310366_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

9 Cape Fear
River Watch
.tune 6th, 2018
Ms. Morella King -Sanchez Environmental Program Supervisor III
N.C. Department of Environmental Quality
127 Cardinal Drive Extension
Wilmington, NC 28405
morella.sanchez-kin ncdenr. ov
Re: Observed Waste from. Flight
Ms. Sanchez -King:
A flight was performed today (6-6-2018) in Duplin and Sampson County by Cape Fear River Watch.
During the flight we observed questionable waste management practices near hog farms. Attached are
time stamped photos containing global positioning system coordinates (GPS) in its metadata and a
Google Earth image of the general area. The attached photos show what appears to be ponded waste
in close proximity to a waste lagoon. No sprayer was visible at the time the photo was taken.
f nnrrlinatPc _U RA01741 -77 RC1AR'3G°
A WATERKEEPER ALLIANCEOMember
617 5urry St Wilmington, NC 28403
Phone: [phone]
www.cal2efearriverwatch.org

.:W S P — � - -. _
_�`;d �„`

Page 3 of 3
Photo III:
Cape Fear
liver Watch
Thank you for your consideration on this matter, and please contact me if you have any
questions.
Sincerely,
Patrick Connell
Cape Fear River Watch
Cell: 910-728-3373
Office: 910-762-5606
[e-mail]

Fs-
rm
. . . . . . . . . .
OF

0 Division of Water Resources
Fac:iity Number f r ter., 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine Lomplaint Q Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access j
Date of Visit: I 101 jP I JAI Arrival Time:- I 1 ) Departure Time: � :) County:
Farm Name: T11 Ch Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: 4 S Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine N
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Curren' l
Capacity Pog.0
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Certification Number:
Certification Number:
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Region: LILL
Design Current
;tittle Capacity Pop.
)airy Cow
Jairy Calf
3airy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
0
❑ Yes No ❑ NA ❑ NE
[] Yes ❑ No
❑Yes ❑No
❑ Yes ❑ No
Yes 4No
❑ Yes y No
[]NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE ,
❑ NA ❑ NE
Page I of 3 21412015 Continued

Division of Water Resources J W 1 V ,- j
Facility Number - ® Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: C Routine Complaint O Follow-up © Referral Q Emergency O Other O Denied Access
1 7 1 P
Date of Visit:LUJ k10 Arrival Time: F_TTTLM Departure Time: County: Region:0
Farm Name: I �t1/ �C�
r Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: S Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
I Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
HLa er
Nan -La er
Pullets
Poults
Design Current
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 DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes k No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
[] NE
❑ Yes
❑ No
❑ NA
❑ WE
❑Yes []No ❑NA ❑NE
El Yes No ❑ NA ❑ NE
❑ Yes No [] NA ❑ NE
Page 1 of 3 21412015 Continued

(Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ONE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]yes [] No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA [] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlieatiOn
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IV No ❑ NA [] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes No ® NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN 7 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 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 XNE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA � NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes [:]No ❑ NA ONE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
[:]No
❑ NA
KNE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
[:]No
❑ NA
IxNE
Required Records &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[] No
❑ NA
r5irNE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[:]No
❑ NA
Uv `NE
the appropriate box.
I %
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [:]No ❑ NA KNE
❑ 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 ❑ No ❑ NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes [:]No ❑ NA NE
Page 2 of 3 21412015 CO inued

acility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA V1 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 7"r No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No I( 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
1/34
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes 0 No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes ❑ No ❑ NA V NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes ❑ No ❑ NA JN NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
NY, I u.M4 v-ev, �e. K, NG+ z, , _pD �.�[ , I�r1i- �+ � llkv-) I
W'� (. -�tD � , w�'�I� -�ti(d CA ' ask 41) W-tto4xA,
- owu ��i-es AVA V& WS \'�4 V"�4 " ruw
O� ev(
c4) �,o v- i - vrR A [ av- J T
Y) rffy'�- �o k!P?- a(�ac o r
C W/, g-k VVC, 4�er
r ElaLlyu_ av&-Akc
Reviewer/Inspector Name:
f '�lll'hone: 9 � ii ` 1,C((Q j �3 i7
Reviewer/Inspector Signature:
Page 3 of 3 21412015

Date of Visit: Arrival Time: Departure Time: County: Region: ��
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: dkqt-
C& , MA � I&Y_ _
Certified Operator: (,(
Integrator:
Certification Number: `I E9 13 s
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design Current
n
Current
Design current
111tathillPoultryity
Fop.
Cattle
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Calf
Wean to Feeder I INon-Layer iDairy
Feeder to Finish
Dairy Heifer
D Cow
Farrow to Wean
Current
Farrow to Feeder
D . lioul
FOEign
aci
Pao
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Pouits
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes P(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
DNA ❑ NE
Page I of 3 21412015 Continued

i
Facili lumber: -U jDate of Inspection: Li �LQ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�,
❑NA ❑NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑Yes No
❑ Yes No
❑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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes q7� No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes KNo ❑ 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 U�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes J2( No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or W tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ •Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): " 1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes TNo
o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes R No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes kNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes k No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes AC No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes EffNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [;%No [DNA ❑ 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 N No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PVo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

l
Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes IX No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes (]No
the appropriate box(es) below. vG
❑ 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 �Q No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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?
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
VNA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes 6 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Coa>iments (refer to question:#) Explain anyAYES answers andlor:any additional -recommendations or, other comments;. ,
Use �drawmas.of:facilrty to:better egplainsiti ahons_{use additioual,apa>;es as necessary)..._.
-CaGbvc�n Jw4,-e W �' 2oiq
Urnd c�Ma �114li'I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/ /20

