................ Operator Certification Number:...............
Location of Farm:
;Erimne ❑ Poultry ❑ Cattle ❑ Horse Latitude a 9 " Longitude 4 °C
Desiign. Current Design Current - Design=. Current
? -.Ca aci Po elation Poultry Capacitv PopulationCattle
CciPoeaon
rarrowtoFinish
Feeder ❑ Layer ❑ Dairy
Finish Z +{ ❑Non -Layer ❑Non -Dairy
Wean
Feeder
Other
Total DesignT Total SSLW'
:,
Nambet of Lagoons ❑ Subsurface Drains Present Lagn Ares 10 Spray Field Area
Hotdg Ponds /Solid Traps, ❑ No Liquid Waste Management System
Disci & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system-? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ..............I...............................................................................................................................................
Freehoard (inches): .3a
5/00
❑ Yes )SNo
❑ Yes _�N0
❑ Yes No
❑ Ye S121No
❑ Yes /PNo
❑ Yesj No
❑YesXJNo
Structure 6
Continued on back

Facility Number: -7 j Date of Inspection y// / D J Printed on- 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes j No
-; seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes/ZNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) J
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ZZNo
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 'gNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ElYes�No
12. Crop type Go,- n 4- k� e✓w% V 10(c, TC13) Vred S_t^- rj) 1 6rA > 1-, —
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 9No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ONO
b) Does the facility need a wettable acre determination? ❑ Yes fNo
c) This facility is pended for a wettable acre determination? ❑ Yes J'No
15. Does the receiving crop need improvement? ❑ Yes gNo
16. Is there a lack of adequate waste application equipment? ❑ Yes JZfNo
Required Records _& _Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes_JZ�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.) ❑ Yesj�YNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes O'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,)EfNo
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? El Yes /'JyNo
24. Does facility require a follow-up visit by same agency? ❑ Yes �lo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ElN Yes /e o
Nd-'yiolations'oT defeiendt,9 were hofp(1' ilitt>}ng �this'visit'. • Y:op wiil•reeeiye (io further. • - -
corres' ondence'. abo' UA this visit
Comments (refer to gnestiot #): Explairi any -YES answers and/or any fecommeiidations or atiy otherecomments
Uie drawigigs'of #mcility *better explain situations. (use addrbo>< al pages as necessa -
rY)= .
-Ve sU,re o use WAj4e �^l s;s nfa-lei w; �'� 4 dam, S o�
Reviewer/Inspector Name 4-
_ _ � ._( "'�i �/l�'• _ ..... ., _.. ��:sL`x. ...-ii �, ,I�-"sic'. `.".,yF
Reviewer/Inspector Signature: �Q�[,�/� jJylf'� Date: '-f l D/ 0l 5/00

Facility Number: 3 — 3,3 Date of Inspection O ? Printed on: 10/26/2000
Odor Issues
26. Does'the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ 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 VNO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ,1J11No
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 YfNo
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 )zNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
AdditionaVUornments and/or rawings:
5100

DIVEslOn of Soil: andWaterNGonservatton =:Operation Review �
y DIv OA (if Soil,,. Water -.Conservation -Compliance )Ciis__ _zit n �z� �
r 4 '
_ DlV15iflA of Water Quaby Compliance IbspecdOA �� g � g
OthIM,Agency Operation Review .ire � _ 3._ � ...: , � , •,. � :,
Routine OComplaint 0 Follow-up of DW2 inspection Q Follow-u of DSWC review 0 Other
Facility Number 3 Date of Inspection
Time of Inspection 3Q0 24 hr. (hh:mm)
0(Permitted © Certified [3 Conditionally Certified © Registered 10 Not Operational I Date Last Operated:
Count ��-`�
Farm Name: .e............... ........... y=.........................��..t:1........................ .......................
Owner Name: ---------------- - Phone No:
FacilityContact: .....Title:.........................................I...................... Phone No:...................................................
MailingAddress:. .......................................... ................................................................... ..........................
Onsite Representative: ....
............................................................................ Integrator :...... k1.�...............................................
Certified Operator: ................................................. ......................................................... Operator Certification Number:..........................................
Location of Farm:
Latitude • C " Longitude • & 44
Design-, Current- ' Design Current_=Design` `:_Cu_'rrent
Swine = Capacity Population _, Poultry Capacity Population ci Cattle - XV4 a>Po0afation
❑ Wean to Feeder JEI Dairy
Feeder to Finish ❑Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total;Design Capacity,;.:
❑ Gilts
❑ Boars _.- Jota'BSLW-`.
Number of Lagoons [E]SubsurfaceDrains Present ' ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, slid it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: r�
Freeboard (inches): T !
❑ Yes Pd No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 14 No
❑ Yes JVNo
❑ Yes XNo
Structure 6
.......................................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [:]Yes ONo
seepage, etc.)
3/23/99 Continued on back

