310348_INSPECTIONS_20171231

NORTH CAROLiNA
Department of Environmental Qual

Type of Visit: om liance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: `9ROutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: Ly�i
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Integrator: Itil
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine @opacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Cattle
Dairy Cow
Design Current
C►►opacity Pop.
Wean to Feeder
Non -La er
DaE Calf
VO
Feeder to Finish
Daia Heifer
Farrow to Wean
Design Current
D , P,oultrCa aci P,o
Layers
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -La ers
I
Beef Feeder
J13eef
MI
Boars
Pullets
I
Brood Cow
Other
Other I I
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes N❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes��Np. ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes E5No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ErNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?: _
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(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 16 No ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
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
01<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
No
❑ NA
❑ NE
maintenance or improvement?
Waste Aoplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZfNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[ Io
❑ 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
[ l No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
[ Flo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
®No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2'F10
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
D o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
g2e4o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
U�-Ao
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
�o
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

[Facgity Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesC]"N-o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �i<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes E"1O ❑ NA ❑ NE
❑ Yes 10 ❑ NA ❑ NE
❑ Yes JE'l�o ❑ NA ❑ NE
❑ Yes �10 ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes. ElONo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ;'V ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional,recommendations or, any -other:cornn eats:
Use drawing ipffa'cili g to better,e% lain situations use'additional pages as neeessa
g ty . P { P g r3').
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
cI ' / tom` /�17� �r/C % ✓! �'�� ����!'�
Phone:
r Date:
21412015

'' ivision of Water Resources
U
y Number ©- Division of Soil aad Water Conservation
� Other Agency
Type of Visit: 2Tornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: C>Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: i t Arrival Time: Departure Time: County: Region:
IV
Farm Name: L 1% $,ray Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: le
10
Certification Number:
Certification Number: `r
Longitude:
9
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
I
Design
Ca aci
Eurrent
P,o ,
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Feeder
Farrow to Finish
Layers
rNon-Laye
Gilts
LArrs
Boars
Beef Broad Cow
Other
Other
Turkeys
Turkey Poults
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
❑ 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 1 of 3 21412015 Continued

Facility Number: — Date of Inspection
i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes [;'No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes 2`No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
!
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in);
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ;R 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 ;�rNo
❑ 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 j2 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes 2fNo
❑ 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 XNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �TNo
❑ NA ❑ NE
maintenance/improvement?
It. 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 > l0% 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
JffNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[--]Yes
Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�T No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2fNo
❑ NA
❑ NE
18. ]s there a lack of properly operating waste application equipment?
❑ Yes
EfNo
❑ NA
❑ NE
Comments, refer to-' uest on'# ."Explain any YES answers and/or an recommendations or any otber4comments " 2
Use'drawingslof facility to better explain situa ttons (use addrttona! pages as necessary)
Reviewerlinspector Name 1 Phone:
�Ju•,. [ 1 _ -. w Z3
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: - Date of Inspection: Z, Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes J2-lqo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes10 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes jalio
❑ NA
❑ NE
❑ Yes j2No
❑ NA
❑ NE
❑ Yes �`No
❑ NA
❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes Pno ❑ NA ❑ NE
❑ Yes ZfNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[—]Yes gNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes VrNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes yNo
❑ NA
❑ NE
questionExplain any YES_answers-and/or, any;adgiAjonal:recommendations.or. any., other._ comments
� .
lComments'(feferto
Use'diavviueiotfacility,toMbetter,eaplain.situations:(us6,additiaual pages:as,necessary).
j fe_ c orot S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
too&L 3 0 0 CQ I-
Phone:��Q�
Date: lZ 2
21412015

Type of Visit: oznpHance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: E Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L5 ,,Z &ft Arrival Time: ,' , O eparture Time: County:'"` Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 'S jam//�aWsel
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Cattle
DairyCow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
l Ca aci P,o
Layers
rFH[Non-Layers
Da Heifer
D Cow
Non -Da'
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
Le
e s
Poultser
tOither
Discharp-es and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes J"No
❑ Yes j No
❑ NA ❑ NE
❑ NA ❑ NE
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 ]Nlo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: 13 VIn Date of inspection: C>
/
Waste Gollection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
rj No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
0"No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
G3 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
T
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�j No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) �`-
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 9No ❑ NA ❑ NE
maintenance or improvement? �f
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes VI 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,dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 9No DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �Z No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
❑ Yes X_No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes _oNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes ZNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes jEffNo
❑ 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 fNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [Z No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - t2 Date of Inspection: Q,
;4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J3'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ETNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes J5 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ,E:rNo ❑ NA ❑ NE
❑ Yes ,❑"No ❑ NA ❑ NE
❑ Yes. No ❑ NA ❑ NE
❑ Yes �`No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 1'No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ,[E!rNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ZNo ❑ NA ❑ NE
Comments (refer. wqu6tion #) E.xplain any YES'answers and/or`any additional recammendations.or:any other -comments:
T. .
Use drawmi s of facili to: betfer ex lamn situations (use additional` a es as necessa
g ty'" P P g ry)::.x
r11z!�-/1V
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
2, -3 �L
Phone: I7�C�
Date:
214 014