Type of Visit: GrCo Hance Inspection O Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: `Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ��� County- UQ�` 1 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: tit {', MIAAf�V
Certified Operator:
Owner Email:
Phone:
Phone:
Integrator: R
Certification Number: 9 b ! l S
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design C*urrent
Design C+urrent
Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Finish
Layer
Dairy Cow
Feeder
Non -La er
DairyCalf
o Finish
DairyHeifer
o Wean
Design Current
D Cow
to Feeder
D , P,ouitry C•_a aci Po ,
Non-Dai
to Finish
EGilts
Layers
Beef Stocker
Beef Feeder
Non -Layers
Pullets
Beef Brood Cow
Turkeys
Turke Poults
101
10ther
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
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
WiNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

IFaQity Number: IDate of Inspection: It
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2/No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [�No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require ❑ Yes Jam-' No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA [] NE
maintenance or improvement?
11. Is there evidence of.incorrect land application? If yes, check the appropriate box below. ❑ YesZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate ManurelSiudge 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 N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes V
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes VN
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes WNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes Ko
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L_rNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 1,1 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes <C [DNA ❑ NE
25.f is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes FJINo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34, Does the facility require a follow-up visit by the same agency?
❑ Yes
dNNo
❑ NA
❑ NE
[—]Yes
1 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
La No
❑ NA
❑ NE
[:]Yes EZNNP
❑ Yes
❑ Yes �No
❑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, pages as necessary):
Reviewer/Inspector Name:
(U
Reviewer/Inspector Signature:
Date:
Page 3 of 3 ° 21*20I S

Type of Visit: 0 C pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: j J Departure Time: County: 12upf!/�` Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 1,, Title: Phone:
v
Onsite Representative: � rw A—T 1 t'/ Mtua— Integrator:
Certified Operator: Certification Number: 1 j3 � I5
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
111
Design Current
Swine Capacity Pop.
Wean to Finish I
Design Current
Wet Poultry Capacity Pop.
I Layer
Design Current
Cattie Capacity Pop.
Dairy Cow
Wean to Feeder I
jNon-Layer
I EEI
Dairy Calf
Feeder to Finish U
Farrow to Wean
Farrow to Feeder
Farrow to Finish
=DjFsian ur en
D , P,oultr, Ca aci P,o ,
Lavers
Non -La ers
Da'y Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharses 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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes �Ivo
o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [7 o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: - Date of Ins ection:
l
Waste Collection & Treatment
41Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? D Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2
Identifier: LA6nF-60
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ _� 7i
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
[:]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmWN19
threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q
rVN
❑ NA
❑ NE
IS. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
NSo
17. Does the facility lack adequate acreage for land application?
❑ Yes
C
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesEy�fo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Zo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application [] Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [—]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes !PN - ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes / No ❑ NA ❑ NE
2q Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes YNo ❑ 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 N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes V ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewerlinspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 2�No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes En/No ❑ NA ❑ NE
❑ Yes b No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
[—]Yes rNo ❑ NA ❑NE
Yeso ❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
o ✓ WgLL
�'"k 1.�11n
Phone:
71b-_
Date: b All J
21411011

Type of Visit: Q Co Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint 0 Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: W= Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: c.Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Design
Wet Poultry @opacity
La er
Current
Pop.
C+attle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
D , Pau Ca aci
Layers
Current
P,oP.
Drycow
Non-Dal
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 Q /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑>io❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

r
2acili Number: - Date of Inspection:
Skaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? E Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes U!fNo ❑ 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 /No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes EZ/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 ❑
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes L� I No
[3 NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes /
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VN
❑ NA
❑ NE
Required Records & Documents
�No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � J N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: IDate of Inspection: b
24; Did the facility fail to calibrate waste application equipment as required by the permit. ❑ YesZN ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes b� 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 2 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 I VIVO ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately. 777
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 IVo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes Zo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes to
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments..:
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone
Reviewer/Inspector Signature:
Page 3 of 3
Date:

i
Type of Visit: Q pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: _ Co7RRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 'S Arrival Time: Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: ��ll�i,l Integrator:
Certified Operator: Certification Number: 4 S I I
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design
Wet Poultry Capacity
ILayer
INon-Layer I
Current
Pop.
Ell
Cattle
Dairy Cow
Dairy Calf
Desigu
C**specify
Current
Pap.
Wean to Feeder
I
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
la
Current
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
L Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: t t A3
'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 freeboardZ ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1
Identifier: LA G-.M 1J
Spillway?:
Designed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): SS
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
dNo
❑ 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
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Z�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 WNo
o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes dNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C2(No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
VT
❑ NA
❑ NE
Re uired 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
VNo
❑ 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 E3<0 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis D Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facffi Number: - Date of Inspection:
124. 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 13<91 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
91?eo
❑ 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
LJ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Vo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
gNo
❑ NA
❑ NE
:Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
:Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
So'k 0
Phone: CgiD L --is a 0
Date: I ► l,, 4
2/4/20