�1 1
r Facility Number: 3 — 3 Bate of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
[:]Yes
WNo
(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
XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
N(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
$`No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
kNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
Pj rNo
12. Crop type t✓L�
13. Do the receiving cro s differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
gNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
rP<No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
JffNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
,"io
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
_❑ Yes
b�No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
tdNo
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
WNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit? -
(ie/ discharge, freeboard problems, over application) ❑ Yes PNO
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 RNo
�: �'Vo •vio�aiions:or def cie�cies -rare noted• e�uririg �hls:visitf • Y;oir wi�� •reeeiye tio: Further
corres' 6Tide i nce.. abatit: this viisit
Commetats (referpto question #): Explatn any YES answers and/or anyrecommendations or:any other cortxmenis
[Ise drawings offacility'to better.explatn sttuahans {use"addtt,onal pages as necessary) ri 3 � ? r
_
JAI_
A-s-A
Reviewer/Inspector Name
Reviewer/Inspector Signature: ( �1, Date: "?-e-r-QO

' 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 res ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONo
32. Do the flush tanks lack a submerged till pipe or a permanent/temporary cover? ❑ Yes 99�No
AdditionaLComments andlorDrawrngs:_. .r

0 Division of Soil and Water. Ci
- Division of Soil and _Water -Cc
Division of Water Quality 'C
[] Other Agency Operatiaia -Re
�tion� Operation -Review = s =
tioia ,Compliance Inspection
nce 1<tispec6on
l§kRoutine 0 Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other j
Facility Number Date of Inspection
Time of Inspection 1 1330 124 hr. (hh:mm)
*Permitted 0 Certified [3 Conditionally Certified © Registered JE3 Not Operational Date Last Operated:
Farm Name: G/ti^e . County: .... ..U....". "... "�.....................................................
Owner Name: " ....................""...---..."..--••---•---••--•
Phone No:..."...""...
FacilityContact: .......... ........................ ............ ................................ Title:.............."...""... .. .... Phone No: ..................................... ........--....
Mailing Address: ..................."-.."...." ..........................
Onsite Representative: '................................................ ................. ..... Integrator: .........
.`.,`..11_r...... . ....................................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
_ ".I
Latitude 0 ° •` Longitude & A 44
._
Design Current Design Current _ Design Current
.,Swine v Capacity Population I?oultry Ca acity`, Population , Cattle 'Capacity Population,y
❑ 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 SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds/ Solid'Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes fi�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 gaYrnin"
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 XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [-21NO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes RNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ..-...../.�-,.......................................................................... ......."..."......... "..."".........."....".......................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 9No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 - 530 Date of lnspection
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? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have'alt 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?
�c1o•viglati6tis:ot. deec!6nties •were noted• do it7g �his;visit; • Y:oi} will.teeeiye iid fui-tht f • : • ; -
cGrreSDoric�eirice: about this Visit... . .
❑ Yes 0 No
❑ Yes XNo
❑ Yes D(No
❑ Yes XNo
❑ Yes J�(No
❑ Yes XNo
❑ Yes V No
❑ Yes 9No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes [NrNo
❑ Yes r1o'No
❑ Yes KNo
❑ Yes qNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes ®No
❑ Yes � No
❑ Yes [N No
3/23199

Facility Number- — e3 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
9Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
2&
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
VNo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
El Yes
j�No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or .
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
kNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
9No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
� Yes
❑ No
Additional-,.Comments.an or:Drawings:_ T = 1
3/23/99

❑ Division of Soil and Water Conservation ❑ Other Agency
53 Division of Water Quality
Routine 0 Complaint 0 Follow-up of DWO inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number j 3 3D '
Time of Inspection 0 24 hr. (hh:mm)
[3 Registered ;9 Certified 0 Applied for Permit C1 Permitted JE3 Not Operational Date Last Operated:
Farm Name: ........ Wu-wkx...... ......... nw County: D..*r\.......................................................
OwnerName:..............�1[ St .............. ........,,r........................... .................. Phone No:...1'glQ..1.`x�'..`Ei.Q...............................................
Facility Contact: .................................
Title• .........................
Mailing Address :...... Z��.�........ P6,xA l... R:..................:...........
........................
Onsite Representative: ....... E.faXAL&I........ caw.6.........................................
Certified Operator: ............................................;.....
Location of Farm:
Phone No:
iIAL,.....lphIL........................................x g.........
Integrator: ...... ktt......................................... J......
Operator Certification Number...........t. ...... ...........
....tiS.....on.....?a:1�+-..:M .. JO.E.St ... t7ts1..�..Q.:.�.���... eml...Af..........1.4Z....................................
_ .....................................................................................
Latitude �•,�' �"
Design .;'. Current
„swine capacity 'Population
❑ Wean to Feeder
Feeder to Finish
❑'Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Longitude 0• ��"
Design Current
Poulfry ; Capacity Population Cat
❑ Layer
❑ Non -Layer ❑ P
❑ Other
ti
Total Desien C.
Total
Current
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what'is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes 0 No
❑ Yes No
❑ Yes No
NIA _
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes P No
❑ Yes 1P No
Continued on back