Type of Visit: �ampliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q'ftoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: yj /Arrival Time: Departure Time: County: D_i�f�
Farm Name: Le U{t 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:
113
Certification Number:
Certification Number:
Longitude:
Region:
Swine
Wean to Finish
Design C+urrent
C►►opacity Pop.
11
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Dairy Calf
Design
C►►opacity
C►urrent
Pop.
Wean to Feeder
iNon-Layer
I E]
Feeder to Finish
Dairy Heifer
DEZCow
Non-Dairy
Farrow to Wean
Farrow to Feeder
Design Current
D , 1;■Dolt , Ca aci P,o ,
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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 0No ❑NA ❑NE
[D Yes 2] No ❑ NA ❑ NE
❑ Yes [a -No ❑ NA ❑ NE
❑ Yes ;3 No
❑ Yes EI'No
❑ Yes 0_1N0
[DNA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: Date of Inspection:
&Z
Waste Cbllection & 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 ETNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes E'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes j2fNo
❑ 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 J ' 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 _,E]'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ,ONo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes [D"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 J[D'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes O No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes J21, No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes J�]rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ,Ef�To ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes P3-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 _[D'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 ff No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes 'F21 No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit'?'
❑ Yes [�rNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Z No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Jallo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes E2,1Qo
❑ NA
0 NE
and report mortality rates that were higher than normal?
T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
JE3`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
2 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
J:�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
[2-1�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ff"No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
P'No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any, other comments.
Use drawings of facility to better explain situations `(use additional pages as.necessary).
- A�care'
o,s
ReviewerAnspector Name: Phone:
Reviewer/inspector Signature: Date:
Page 3 of 3
21412014

Date of Visit: 5�"Arrival Time: eparture Time: County: Region: w!%
Farm Name: / J�-`t�� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: s
ktj,�r� -
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: rn/�
—7
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
I
jNon-Layer
I E]
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design ur en
oul C•_a aci P,o P.
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts '
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ 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 C] Yes Z o ❑ NA ❑ NE
of the State other than from a discharge? -
Page I of 3 21412011 Continued

FaciliNumber: - X Date of Inspection:
Waste Colrection_& Treatment
4. 14 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 1 Structure 2 Structure 3
Identifier:
Spillway?:
Structure 4
Designed Freeboard (in):
Observed Freeboard (in):
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?
❑ NA ❑ NE
❑NA ❑NE
Structure 5 Structure 6
❑ Yes 4 No
❑ Yes oNo
❑NA ❑NE
❑ 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 0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ;�`No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 1`I / No ❑ NA ❑ NE
maintenance or improvement? �
Waste Apnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo ❑ NA FINE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes)2Nlo - ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes��Z/No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yeso/ No ❑ NA ❑ NE
❑ Yes &o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ONo Q NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,�fNo ❑ 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 ]2'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes g) o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P'*No ❑ NA ❑ NE
a .
25+Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[� YesNo
❑ Yes No
❑ Yes XN0
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
0 Yes �No ❑ NA ❑ NE
❑ Yes � o
❑ Yes �o
❑ Yes VN0
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional napes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: W L-'-ll-
Date:
21412011

� �Ivision of V1'ater Qu ty
F,€tCt wittY Number } W9 Other A encoit and'Water Conservarion
e'a»- :-an- vb . ;:..c". c:; _.... �.. ...a+ .. -'.. . _ ... _ >. - > >' _ - .. -.. - - -.. "^.. ,... ' `:'�µ -4t�.. ="ac Ft"4• _ .�r.
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit-O"Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: r Ci eparture Time: County: Region:
Farm Name: `-'I 06r4 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: may,,, Title: /Phone No:
Onsite Representative: Taw `c Integrator: /LJ
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 c 0=[= Longitude: = e❑ 6 Q«
Design Current Des�gn� Current
Swine A, Capa6ty Population Wet Poultry »wsCapaciity Popnlattoti
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ] r] Non -Layer
❑ Feeder to Finish
❑ Farrow to Wean
n `Dry.Poultry �;~ „
Farrow to Feeder
-Finish
Farrow to
Gilts
Boars
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Po Its
❑ Other
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood C
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo [:I NA El NE
❑ Yes ZfNo
❑ NA
❑ NE
❑ Yes PNo
❑ NA
❑ NE
❑ NA
❑ NE
[]Yes O.No
❑ Yes �No
[]NA
❑ NE
❑ Yes VNo❑
NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number: 113ate of Inspection:
Waste Collection & Treatment
4 ,H 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 ]D—No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c
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.)
T
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes.,Eallo
❑ 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 Q'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes JZITo
❑ 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 n,No
❑ NA
❑ NE
maintenance or improvement?
T
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 j3 110
❑ 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 P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes%o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Ye�_�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes _E50'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 [DNA ❑ NE
the appropriate box.
❑WUP El Checklists [3 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 ransfers ❑ 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 [3 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yeso [] NA [] NE
Page 2 of 3 21412011 Continued

Facifi ,Number: - Date of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 ONo ❑ NA ❑ NE
Other'Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
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
7
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
A No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
)6, No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
ElYes
No
❑ NA D NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations nor;any,other comments: -
Use drawings of facility to better explain situations (use additional pages as necessary).
C9
O.641/ yr
a•6y 5
ac�c,P
4, Z-3
z--7Z
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: R� —/ �g 47T
Date:
21412011

Division of Water Quality
Y
Facility NU er 3 O Division ofSoil and'Water Conservation a
Q Other Agency
Type of Visit PCo pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit SD Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 7, 7//A Arrival Time: Departure Time: County:
Farm Name: _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design,
Swine Capacit}
❑ Wean to Finish m
.1❑ Wean to Feeder
u reeaer to rimsn
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars-
'Other-
1❑ Other
Phone:
Region: 4/y/
Phone No:
Integrator• Alzx&
Of ' Ga_>7'
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = i = Longitude: = o = i = «
Current Design Current
We# Poul `:..
opullation try. ,Capacity.: Population. Cattle
Non -Layer
Dry Poujtry�
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
IU Beef Brood
�Plumbe"ran#
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 j No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes 2rNo
❑ Yes ZNo
❑ NA
❑ NE
❑ Yes /dNo
❑ NA
❑ NE
Page 1 of 3
12128104 Continued A