Type'of Visit: (-TCuyfhpliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Q Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Denied Access
Date of Visit: Arrival Time: Departure Time: /� County: ! { Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: � 1,6j Aij Mil Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number: 179 3 S
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
ld
Layer
Design Current
Cattle Capacity Pop.
Da' Cow
Feeder
Non -Layer
Da' Calf
o Finish
DairyHeifer
o Wean
EFarrowo Feeder
Design Current
Dr. I;ouI Ca aci Ilo .
D Cow
Non -Da'
o Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Other Turkey Poults
Other Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes CJrNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection: I t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 25/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3-7
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?
EYes No ❑ NA ❑ NE
❑ Yes �] No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmZNo
l threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 9No ❑ 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 WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 21 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [yNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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): j
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Y s
[3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
rX0
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
El Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NANE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ 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
VNo
❑ NA
❑ NE
th b
e appropriate ox.
❑WUP []Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facifity Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes • No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �Zo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
❑ Yes PXo' [DNA ❑ NE
❑ Yes P1 ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes To ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EfNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes to
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as.necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: / I 0 U
Date:
4/2011

(Type of Visit: Q Zoutine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up Q Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Ja,,yAM AIJ WbIJ-11C(L
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator: q �t
Certification Number: 1 g / %3�5
Certification Number:
Longitude:
Design Current Design Current
CapacWet PoulYr-y C•apacity .Pop. Cattle 0Capacity
Finish La er Dai Cow
rFeede,
Design
Current
Po1110
Feeder
Non -La er
Dai Calf
o Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
Design Current Dry Cow
Q ­r'yjP,oult C_a acity Pf , Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Qther
Turkeys
Turke Pouets
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 MIN
[:]Yes ❑ No
❑ Yes ❑ No
[:]Yes [:]No
❑ Yes ff No
❑ Yes �4
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: -3L IDite of inspection: jq3jn
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes n No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1
Identifier: t A&c6 IJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): AA
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes C' No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or en onmental threat, notify DWQ
en
7. Do any of the structures need maintenance or improvement?
❑ o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
ElYes
[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
[:2/No
❑ NA
❑ NE
maintenance or improvement?
Waste Ariolication
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
EJ/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 o ❑ 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
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
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [yNo ❑ NA ❑ NE
[:]Yes dNo
[—]Yes Ea/No
❑ Yes � o
[:]Yes rNNo
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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 ❑ N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE

Facili NAmber: - Date of Inspection: L1,13 III
24.:Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [2'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes O No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes 0"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.
❑ Yes C3"No
❑ Yes dN0
❑NA ❑NE
❑NA ❑NE
❑ Yes ✓ No ❑ NA ❑ NE
❑ Yes [3/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 �o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes gNNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or.any additional recommendations or -any other commentsti. W�•
Use drawings of facility to better explain situations (use additional pages as necessary).;
7,) C T. b<- t� u� 6� Blau--
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: i tl 3
2141201

Division of Water Quahty
Factltty Numtier .�6(o O Divtsion of Soil and Wti ater Conservaon
Q Other;Agency ."
Type of Visitcoompliance
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 ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: !Dt*L -W Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: iloN Ar)JAO Mco— fR_
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 4 ❑ " Longitude: = ° = 6 [� «
saw:
- Design Current Design -Current '
..
".Swine"' Capacity ,Population Wet.Poultry p Capacity Popu[afion
., ❑ Wean to Finish ❑ La er
V❑ Wean to Feeder ❑ Non -Layer
w ® Feeder to Finish gqq1 2466m w y
❑ Farrow to Wean Dry,Poiiltry $, �"
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers .
Boars l_I Pullets
_ []Turkeys
ie. �� ❑ Turkey Poults
Other ❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CoAj
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ NA
❑ NE
El Yes
,[o
L 0
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
iCJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: CA 6-0
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 3G
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[dNo ❑ 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
ental threat, notify DWQ
envi7yes
7. Do any of the structures need maintenance or improvement?
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Id 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
1:1 Yes
WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2 Nc ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
IJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or I 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2 o
El NA
[I NE
16. Did the facility fait to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
No
El NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ef� o
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
[I Yes
WNo
❑ NA
❑ NE
Comments refer to. uestion.# : Explain'an YES,answers and/ ( q ).y or any r"ecommendations or anv other�comments -� �
Use drawings of facility to better explain situations. (rise additional pages as Necessary).
wtovfP to lVVfqc- O/ t,,4c-ctw AztMU 4r� B
PUASF.
4Z wv( NE6 ns Ac2EAG vPn�a �, !6. r Vj' 0
Reviewer/Inspector Name � 7;14� MkjV L �� _ -
'„ Phone:(sf 6) 711
Reviewer/Inspector Signature:
Date: I% 9
Page 2 of 3 1 12128104 Continued

Facility Number: Date of Inspection F-1, IsIlb
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 [dyes ❑ No ❑ NA ❑ NE
the appropriate box. L3 WUP ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
VNo
❑ 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 Inspection�No
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
12/Vo
❑ NA'
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes7NO
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ 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
[/To
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
l.Q �
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Yes
IVo
❑ 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
0 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
Ej o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,�,%
Did ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
[I32. NE
33,
Does facility require a follow-up visit by same agency?
ElYes
LJ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