Facility Number: 31 — 330
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaLoons,lfolding fonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Identifier:
Freeboard (ft)..............�.j,f.......................
Structure 2 Structure 3 Structure 4
10. Is seepage observed from any of the structures?
11. Is erosion, or any ether threats to the irate -rite of any of the structures observed?
❑ Yes FM No
YW
❑ Yes No
Structure 5 Structure 6
............................I..........
❑ Yes ,9 No
12.. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate puhlic health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers"
Waste Applicatiotx
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 ..............61I.MIA,............._........_................... ..... .......... 1'"An........................ ....................... ..........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AW41P)?
17. - Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
r
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
0 No.violations or deficiencies. were noted during this. visit. - .Y6u4i11 receive no further
correspondence about this visit:• .
❑ Yes J91 No
❑ Yes N No
❑ Yes ® No
❑ Yes ® No
...'.I ...........
I........, .......
❑ Yes
0 No
❑ Yes
f O No
Yes
O No
❑ Yes
® No
❑ Yes
Dd No
C( Yes
(51 No
Yes
❑ No
❑ Yes j No
❑ Yes No
Cl Yes (] No
Comments (refer to question #).—Explain any YES answers and/or any recommendationsor any other con�nnents
Use drawings of facility to hetter'explam `situations. (use additional pages as necessary) r
r..
1
LT_ Ct'A4, ca.Vw,. �t3rn. 51�ou� t� fi e, or• 5 i Vic,
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: A, - l /��rf,,��� Date: eF�Q/9Sj

r7� f.Y
Y, P
n.. ,. ..3.:5`� �. .. ::o...:ca'fv .:-:.v::yy _ v..:t '.-•`�c&•vvic %tv .: ,.:.-:+e .... _"tv,"G` : A .
y
� yk
A
!❑ DSWC Animal Feedlot Operation Review
�
DWQ Animal Feedlot Operation Site Inspection
r
frn z�
Routine 0 Complaint 0 Follow-up of DW2 ins ection 0 Foliow-ue of DSWC review 0 Other
Date of Inspection `]
Facility Number 'S p
Time of Inspection 24 hr. (hh:mm)
Total Time fin fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit Iex:I. 5 for I hr 15 ruin)) Spent on Review
JZ Certified ❑ Permitted or Inspection (includes travel and processing)
113 Not Operational Date Last Operated: .................................................................................................................................
Farm Name EK?94... ?!` ....... County: .......4k&...........................................................
Owner Name: ........ ..rJ.'..'.r.tg5A- .....ca el r........................................................................ Phone No:.. ..fib .. `...-.......................................
Facility Contact: ... F�_ 1. , V...... 'r............................. Title: 004 LC.................... . Phone No: ......
Mailing:address:........?,gI....?'!,.....�:....I..-.......................................................... ...�ll�lti��.tl... i�.�........................................... � ?'7�..........
OnsiteRepresentative: ......�vv.u!*t....Ca.f_T[.r ..................... Integrator:. Ii ............................
Certified Operator: .................................................. ..., .... Operator Certification Number: ... �..�.3 ......
Location of Farm:
ta........ ...,`......taar'1 .....£ma►..... rnAlt.,...%tnrtn..,.x1.......0)A..-6........S.......L'��Q� .... rS...ora..... ...............
.s►��.......rX..........a.....................................
..............................
Latitude �• �� �:� Longitude �• o� �'�
Type of OperationV Design Current =Design Currenf7 =Design Current
Swine Capacity: Population'. Poultry Capacity..Population Cattle,::: Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
Number of Lagoons 1 Holding Ponds - Subsurface Drains Present ❑Lagoon Area PtSpryfield area
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes EINo
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 RNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes M No
c. If discharge is observed, what is the estimated flow in galinun?
d Does discharge bypass a lagoon system'? (If yes, notify DW ❑Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes CtNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes [A No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes E�L No
4/30/97 maintenance/improvement?
Continued on back

Facility Number:
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft}_ Structure 1 Structure 2 Structure 3 Structure 4
.................... ...............................................................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes JRNo
❑ Yes X No
❑ Yes )" No
❑ Yes ONo
Structure 5 Structure 6
15. Crop type........................Q06..�A.t......... .W.QX.tttal.............................................. �.FAA.... ..................................... .
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
�►Z- L"5&Y' al CA Ivls`,l,r VX. Snpve S
h� lrt`sc�oled. •
i� • corn 00'Aw ; r.r tRa nul beer Pj&os c&4
C�'�i d� o c ci tnet avx Si 4
Reviewer/Inspector Name
Reviewer/inspector Signature:
❑ Yes MNo
U Yes ❑ No
0 Yes ❑ No
❑ Yes &No
❑ Yes 0 No
Yes ❑ No
Q Yes WO
❑ Yes WO
❑ Yes ® No
Pd Yes ❑ No
❑ Yes �RNo
Yes ❑ No
❑ Yes RNo
❑ Yes JS No
4ci c.J reseeded, garc . aretas
for betry�tuc� cw� -
)CCU in ��egs of- V-w-e- is -
Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97