Facility Number: - Date of Cns ectian:
Waste Collection & Treatment
4. Is storage cSpacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
)214o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[;rNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
T
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
o
❑ 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 A No [DNA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [—]Yes PfNo ❑ 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 PTNo ❑ 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 ZfNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ONo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �No ❑ NA ❑ NE
. acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes
C2r�4o
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes VrNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RJ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes _..ZrNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number:. 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 2TNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes .6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ;10
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes E(No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes A No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes XNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes XfNo
❑ 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 PrNo
❑ 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 ONo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes ONo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes jZrNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes O No
❑ NA
❑ NE
Additional Comments and/or Drawings:
PA
Page 3 of 3 12,128104

Type of Visit 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 oVisit: �
f Arrival Time: Departure Time: County: Region
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator• /
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' = Longitude: = ° = 4
Design Current Design Current
Design Current
Swine Capacity Population Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish ❑ Layer I I
I ❑ Dairy Cow
❑ Wean to Feeder JEJ Non -Layer I I
❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
El Layers
❑ Non -Layers
❑ Pullets
ElNon-Dairy
El Farrow to Finish
❑ Beef Stocker
❑ Beef Feeder
❑ Gilts
❑ Boars
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkev Poults
❑ Other
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 I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

)Facility Number: 3 — Date of Inspection d
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
Struckare I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ��
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l O 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
IT Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments refer to . uestion # • Explain�an YES answers andlo . ( q }.y � r any recommendations or any other comments
Use drawings of facility h to better explain situations. (use addihonal pages as necessary)
...
IV
Reviewer/Ins ector Name
p Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 1212 104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
l9. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PNo ❑ 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.
❑ WIJP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
/ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
T
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
13No
❑ 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
�;Mo
❑ 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
7No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XNo
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
/No
❑ NA
❑ NE
Addihonal:Comments;andtor Drawings
raw
AV • �G��a�s dad a -
— c5�
I
�17/0 �° s
it /7 o y
Page 3 of 3 I2a8/04

IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint O Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: / i Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: + Title:
Onsite Representative- 7(a:`] e- r;a 17.a'laz
Certified Operator:
Back-up Operator:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = u = 4 = is Longitude: = ° = ' 0 4,
Design C►urrent
Design Current
Design Current
Swine C*apacity Population
Wet Poultry Capacity Populafion
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
ElNon-Dairy
El Farrow to FinishEl
Beef Stocker
Gilts
ElNon-La ers
ElBeef Feeder
EBoars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
ot]
urkey Pouets
FET Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes -7No
El NA
El NE
Discharge originated at: ❑ Structure El Application Field ❑ Other
f/
a. Was the conveyance man-made?
❑ Yes o
❑ 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)?
71
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 MNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes 10
El NA
❑ NE
other than from a discharge?
/
Page I of 3
12128104
Continued

Facility Number: —3 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
Sture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12, Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Commentsr;�efer�toaqueshon�#) �Explatn,any�YES�ans�wers�and/or any�tecommendatioios�ar any other comments.
$"'L�"�jq'.'<.dIYR�}"hy.3SR..•�4 -V 9r '°�%'..�`i qT"4 fi ^."6 # 'l®."i. F".'t -lam--IIa."c -
EUse`b?`drawingsof facility to better a%plain sEtnatlans ,(use addtttonal pagesas necessary,): -
er/Inspector Name Phone:erMspector Signature: Date: 6
E
Page 2 of 3 12178104 Continued

Facility Nti;nber: zw Date of Inspection
Re uired 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 appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ElNo
ElNA
❑ NE
bid
the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ElNo
ElNA
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
❑ 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
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
AddiAbnal"Comments and/or Drawin s y �.+- yr g�°`+`b
,g.. 4 4r:�.�h....d"�':=:'Mz..a.. `a....'. ..y�.O�Fx.S i.�,.' 9v ✓: "�4gyC. w%°'{'�„, Kk—
y
as�fieaX -Cax
s1ud�r'A
scid-zley
6-1 CCQy
- /�:�/i'1 C/-- laai-
oC 44v__ Z�>7
0
cJO/
Page 3 of 3 12128104

Division of Water Quality
Facility Number 3 O Division of Soil and Water Conservation
- Q Other Agency
(Type of Visit 0 Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit i6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: � County:
Farm Name: TAG '6� d 0(-�- Owner Email:
cbwnPr NUMP• --F A-AA`� Phnne-
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �� %/9,�I Get/ A�J') A S
Certified Operator:
Back-up Operator:
Location of Farm:
5/` Region:
Phone No:
Integrator: _.
Operator Certification Number:
Back-up Certification Number:
Latitude: = O = , „ Longitude: = ° = ,
x�
b, _ s"Design �Currerit Desigu. Current Design Current
Swine Capacity'. Population Wet Poti,ltry Capacity Population Cattle Capacity Population> ..
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder 10 Non -Layer
Feeder to Finish 2 D D
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 Co
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
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes,9No
❑ NA
❑ NE
❑ Yes
�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?
a. If yes, is waste level into the structural freeboard?
❑NA El NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31.
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 j(J No ❑ NA ❑ NE
through a waste management or closure plan? /
❑ Yes 10 No
❑ 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? ❑ 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 :XNo ❑ 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 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
ONo
❑ 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
PrNo
❑ 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):
Z� Z.�) N,!, 605 r ,8E pY jo
A*P-(17 / 0),,S 5'0 - 0 0
AEEP7S2- S74C z �4
p 5
'S,
7
Reviewer/inspector Name Q
Phone: /O,3207
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