0
Type of Visit Q(,C,00mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit C? Routine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: NqE Arrival Time: Departure Time: County: 1 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = I = « Longitude: 0 ° = - 0
61
Design Current
Design Current
Design Current
Swine Capacity Population
-
�+'et Poultry C•apaci�ty Population
Cattle Capacity Population
-
inish
❑ La er
❑ Dai Cow
EWeanEtF
Weaneeder
❑ Non -Layer
❑ DairyCalf
91 Feeder to Finish
Gt3
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ Layers
❑ D Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Turkeys
❑ Beef Brood Cow
-
Other
❑ Turkey Poults
❑ Other
❑ Other
iVumber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes Ld No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ o
❑ Yes
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Jl
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
dNo
❑ 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: (—A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �1
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
d/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?
0'"V-es
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes El"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 E]"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U No ❑ NA ❑ NE
maintenance/improvement? . �
I I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [3 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
P�NNo El NA El NE
E No ❑ NA ❑ NE
Q"'No ❑ NA ❑ NE
;'❑NA El NE
No❑NA ❑NE
Comments (refer to queshdi"ationsor anv�other comments.,
#) "Eirplarn any YES answe'cs arid/oray-recommend
Use drawings of facility, to better explain.situattons (use fiddiiional'nages as necessary):
_. �-
�� C i,JTUL/ w d
Zo.�
Pia fi� WV P.
Reviewerfinspector Name / ��. =r o �y Phone: 6 — rf
Reviewer/Inspector Signature: Date:
12128104 Continued

I�
Facility Number: — (,{� Date of Inspection o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have a components of the CAWMP readily available? If yes, check Yes El No ❑ NA El NE
the appropriate box. �yUp ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I rJ 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 [I Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ICJ No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes 7N9
El NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ElYes ❑ 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 LJ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes N�o ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
Ll No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
. No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
ElYes
No
❑ NA
❑ NE
Additional'Commenfs_andLorDrawrngs Hw
12128104

64
Type of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Arrival Time: ' U Departure Time: County: dWLEO Region:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 6AJA
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = f = " Longitude: = o = 6 0 «
Design Current Design1011.1
signine Capacity Population Wet Poultry Capacityulation C►attle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
��l
❑ DairyCalf
Feeder to Finish
d
❑ DairyHeifer
❑ D Cow
❑ Non-DaiFarrow
❑ Beef Stocker
a ers ❑ Beef Feeder
7Nn
❑ Beef Brood Co
❑ Turkeys
❑ Turkey Poults
❑ Other Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
to Finish
Gilts
❑ Boars
Other
❑ Other
Discharees & Stream Impacts
jNo
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
o
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
�'No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3.
12128104
Continued

i
Facility Number:
Date of Inspection
,1
*aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 24
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
environ ntal threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
NA [INE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
7No
9. Does any part of the waste management system other than the waste structures require
ElYes
❑ 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(&)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
� o
ElNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
WNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
� o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
7No
❑ NA
❑ NE
Comments (eferrtq�queshon #)` Eapta><n,any YES answers+a � r�pny recomm ndations or any other comments.
.M�*. a e m;s''y'�t Keay °a�e�s xe$-r
Use drawtngs,bf facility to better ezplam situations (use addtttonal pages as necessary)
����'.r.
7 &T _,�,Z A E ar'4 uA U- Y4 5 SfoLz d of C" Sa & J . 63ax r✓ G- Sort_ A4 9 SEED'`
t--kc.,Ll I-EMPEieATV" Pr, hr2ITl. S&- L ,SAW(_ ADt/ISCO, VX lqn�) ^/ IL/lEG)
Salt, �aA� 6-AaW PAt07f (,T-Nd , 04 Cu yl QL✓d kk A"Jo J'EJn PT' A
Reviewer/inspector Name if tq..;� Phone: ?1u)7 4 ,73 M
Reviewer/Inspector Signature: Date: Y a

f
Facility Number: Date of Inspection d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists g p El Other
❑ Design ❑ Maps
_�TNo
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Er/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
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
F
❑ NA
❑ NE
25.
Did the facilityfail to conduct a sludge survey as required b the permit?
g Y q Y P
❑ Yes
rlo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes❑
rNo
NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes�7No
❑ 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
D N"'o ❑ 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
0 Na ❑ 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
CJ No ❑ NA
El 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
ElNE
33. Does facility require a follow-up visit by same agency?
❑ Yes
o ❑ NA
El NE
Additional Comments°and/or Drawin s "t
AL
Page 3 of 3 12128,104

Division of Water Quality
Facility Number 0 Division of Soil and water Conservation
0 Other Agency
Type of Visit om once Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint ,10 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 67 Arrival Time: (Qv{J Departure Time: County: Albal Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: O Integrator•
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o ❑ d ❑ Longitude: ❑ ° ❑ d
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑Non -La et
Dry Poultry
Non-L
Pullets
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: FJ
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
'1
❑ Yes 2/No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ o
❑Yes
[]NA❑NE
❑ Yes FNo
❑ NA
❑ NE
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?
a. If yes, is waste level into the structural freeboard?
Structure Structure 2 Structure 3
Identifier: � C 71V
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4
❑ Yes [; No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
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 El Yes �V 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 environmentaltreat, notify DWQ
❑
7. Do any of the structures need maintenance or improvement? Yes ,�/No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes Ld No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,.,�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Lf No ❑ NA ❑ NE
maintenance/improvement? Vo.
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYesElNA ❑ NE
ElExcessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ 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
dlNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
I No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2No
❑ NA
❑ NE
Comments (refer to question ft 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):
w
Reviewer/Inspector Name Phone:3
Reviewer/Inspector Signature: gfDate: -10p
/ 12128104 Continued