Facility Number: �j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 10No ❑ NA ❑ NE
20. Does the facility fail to have al] components of the CAWMP readily available? If yes, check ❑ Yes ;eNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design
g p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Main Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
A NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
10No
O No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
PNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
/� No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
«<
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit ACompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for VisitA!!5-Routine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: r CR. Arrival Time: Departure Time: County: �Gt. Region: 4�zlql
Farm Name: _,✓.rc7o� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: Gl
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
'Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Back-up Certification Number:
Latitude: = o = Longitude: = o =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
� ❑ Layer
❑ Non -Lay -et --
Other
❑ Other - - -- -- -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharees & Stream Impacts
I. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 2No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes An No
El Yes '!�N
El NA
El NE
❑ Yes No
❑ NA
❑ NE
12128104 Continued

v/
Facili f ty Number:�� — 3� �
�
Date of Inspection �
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[--]Yes 2rNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Struc re I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 7
Spillway?:
q �-
Designed Freeboard (in): (� 5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 1,3 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 41-No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 12No ❑ 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ,-% f� �(e% } S t:;:'-
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�.INo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;J'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
2-No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EINo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E o
❑ NA
❑ NE
,Comments (refer to question #} Explain any YES answers andlor any4&dmmendations or'any other comments
Use ilrawings of facility to:better explain sttuahons; (useaiidihvnal pages as necessary) M�
�Az^ie_ •...ar..,��i:w
Reviewer/Inspector Name �(� ��d � ( Phone:
Reviewer/Inspector Signature: 4 Z_— Date: % as
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents '
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes -En-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,ETNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [,-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[les [I No
/❑
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes E No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes .❑ No
ZNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
�_erNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes,, 2No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA ON'
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes /E5No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
JFeMo
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes P l
❑ 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 PTNo
❑ 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 ONo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
[:]Yes L] 1 o
❑ NA
❑ NE
Additional Comments ;and/or Drawiih sj a ryx R3M
n� 7ecjS P_ ill's
Cu/`
ILe
/` E

of Visit .0Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number "� Date of Visit: / / U Time: fU � OuJ
0 Not Operational Q Below Threshold
© Permitted p Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold-
Farm Name: .'?ls yl�GG7 �r _ ___ County:
Owner Name: , _ _ , _ Phone No:
i Uiling Address:
Facility Contact: _ __ — Tide: .. _ Phone No:
Onsite Representative:. / 3 at . ti _ , ._._.. __ T _ ,, . Integrator -
Certified
Operator: _ _ ..._. ._._ , , , , __.__, .. _. _ . _. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �' �"
Discharges & Stream I:n acts
1. Is any discharge observed from any part of the operation? ❑ Yes�No
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Strucrl Structure 2 Structure ; Structure 4 Structure 5
Identifier: _ _
Freeboard (inches):
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes _QNo
❑ Yes '2No
❑ Yes -®'No
Structure 6
12112103 Continued

Facility Number: — Date of Inspection
5e Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes 0"No
seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a waste management or
❑ Yes 'i 1fio
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes 2No
8. Does any part of the waste management system other than waste structures require maintenancedimprovement?
❑ Yes eNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes ;ONo
elevation markings?
Waste APPUcation
10. Are there any buffers that need maintenancerimprovement?
❑ Yes 8'No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes ONO
❑ Excessive Ponding ❑ PAN ❑ H dra 'c Overload ❑ Frozen Ground ❑ Copper and/or Zinc
- I" )
12. Crop t37e 4 I�
13. Do the receiving crops differ with those designated in the Cerdfied Animal Waste Management Plan (CAWMP)?
❑ Yes ,�] No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes 12TNo
b) Does the facility need a wettable acre determination?
❑ Yes .,[T�to
c)'This facility is pended for a wettable acre determination?
❑ Yes, ERNo
15_ Does the receiving crop need improvement?
❑ Yes J Ro
16_ Is there a lack of adequate waste application equipment?
❑ Yes $go
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon' fail to discharge at/or below
❑ Yes Ea No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes -ONO
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes ONO
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 _M'Ro
Air Quality representative immediately.
;Comments (refer td q on' �Expiaaa* auy YES answers and/or ate' .atry�othe aommeais.: , xr
em�-.. _ a
Use drawiags.offsaility to better aam sjbQatia. (fie sdldol pages ffi nears) ❑ Field Copy ❑ Final Note s
//,-7 C%O[,
T
r _
Reviewer/inspector Name _1 ;
: r l
ReviewerAnspector Signaft re: Date: /
12112103 Continued

F2d* Number; — Date of Inspection f-
9eanired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes eNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ieJ WUP, checklists, design, maps, etc.) ❑ Yes UNo
23. Does record keeping need imp vemeat? If yes, check the appropriate box below. PfYes ❑ No
❑ Waste Application board ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes 12rNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ieJ discharge, freeboard problems, over application) ❑ Yes . O!No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? [:]Yes [;jNo
28. Does facility require a follow-up visit by same agency? ❑ Yes CJ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMEn ❑ Yes 0 No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) [:)Yes O'fio
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 I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

of Visit OLCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit lD� Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: Z m
O Not Operational O Below Threshold
ElPermitted M Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold.
•------------•
Farm Name: tTl!'......11 f .l�.. 'l1 ....T�X!+t ... County: - -- -- -- It ---------------------- ----------.. --
Owner Name: �c Phoneo: N
------f--------------�Ett�------------------------- ------------------------------------._._..
MailingAddress: ................................................................................
Facility Contact:•..........................................................Title:....................:................... PhoneNo:
OnsiteRepresentative:---.�9�------ - - --------------------------- Integrator:.-----!/llfrytQli`�---- ---- --------------
Certified Operator: ............. Operator Certification Number:
Location of Farm:
Discharges & Stream Impacts ,
1. Is any discharge observed from any part of the operation?
. El 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 gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past,discharge from any part of the operation? ❑ Yes C•No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ®,No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 91 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: -- -- -- - f-----•--•--•----------------•-
Freeboard (inches): Z$
-------------------------------------