Facility Number: — Date of Inspection
.'
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑yes No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate bo below.
dyes
El No
El NA
El NE
❑ Waste Application ❑ Weekly Freeboard El 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
L'J No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EI No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E(No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El
No
❑ NA
[I NE
Other Issues
No
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
O 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?
El Yes
. _,�
F. o
❑ 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
6 li<o'
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,.,/
I' No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Division of Water Quality
'Facility Number 3 0 Division of Soil and Water Conservation
.��-•• O Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit PIRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: YArrivaIT' : © Departure Time: County: U Region:P
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ A = Longitude: ❑ ° = 6 = g,
."Design Curren
.. g t' Design Current Design Current
Swine Ca a.ct .: Wet Poultry.: Capacity. Population Cattle' Inlation
Capacity Population'
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other -
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
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: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(iel 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
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages.as necessary):
Reviewer/Inspector Name i -� Phone: Q -- Z
Reviewer/Inspector Signature: Date: l ��
Pape 2 of 12/28/04 Continued

Facility Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ 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
5. id the facility fail to conduct a sludge survey as required by the permit?
El Yes
[I No
El NA
❑ NE
6. 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
Additional Comments and/or Drawings:
' Coo l!?a-a- � � �s X e-J/r? Z//,f
l� vas
All
lav-11V6 �t �
31-210
Page 3 of 3 12128104

Facility:_:
N�umy�a 3i � 3�,y � Q Disisi�a„n��o1'Sotl and Water Conservation
Type of Visit dCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (� Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of � isit: ' 3 t,ID oS Arri,Time: i l o° Departure Time: p 0 County: OOFLl.�J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
OnsiteRepresentative: GFNo le-f0ijko >' Integrator:
Certified Operator: 6'ACLt..1t: y _ TZA°u�-_s Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: ❑ o = [ [=64 Longitude: = ° = 6 0 «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
0 Feeder to Finish
Zak LA 2Zara
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Fleifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Plumber 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?
I
❑ Yes El No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
WINo
❑ NA
❑ NE
❑ Yes
L �N/o
❑ NA
❑ NE
I2/28/04 - Continued

Facility 'Number: 4 — �{o(o
Date of inspection 3 I o cr
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
� No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes.
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: LAGCOD
Spillway?:
Designed Freeboard (in): ?
Observed Freeboard (in). 3b
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo
❑ 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
dNo
❑ 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
E(No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes -
EZNo
❑ NA ❑ NE
maintenance/improvement?
I t . 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
Uf Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of
Area
12. Crop type(s) (c.Rf" 1JY) A L G 4- S rs O
13. Soil type(s) LN A G 8 A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ej 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
i ❑ Yes
E�No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E,'No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[J/No
❑ NA ❑ NE
Gq (LF- FkJLL . "'d avcn_ A PP-r<ATtaj{ ,
S ' Ftze E 6oARb
�.� i1A Cs ao.J 0 � � !� V E� t �'� a G+J � � rJ
CafouCT c' LS MF T(,a
Reviewer/Inspector Name 74 4 r� rA rLv E L Phone: ('110 3 5V— 3,1a n �- Z'6�
Reviewer/Inspector Signature: .tt Date: 31 t n ! ° s
12128104 Continued

Facility Number: 3Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 13 Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUp [] Checklists Design - ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 3No ❑ 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
E(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LI No
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
ElEl[
No
,_❑_.,/NA
2(NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[] No
L1 NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L1 No
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
^❑ //NA
E?' A
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElL�l 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
LI 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
QN/o
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
_,/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
E No
❑ NA
❑ NE
33.
Does facilityrequire a follow-up visit by same agency?
❑ Yes
Id No
❑ NA
❑ NE
Additional "Comments and/or Drawings:
12128104

Facility Number Date of Visit: Time:
O Not Operational Q Below Threshold
® Permitted MCertiified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: _.__�. _.....
FarmName: ...... !........................................................... County:.......... A- ........................ ...............
Owner Name:
Phone No:
Mailing Address: ............. ._...............
Facility Contact: ........................ ._..._....._......� ...... Title:.._....._ -- ............. Phone No: ........... ........ ...... ........
Onsite Representative: ..,. _►2'" Integrator: ..rk
Certified Operator: .. . ................... . .......... . . . .... . ..... ................................... Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ` " Longitude • 6 44
Design -'Current - Design Curceittt. Design C.
5wrme� R x -
_
- —
- - -
y -ai Cattle Ca `Po lion
_ _ -,«Ca a .APo
elation... -q44 ____, �_Po ulation: _ aci m-
i El Wean to Feeder
❑ Layer ❑ Dairy -
Feeder to Finish
Non -Layer '' Non -Dairy
{
Farrow to Wean
z
Farrow to Feeder
Other r-
Farrow to Finish
_
F = Total Dena Ca act
Gifts
''
s '' =ITMA SSLW
❑ Boars
`i Nnm�er of Lagoons
Discharges 8 Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5.
Idendfier:
Freeboard (inches): 3/
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
12112103 Continued

Facility dumber: � -- 3 Date of Inspection
5.'Are there any immediate threats to the integrity of any of the structures observed? (iel 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 ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenanceliimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAW1vT)? ❑ 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 ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional [] Yes ❑ No
Air Quality representative immediately.