W/U.Nul
Facility Number: 31 — g
Date of Inspection / dZ
t.untmaeu
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?
❑ Yes IN No
❑ Yes IN No
❑ Yes 09 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over applications?!� `❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type rip u /%4 l rTky J ��i.� 411 car 4 in I %uY:�3~f
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes Q No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? & Yes §0 No
16. Is there a lack of adequate waste application equipment?
❑ Yes
VLNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Kj 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
1�1 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
9 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
V3 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 A"P?
❑ Yes
93 No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
:Commenfs{refer to uestic►p E pIrk y or a"
lain any YES answers;annd an recommendations; yME
n . J
se. rawrngs iifsfacility to.=better explam�§ituations: (use additional pages as'necessary :" ���
. - � - -�• Field Co Final Notes
y 0
�.:. fi ^ev- P 4a c f» re �dn'� : r< nee- ec:!*✓�•
fu ntN�c�/ lcsY� Par- Act
/1e5�" r cprOcs V— f'A✓n ore )4 6 f,o W
rr
-s. - += ✓?g1 i .,-y '"aq'rTr� f,- -„� .^�.-r, i 'Z"z -r - �« ri�,i
Reviewer/Inspector Name'�..���.�'�'�'�
Reviewer/InspectorSignature: Date;
r

Facility Number: Date of Inspection
or Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
❑ No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
❑ No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
❑ No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Additional Qamments sn or ,rawmgs,',o=e
i
r
05103101

-, _ DLvh%= O� Water Qualrty
;� Q Div oit of Soil1and_Water Consesvat one n. '
Type of Visit ACompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit gRoutine O Complaint O Fonow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: 3 V
Q Not Operational Q Below Threshold
Permitted 1} Ce ' ed 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: -....._.
�l 1
FarmName: ..................-..JG........................................................................... County: ---- �..
OwnerName: ................................................... ....................................................... ................ Phone No: .......................................... ...... ........ ........
_ ._.... �.
FacilityContact: ............................................................................... Title:................................ ........................... Phone No:...................................................
MailingAddress: .....................................................................................................................
Onsite Representative: ..... (I�L 2.�^ .................... ................ Integrator:.... f. ........................ .................
_
Certified Operator: ................................................... ............................................................. Operator Certification Number: ...................... ..... .............
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude * 4 66 Longitude 0 S «
Design. ' Current . ,Design Current Design _.1
Ca aci ` . Po ulatioa "try . tr3' Ciipacity Po elation , _Cattle : Cal...ace Pi
swine:;,
Wean to Feeder
Feeder to Finish
g
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
Gilts
❑ Boars
❑ ❑ Layer Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other I I
=
ToWbeAgn Capacity
TOWMLW
Nnmber'otLagooag ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
-Holding Ponds7.SaGd Trips'_ ❑ m
No Liquid Waste Management Syste
.4
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
XNo
Discharge originated at: ❑ Lagoon [ISpray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
ElYes
❑ 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
[INo
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
V No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ElYes
RNo
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): 1
5/00
Continued on buck

[Facility Number: 3 ! -- 2L(gi Date of inspection
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 maintenancelimprovement?
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 ARMication
10. Are there any buffers that need maintenance/improvement?
11. Is there evident of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type hb11.-�
13, Do the receiving crops dider 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?
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0; �'v4 yiolaii[injs:o defcier�eie v gre poled• during this'AAsit; - Y;oo wii�-tooiye pti further: - : - :
6 iisnorideiic_e:anti this visit .......::..::::.................... .
❑ Yes 4No
❑ Yes ONO
❑ Yes gNo
❑ Yes V No
❑ Yes 10 No
❑ Yes gNo
❑ Yes ONo
❑ Yes jqNo .
❑ Yes NNo
❑ Yes 1�No
❑ Yes &No
OYes ❑ No
❑ Yes DqNo
❑ Yes XNo
❑ Yes P(No
❑ Yes J'No
❑ Yes C<No
❑ Yes RNo
❑ Yes gNo
❑ Yes 0 No
❑ Yes KNo
❑ Yes 2(No
Catkirnents;(refer,to gr[estion #) Explaiii-any-'YFS atg weri'and/or any"i&dhimendations bir any outer cotnBu'M' b - -
[Ise dire _ of faaihty4o better egplaiia`situations (use additional pages as necessary) ' r wings
ReviewerMspector Name v �
Reviewer/Inspector Signature: _ 1, Date:/pp

mow. 1.
Facility Number: 3 — Z($ Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ;K"No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes kNo
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 kNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes RNo
AdditionaLCominents and/or - ravings:
5100

t.
Division of Water Quality
Soil
Q D�vrsion of and Water Conservation
r ��
a
?z
1
a
Type of Visit 0,,Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit P(Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: `— Time: CJC Printed on: 7/21/2000
Facility Number
Q Not Operational Q Below Threshold
�i Permitted ❑ Certified ❑ Conditionally Certified © Registered Date Last Operated or Above Threshold: .......................
!,'141Jz_ ]SV"; ll County:
Farm Name:.......................................�................................................................................... _...........0.. -.........................................................
OwnerName:........................................................................................................................... Phone No:
Facility Contact:..............................................................................Title:............... Phone No:
MailingAddress: .....................................................................................................................................................................................................
On -site Representative:..1J��.�....- +.. `' ... Integrator:......." e.��(-........
.............
.............
...............
Certified Operator: .................................... ......... .............. Operator Certification Number:. _-
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finishg-t-JLN
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I JEI Dairy
❑ Non -Layer I Irl Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag--. 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 �(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made-1 ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State`' (If yes, noiify DWQ) [] yes ❑ No
c. If discharge is observed. what is the estimated llow in gal/inin"
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes j"o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes VNo
Structure I Structure 2 SIMCIUrc 3 Structure 4 Structure 5 Structure 6
Identifier:........................................................................
Freeboard (inches): 3 O
5100 Continued on back