Facility. Number: 3 L3GG Date of Inspection r
Required Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No _
26_ Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
INTDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

4-
Type of Visit O Compliance Inspection O Operation Review CKagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
Not O erational d Below Threshold
Li Permitted 0 Certified Q Conditionally Cerh6ed U Registered Date Last Operated r Above Threshold:
Farm Name: County:
Owner Name: Ra chl t P Phone No:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
04"ine []Poultry ❑ Cattle ❑Horse Latitude �' �� r�7« Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle` Capacity Population
❑ W to Feeder ❑ Layer ❑ Dairy
BT
eeder to Finish ❑ Non -Layer I Non -Dairy
-- _
El Farrow to Wean _ - ..
El Farrow to Feeder
❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 0 ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding-Pondsl Solid,Traps 0 . ❑ No Liquid Waste Management System
Discharges && Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c, if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

•Facility Numbe,:3 Date of inspection Its /Y/J
5. Are there any immediate threats to the integrity of any of the structures observed? (Tie/ 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? El Yes El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ❑ No
9. Do anv 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 maintenancelimprovement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN' ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWNIP)?
❑ 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
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑Yes
[] No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
29. Fail to notify regional D)j--Q of emergency situations as required by General Permit?
El Yes
El No
(ie discharge. freeboard problems. over application)
23. Did Reviewer,'Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
El Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments°(refeir io gnestioii.:Ezplam y YIES sss�versnd/or_sdy t etommeadahoas,r any offier wmime�st R'
n
IIse drawings of facility to better esplasa s�itnattoas : (nse aciditxonal pages has tteeessary) ❑ Field Copy ❑Final Notes
.
o . .e
r
Reviewer/InspectorName...
Reviewer/Inspector Signature: Date: iffo 3
05103101 U - " Condnued

Type of Visit 'I&Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 'Q-Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 7i Time:
18 Not O erational 0 Below Threshold
Permitted 10 Ce 'fled O Conditionally CertifidL 7ed [a Registered Date Last Operated or A ove Threshold:
Farm Name: Qc_tVCounty: GAM I
Owner Name:
Mailing Address:
Phone No:
Facility Contact: f` Title: Phone No:
Onsite Representative: [�tD Q/it o _ _ Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 a Longitude a G
Design Current
Design Current Design Current
Swine Ca acity P,o elation
Pkoultry Ca acity P,o elation Cattle Ca acity Ro elation
❑ Wean to Feeder
❑ La er ❑ Dairy
Feeder to Finish
❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
r=--
Total Design C*opacity
❑ Gilts
❑ Boars
Total SSW"
Number of Lagoons
❑ Subsurface Drains Present ❑ La oon Area
I0 Spray Field Area
Holding Ponds I Solid Traps
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, 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 Collectrn & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure S
Identifier: _
Freeboard (inches):
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes RjNo
❑ Yes R5,No
❑ Yes (LNo
Structure 6
05103101 Continued

Facility Number: 2 —Z6 Date of Inspection I Z41-1h-2-1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
P No
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
El Yes
�ry
�F No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
21 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
kNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
ANo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
KNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
INo
12. Crop type m rt �[ -` , aZc-
-
/
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
21vo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
bNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
([Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
ENo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
b�jNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
rSLNo
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19. Does record keeping need improvement? (iel 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
RINo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
F[No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[$1No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewerlinspector fail to discuss review/inspection with on -site representative?
❑ Yes
K[No
24. Does facility require a follow-up visit by same agency?
❑ Yes
N -No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
EA.No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.. :.
�Coitiments' refer to uesbon # Ez lainn aYES=answers and/or an trecommendahons or an 'other commentsr
Use drawrngs of facility to better esplatm situations: (use additional -pages as necessary) ❑.
Field Copy ❑ Final Notes
/'�7J-'S ,- ,,a
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Z�
051033101 Continued

Facility Number: — 3 Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
�o
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
b�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
IxNo
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
19 No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
M No
32.
Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
JZJNo
Additional Comments and/or Drawings:
AL
05103101

Type of Visit ACompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit 6 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 6 Date of Visit: Time: Qp
Q Not O erational 0 Below Threshold
13 Permitted 0 Certified U Conditionally Certified J3 Registered Date Last Operated or Above Threshold: ........ .... ...»» ....
. - ,
Farm Name: �t"Q- . ,�'..... County: ..,,,,..
..... ......... .. ..
OwnerName:........................................................................................».................................. Phone No: ..................................... ... ....... .......... »» ......._.....
FacilityContact:............................................................................... Title:................................................................ Phone No:
MailingAddress: ........................................-......••---............................------................................ ............................... ....
....................
..._.. ................ »
Onsite Representative: �r. v`t- ............... Integrator:ve1'"�ll..r.-� J .
Certified Operator:................................................................................................................ Operator Certification Number: ............................. ..........
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 64 Longitude • 4 «
Design : :Current - ' Design . . Current Design Cori�ent
Swir►e Capacity.,. Population Poultry Ca ai i l'a ulaton Cattle ,Po ulation ;_:
❑ Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish $ ❑Non -Layer ❑Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑ Other I-
❑ Farrow to Finish Total DesignCapadty
Gilts
Boars Total SSLW'
Niimtier:of.i.agoons ❑Subsurface Drains Present ❑ Lagoon Area . ❑ Spray Field Ares
THolding Ponds / SoGd Traps; ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes j?fNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is obscrved,'was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes N(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes O�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 - Structure 4
❑ Yes &No
Structure 5 Structure b
Identifier: ....................................
Freeboard (inches): 46
5100
Continued on back

Facility Number: ` Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 10No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes oNo
(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? b(Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes kNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 9No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 4No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes NrNo
12. Crop type YJ2 —�—�yr :L 1 5-!�j oy ---„ ._
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes jgNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes CgNo
b) Does the facility need a wettable acre determination? ❑ Yes &�No
c) This facility is pended for a wettable acre determination? ❑ Yes 'j�No
15. Does the receiving crop need improvement? lRfyes ❑ No
16. Is there a lack of adequate waste application equipment?
Required Records &_Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ 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?
i�'0•Yi0f;atiQgs:ojr defcJ6n01es •were pote(l ding �his:vjsit;. Yo will•1reeeiye #o futthee
coi resporideiri& ahatit: this visit.
❑ Yes (3 No
❑ Yes IgNo
0Yes *No 1jjNK
❑ Yes No
❑ Yes No
❑ Yes kNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes M(No
. beter. -
essayUse na
.drawurgsofayouituatons.(ue:adopages as nec
1/)
;�hQ�1 ��R✓�v G1r'--� , ✓�'c C4h•.t,� �JSC'�.
AB ir;t v4A vtx5 •k4 ve1. �;r c n hey .
Reviewer/Inspector Name A`
Reviewer/Inspector Signature: Date: 900

Facility Number. Date of Inspection--�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below 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 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 ❑ o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ o
Additional,Commentsand/orDrawings:W
Vv AL
2aLl� A�
5/00

SDivision of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit A6CCrompliance 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 1"atv of Visit: R7 k5 GG Time: i S6d Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Permitted [] Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
FarmName: ......... ... ........`............."`................................ ........ Countv:.... A. .... ................................ .......................
OwnerName: ........................................................................................................................... Phone No:.......................................................................................
Facility Contact:.............................................................................. Title:.................................. Phone No:
.............................. .....
:Flailing Address:....................................................................................................................
Onsite Representative:012?' 2�(�} �'"� Integrator: ,,,., ,,,��
....... s._............................................................... ........ .....................
Certified Operator:,,,,,,,,,,,,,,,,,,,, ............................................................. Operator Certification i\umber:,,,,,,,,,,,,,
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 �° �� Longitude �• ��«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer I I ❑ Dairy
Feeder to Finish a ❑ Non -Layer I 1 10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, slid it reach Water of the State'? (if yes, notify DWQ) ❑Yes ❑ No
c. If dischar,*e is observed. what is the estimated flow in gal/ruin"?
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 9No
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatrttent
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes P(No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................................
Freeboard (inches):
5100 Continued on back

Facility Number: — Date of l��spcetio�� 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 KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes C!�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
b(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
ElYes
KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
NrNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
�(No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
'VNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
`IZ(No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
b<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?
KYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
tKNo
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?
(ie/ WUP, checklists, design, maps, etc.)
XYes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
XYes
El No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
15(No
21-
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
PrNo
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
XNo
24-
Does facility require a follow-up visit by same agency?
El Yes
&No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
"RNo
�'Vo [jns;or deencies were h, fe'd* diW' i iiiihis:visit; Yoit ;witl receive Rio further ;
- - : • comes ondence: about. this visit: ' :::::: ' :::::...:::::::::::::::::::: :
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
45Y k.,� e_�41t
Reviewer/Inspector Name ���,,� 6-3��3700 X D-a 16'
Reviewer/Inspector Signature: Date: 1 (5--- b_ -- 00 5100

Facility Number: Date of I uspection U OQ 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 aYor below I<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? (Le. residue on neighboring vegetation, asphalt, ❑ Yes C<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 WNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 4No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNo
Additional omments and/orDrawings:
Ci
9) LA 2 ���, arcs-•e� v`-. `. +—ee �t
�� pew �e_L�. ►-��� v�c�� �-�� . �� � -�,� �
1
si
w
5100

Lagoon Dike Inspection Report
Name of Farm/Facility
Location of Farm/Facility LY r L4i Z, -
Owner's Name, Address ]
and Telephone Number !! __
---,c,,A 1,7,
Date of Inspection 5 Names of Inspectors d
Structural Height, Feet Freeboard, Feet 3�
Lagoon Surface Area, Acres d Top Width, Feet
Upstream Slope,xH:1 V Downstream Slope, xH:I V !1 L/ _
Embankment Sliding,? Yes No
(Check One, Describe if Yes)
Seepage? Yes No
(Check One, Describe if Yes)
Erosion? Yes No
(Check One, Describe if Yes)
Condition of
V to 've Cover
as rees)
id Dike Overtop?
Yes 74 No if Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes '-/-- No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes No
_-n.,_",-_-',.'•rx,:. -_%� °-"Xs':� per` �'�{' Scr i;?-ti-�:.C?:tt... ..-;�j

1
10 Routine 0 Complaint 10 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other j
Facility Number L(y Date of Inspcclion
Time of Inspection 24 hr. (hh:mm)
Permitted 19 Certif�ieed_ [] Conditionally Certified [3 Registered � Not Operational Date Last Operated:
FarmName:... ........... -�Q ... iAW........t-t:4..........----......................................-...... County: -..... i k................................-...............................
Owner Name: ..................-........... Phone No:...����,..L�.".3sf�?..............................................
Facility Contact: ..................................... ..... Title:....-......-. Phone No:...................................................
.. ........... ................... p...................
MailingAndress: ......... Z.6.L...... ?'A%>......�a�.:..................................................... ....... ..... ..............�ge...6A1 �.G................. .............. �...........
Onsite Representative: ............. &m........ 960s� ........................................................ Integrator:.......b1W.J...........................................................
Certified Operator : ................................................... ............................................................. Operator Certification Number:...........
Location of Farm:
IN
..................•..................................................----..........................................................................................................--....
Latitude C�' �`°� Longitude
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
24
❑ Non -Layer I
1E1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity
z
I[] Gilts
❑ Boars
Total SSLW
Number of Lagoons I0 Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Disc�es & Stream. Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-rnadc?
b. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. if discharoe is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any 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?
Structure I Structure 2
Identifier:
Freeboard (inches): ............3.1.... .................................................
/6/99
Structure 3 Structure 4 Structure 5
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
No
Structure 6
Continued on hack