acility Number:, —3 Date of Iyspection L� Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
JR(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?
XYes
❑ No
Waste Application
10_ Are there any buffers that need maintenancelimprovement?
❑ Yes
MNo
11_ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
El Yes
WNo
12. Crop type b6�Pl CIfI--3� —TI S�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
Oyes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
IR,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?
9Yes
❑ No .
16_ Is there a lack of adequate waste application equipment?
❑ Yes
ONo
Required Records & Documents
17_ Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ No
(ie/ WUP, checklists, design, maps, etc.)
XYes
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
RNo
21 _ Did the facility fail to have a actively certified operator in charge?
❑ Yes
1No
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 (RfNo
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 )4No
atigris or defciencies were poted d&irig- his:visit:• You' ill->c&6*4y iiti further •
••:•comes oridence: :•:•:•:•:•:•:•:-:-:•:•:•:•:•:•:-:•:-:�:•:•:•:•:-:
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):
3� 7 `
Reviewer/Inspector Name
Reviewer/Inspector Signature: _ cA, Date: �� ��(= 5100

j" . , b

Facility Number: Date of Imspection W 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 Actor below ixYes ❑ 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 MNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �NO
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i_e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
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 (JNo
Additionaomments'and/or rawings:
1�) Va"k CR L-4'-41-4 y -5r-� 59D-A k LA
5-f,��5�
J
5100

Lagoon Dike Inspection Report
Name of Farm/Facility �3 1 _ 3 q's _ "
Location of Farm/Facility 6Pr- % 83 O
Owner's Name, Address
and Telephone Number
Date of Inspection Names of Inspectors A
� f
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:IV
Freeboard, Feet
Top Width, Feet
Downstream Slope, xH: IV , ,
Embankment Sliding? Yes ^ No
(Check One, Describe if Yes)
Seepage? Yes No
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
j've Cover
s, rees)
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
Yes __V,—No
Yes No If Yes, Depth of Overtopping, Feet
Yes X No
Yes �24— No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes _ 4 No

Cr
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
■ Permitted ■ Certified la Conditionally Certified p Registered in Not Operationa Date Last Operated:
Farm Name: Little.Broak-Hog.Farm............................................................................. County: Duplin WIRO
Owner Name: Stanley ...............................
Facility Contact: .......... ..... .... ... I.................
Mailing Address: 5M.,S..N.C.S.Q...........
Onsite Representative: ............................
James ..........................
....Title: ...
Certified Operator: Liars:ood.F........................... Henderson.................
Location of Farm:
........ Phone No: 910-2854.7.7.3..........................................................
.............................................. Phone No:.........................................
........ w..allace..NC........................................................... 2846fa..............
........ Integrator. Murphy..Famity.F.atrrns......................................
Operator Certification Number: ISQM.....
Y.C.�11.N.zu�xard.Chi�n�>.tapin;.ga_2.S.mfles.and.tu�rm.�t..mnt,o►.SB..1S2.7..tQ.P.ia..l(4o�al�,,.turn..Lt..�ntry.IYC.SAN,-ga.tl.7.mile,.:turrx..... �
Latitude ®• ®° ®« Longitude ©• ®° ®°
L
-• Design Current ;'.Design Current Design Current.
Swine = 'Capacity „Population _Poultry Eapacity Population _ Cattle , Capacity Popu[al
❑ Wean to Feeder
® Feeder to mts
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number.of;Lagoons ® u sur ace rams resent ❑ agoon rea pray FieldArea
H61din Ponds g. / Solid 1"raps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes []No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If ves, notify DWQ)
c. If discharge is observed; what is the estimated flow in gal/min?
❑ Yes ❑ No
❑ Yes []No
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 ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes []No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway []Yes []No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 3 Structure 6
Identifier:
Frccboard (inches): ...............24....
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
3/23/99 seepage, etc.)
................ ............. I.....
© Yes []No
Continued on back

is
(Facility Number: 31-348 I Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? p Yes []No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
p No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
p 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?
p Yes
p No
11. Is there evidence of over application? ❑ Excessive Ponding © PAN
Cl Yes
p No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
© No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
© No
b) Does the facility need a wettable acre determination?
p Yes
p No
c) This facility is pended for a wettable acre determination?
❑ Yes
p No
15. Does the receiving crop need improvement?
p Yes
© No
16. Is there a lack of adequate waste application equipment?
❑ Yes
p No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
p Yes
p 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.)
p Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
p Yes
p No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
p No
21. Did the facility fail to have a actively certified operator in charge?
p Yes
p No
22. Fait to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
p Yes
©No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
p No
24. Does facility require a follow-up visit by same agency?
p Yes
p No
25. Were any additional problems noted which cause noncompliance of the Certified A WMP?
p Yes
p No
a - Na.vialations:or' -deficiEncies4ere" i rated :daring: this visit. _ You: iviil.receive na farther ::
CkT6p"deitee:Ooitf this:visit:::.:::::::.:::.:::.:.:.:.:::::::.:::::. ::.::::::::: ::::::::::.:.
nr:uav3rornm mow ni�nnc=n r..Caav: of nr€rum
ent freeboard available. Good grass cover of dike walls. Grass cover needs mowing. No further recommendations at this
Reviewer/Inspector Name glan:aohnson C. Kaai tz (DI Q) -
Reviewer/Inspector Signature: Date:

Conservation �Ope�ation Review
Conservation :Compliance inspection
;Compliace nInspection h
Review
.,
section Q Follow-up of DSWC review
Date of Inspection
Time of Inspection
Permitted 0 Certified Q Conditionally Certified © Registered JE3 Not O erational
jj..
ff
Farm Name:.....U�....................................................... County:....... ...
Other
24 hr. (hh:mm)
Date Last Operated . ..........................
Owner Name:.... ........................ _.. Phone No:
FacilityContact:.............................................................................. Title: .......................................... . Phone No:.....................................--............
:Flailing Address: ......................................................................:................................ .......
Onsite Representative:.. V`4X �......... ��� r. ........... Integrator: ........!-:'� ...... �f............_..........................
CertifiedOperator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
,EIP-A
Latitude • �
- - - Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Division of Soil and-�
'U'Division of Soil and-V
r Division of WalterV4.,
UtherAgency,- wOpert
a;
Routine O Complaint Q Follow-up of DW
Facility Number
........................................................................................................................................................................
Longitude �• �� �"
Design Current Design Current -
Poultry Capacity Po ulation Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer 1E] Non -Dairy
❑ Other I-- --
Total -Design Capacity
-Total SSLW
Number of Lagoons I ',; ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Feld Area
Holdmg'Ponds/ Solid'T'raps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes Wio
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Dues discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes qNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes boo t
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ,gNo
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 b(No
.seepage, etc.)
3/23/99 Continued on back

r f
Facility Number: 3 8 Date of Inspection
6- Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
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
*0
8. Does any part of the waste management system other than waste structures require maintenarice/improvement?
[:]Yes
KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
;ZNo
Waste application
10- Are there any buffers that need maintenance/improvement?
❑ Yes
,KNo
11. Is there evidenceofover application? '❑ Excessive Ponding ❑ PAN
❑ Yes
WNo
12. Crop \19 6��X
type t SQ 1 cd W
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
UrNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
r'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?
XYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
,R'No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
XYes
❑ No
18. Does the facility fail to have all components of the Certified. Animal Waste Management Plan readily available?
No
(ie/ WUP, checklists, design, maps, etc.)
KYes
❑
19- Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
XYes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N'No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
gNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie/ discharge, freeboard problems, over application)
❑
t'No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�eNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
,kNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JgNo
0: N,6•yiolati6ns:or &ficiencies were h d• diWing this:visit? • Y:oir will•reeeiye iio further
corres�ondeice. abo' UA this .visit .. . . ... ... ... . ... . . .
Comments=(refer'io`questi6n.#)..Explain any°YES answers and/or anyrecommendations or,any,other comments -,
Use drawtngs:of facility.to better explatn:situations (use'addsttonal pages as necessary) 3
�l\���> sir 5O 1 �r 2C��3r�2 S' �' 1�-, � G►� �-{ �
\ \� ly L SCiI I t E\cam[ s_ L►.-� v.� -�i �L-� .St 7 '1 S GC.� L.,LJ;_,� 1
Reviewer/Inspector Name (
Reviewer/Inspector Signature: Date:
3/23199

1'
(Facility Number:- 1)ate of Inspection i ']
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below KYes ❑ 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 0 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ElYes �No
roads, building structure, and/or public property) /�
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ExVo
Additional omments an or awrn S. v -
r V
t r
3/23/99

[] Division of Soil and Water Conservation [] Other Agency
0 Division of Water Quality
Routine O Com )dint O Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Date of inspection
Facility Number
Time of Inspection i 6 24 hr. (hh:mm)
Registered P Certified 13 Applied for Permit © Permitted JE1 Not Operational Date Last Operated:
Farm Name:......... ....... ...... ....1- i ,r....................... County �U� 1'r%.................... ..................
............................. - • ....... .
OwnerName: ...... Slu-�...... A.l3u►............................................................................... Phone No:....�� r ��.���.f..�7��..........................................
Facility Contact:---......................................................... ...... Title: ............. Phone No
Mailing Address: ... fS.. t....... ...N.........0............................ 1�� ��a�.�,r.......�i.� .............................. .... "M.44.14 ........
....................................... ... ........
OnsiteRepresentative: .......s.[ 1 �k!,�kY...... integratnr:-.,..!�
II.............................................. i,�1� Iut........................................................
Certified Operator_.LwvA?k.............. F....... ffC.-Y 1............................... Operator Certification )Number, .... j 6.1'1..................
Location of Farm:
Latitude 3 ` ` " Longitude ? 7 ' ®4 GC
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
' 4
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?
❑ Yes No
❑ Yes ® No
❑ Yes 0 No
❑ Yes ® No
❑ Yes A No
❑ Yes [A No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ® No
Continued on back

TIity -Number: I —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 9 No
Structures (Lagoons,11oiding Ponds, Flush Pits, ete.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 10 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):.............7.......................................................................................................................................................................................................
10. Is seepaY-e observed from any of the structures? ❑ Yes ® No
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes I9 No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
RNo
Waste Application
14. Is there physical evidence of over application'?
❑ Yes
IN No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type-tTsR.........11,.�a..----•------..Sh...............ftalli-....... .... .....-...... ............... ...............
........ ........'. .............................
Ib. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
Yes
❑ No
I7. Does the facility have a lack of adequate acreage for land application?
M
❑ Yes
No
18. Does the receiving crop need improvement?
Cl Yes
No
19. Is there a lack of available waste dppiication equipment?
❑ Yes
[$ No
20. Does facility require a follow-up visit by same agency?
19 Yes
❑ No
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22. Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fait to have a copy of the Animal Waste Management Plan readily available?.
❑ Yes
I!3 No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
[0 Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
❑ No
0 No.violations or dericieRcies.were noted during this:visit.- -You.will receive no ftirther
correspondence about this. visit,.,'
C& ents,(eefer`io,question #).. Explain, any YES `answers andlor•any recommendations -or any other comments R
Use drawings of.facilityto better explain situations. fuse additional pages as necessary).".
�'.i...:-1
`
r.e5 s l� out 6 rt► tr< tl
�1� � ���_ r-
UM C
�. I ca.- dt`ts.t 10.0 - L"sior 0. v
�j + ( ! e,c.c o1, t�w dirt: wG.tl Sl�tdtl�ri 6e
� S��''t" Spt c/ 4r r� �r A sSfs{j,y.<e -
t6 • Vt,sr ve, av� irl e P i,K. cc� *
des.)K
h Qi c la , f� r e or'r-1 j,.La},
Slwllit) L)" �`r.
CokWMA. St"111 ricods swold 6z. gy- �
pull Mj h,1dV%"4W
ems-e^er acvtojis.
7J1: W6•A�_ &V`rc4 4* tx*' % mt
CAWMP.
7/25/97
Reviewer/Inspector Name
x
Reviewer/Inspector Signature:
v
Date: 4

Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection 1 7
Facility Number 3 { $ Time of Inspection jj,0210 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
W Certified ❑ Permitted I or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:.... - .......:.. .......... _- ............. ..........
Farm Name: ....... �; . ... i . _..r�T .... _....__.... - .... _................. county:._..
1*11 Cam.. .... __....w ...,
Land Owner Name: Phone No: - �L�� .`z:.4� 7 ....... . Name:..--. .- .. �.G.Aa .t �.... _ - -..... ...._- .....__.. -..... - .... ..
Facility Conctact:... ........ � � �c ....... ....... - ---• Title: Phone No: ,.......
Mailing Address: ..... t-C... `,2 �.__.............. � .f r. t.. r.- ..Z.jlT�ia.
Onsite Representative:..... ...... _slt r"-s ....... _...._.. Integrator:
Certified Operator:.... . 5 ...tLAtkstS ...... ....__...._ .... _.... _.. Operator Certification (Number: �•ii�{�-�.... _....�
Location of Farm: 1
af1�..... :... I . e..ir1Cri.... ..... 1.. .L?,7 .J5--C12 ... _....- 4
�e� Ors —...
.-... .a •=�1 �.:. {.�ci.xE.:._..�.�1..... �d.S...-h..e.5.............��........MIU5..........».........................-..............................................................-....................................
Latitude • ®6 44 Longitude ©• ®+ � u
Type of Operation and Design Capacity
zyW=ACaP'aC'1WP66Witiofi11
esrgn winePoultry w r". �Caoaci v-'Xnpulateon Cattle , .r ,Ca `aet " °Pa ulatEon ,°
❑ Wean to Feeder ❑ La er Da
eedertoFinish Non on:-irvi
D❑
Farrowgl-
to Wean
Farrow to Feeder MUC Design Capacity
Farrow to Finish
n
..x� to w 3�
❑ other Ta 1. SSA
..
"-?.�. ... ".".v --•ice 4. .._�v
Number of Lagoonsf,Holdtg Ponds ( ❑ Subsurface Drains Present
❑ Lagoon Area ❑ Spray Field Ares
r
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the cstimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes [0 No
❑ Yes
P1 No
❑ Yes
® No
N�-
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
(8 No
Continued
an back

Facility Number:....... —.3 ...
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 HoldingPonds-)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
2.4
10. Is seepage observed from any of the structures?
Structure 4
1 I . Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes 4 No
❑ Yes JW No
❑ Yes W No
❑ Yes J] No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum Iiquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ........ ....Cmsk..... 1:1t1.1114L ..._............... ............ .......
_.....
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 Cgrtified Facilities
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes ® No
❑ Yes ® No
P Yes ❑ No
❑ Yes ra No
❑ Yes 5a No
® Yes ❑ No
❑ Yes W No
❑ Yes (A No
❑ Yes (Z No
❑ Yes I' No
❑ Yes 19[ No
❑ Yes ja No
❑ Yes 13 No
JS Yes ❑ No
Coriimerits (refer to'4uesti6 Explain -any YES:answers and/or any recommendattor�s or any other comments':
Use diarvmgs of facility to better explain situations (use adiitrional pages „as necessary)
(Z. Mow (G3 . -56j) ..6,C cjri t,�) roof sYsk*ms rc?"Ved . 4
rX. y cyv s .6 kAe- �U.kcj sIX'soij �Oe trLj ((& d ;V%_ CAwJnP.
2,f- 5 r?_Cor, s AOJbe- t O-0- Oh s;k_
cc: vtvtsion of crater Livattty, water yuauty section, tactury Assessment Unit 4/JU/97

Site Requires Immediate Attention:
Facility No. 31-3
�g
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONP SITE VISITATION RECORD
DATE: .1995
Time: 13
Farm Name/Owner: rA �✓G din'' �s rTG� ��lYl ��
Mailing Address:
County:
Integrator. e, -- Phone:
On Site Representative. I41�� /t+r/ L Phone: 773
Physical Address/Location: - l a • % %1/f 1i r '�
Type of Operation: Swine Y Poultry Cattle
Design Capacity: VVs 1r4P Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: 77 ° �T A2(&_" Elevation: Feet
Circle Yes or No -
Does the Animal Waste Lagoon have icient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches Yes No Actual Freeboard: �Ft. Inches
Was any seepage observed from the lagoon(s)? Yes N)Was any erosion observed? Yes r o
"Is adequate land available for s ? Yes or No I e cover crop adequate? Yes or o
ray
Crop(s) being utilized: 60 � LalP
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings Yes No
100 Feet from Wells. Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters o e state by man-made ditch, flushing system, or other
similar man-made devices? Yes N If Yes, Please Explain.
Does the facility maintain adequate wa a management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
Additional Comments:
Inspector Name attire
cc: Facility Assessment Unit
41
Use Attachments if Needed.