et
FarOlity Number: 3k — ie Date of Inspection `j�
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑Yes ❑ No
seepage, etc.)
'6. Are there structures on -site which are not properly addressed and/or managed through a waste manakement or
closure plan? y ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any patt of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [-]No
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen ❑ Yes ❑ No
12. Crop type ........... ....:................... .......................................................................... .................................................................................................................... ...........
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. Does the facility lack wettable acreage for land application`? (footprint) ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, Freeboard, waste analysis & soil sample reports) ❑ Yes ❑ 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 certified operator in responsible charge? ❑ Yes ❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
�. No.vioJations.or. deficiencies were noted duirin this:visit:. I'ou will.re�eive nu further .:.:.
etjrresb6ddence: about: this visit.: ; ; - -
Comments (refer to question #): Explain any YES answers and/or any._r_e_commendatiops or any older comments.
Use drawingsof facility to better explain situations. (use additional pakes as necessary) - _
� � Vi4ti
Wr_1, -6 tUlift �trp~ (jA4;4_Ons AAA� i't. wr\% ty- N4�1'ce aF
Vc�itiW,cy rsSut� l I2-/3JIg &,A 3l N6D �,- 3Jt4 w1;1� s ,,�. cJk L W
l^t��etJ �►rY�ga,�iar t'�tart9S a �Cci�° oy� N0b NY �to.
�ax•�W , ll��Jr C, s o; k + s�,1��r i $,rYa� 5�� I� , Daroor Vw%,t f kcck st-fi c - lia 1 LdV_ -c- I ,.
lx �ww,._c e- -
T
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 3/1 & Aq — ' 116199

Divson So[ WOperation
� Review
0 Division of Soil and Water Conservation -Compliance Inspection
-
1 Division of -Water Quality Compliance Inspection r
g... y'-O P
Other. A eric eratEon° Revie
jil Routine Q Com laint Q Follow-up of DWQ inspection Q Follow-up of DSW C review 0 Other
Facility Number 3 Date of Inspection
Time of Inspection : 3a 24 hr. (hh:mm)
93Permitted 0 Certified © Conditionally Certified © Registered [3Not O erational Date Last Operated:
Farm Name: .............Ra} ......�L. ............................... ... County:.........Ds11&
OwnerName: ....................!.. ...................... .......................................... Phone No: -.......C..(Iz7.....................................
Facilitv Contact: Title:. ..................
Mailing Address: ,,,,,,2Z,�
...1.....................................................
Onsite Representative: ............ 1fr. &SVks.... .. n`....`......................................
Certified Operator: ....................... Cn,.............. ...... !S.hc�[I.fs............. I ...
.....
..........
Location of Farm:
Phone No:... ................................ .
...... ............ .oSt...... A1j..r.fJ�.................................... rV.S.y.....
...... Integrator: ....wc!d
Operator Certification Number:... ..........................
................
.................................................................._................................................................................... .........r ;
Latitude Longitude 0 • �' �" --
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish Zqt4 31 1[] Non -Layer I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity Zt4µ8
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area JE1 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharkes & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
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 Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation'?
3. Were there any 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?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
ier:
Freeboard (inches): ........f{Q....................
...........................................................................................................
Structure 5
❑ Yes 0 No
❑ Yes
*1 No
❑ Yes
P-j No
A-
❑ Yes
(� No
❑ Yes
[� No
❑ Yes
EA No
■ 11f
Structure 6
1 /6/99
Continued on back

VacititMumber: 3� — 3(�(e Date of Inspection �fr �1fgR�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Y
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Y
(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`? ® Y
8. Does any pact of the waste management system other than waste structures require maintenance/improvement? 10 Y
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Y
Waste Application
10. Are there any buffers that need maintenance/improverent? ❑ Y
11. Is there evidence of over application? ❑ Ponding ON'
Erogen ❑ y
12. Crop type bCr!nd............................................... 7[!1A(..... Xdlt.........................................................................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Y
14. Does the facility lack wettable acreage for land application? (footprint) ❑ Y
15. Does the receiving crop need improvement? ❑ Y
16. Is there a lack of adequate waste application equipment? ❑ Y
Required Records & Documents `
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Y
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
es
® No
es
® No
es
❑ No
es
® No
es
JNo
es
PkNo
es
D4 No
es
[ No
es
® No
es
R No
es
No
es
® No
(iel WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, Freeboard, waste analysis & soil sample reports)
0 Yes
El No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONo
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
&INo
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
P3 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[9 No
0 No.vi(Aaitions-otr. deficiencies .were noted dtaring h' is' visit:. Y-oti wiilfretceive'tor further . .
correso6ddehif e' about: this :visit.. ... .... _ ... .. ... .. . .
Comments (refer to question#): Explain any YES answers and/or any<'recommendations,or•any other. com_nients.,
Use.drawings.of facility"to better explain situations. (use additional pages as necessary)
-skid bt. k I tte a,,�
.6• 5�cion� be- ;VN(KbV a 4
(I. k OA-0 volvmc uses] 4 Cover M444- S" C\iQj S\ot/(J be- vse� t; a, COJ(CLA&klt
h: �er~ loa�avtc,•as r�,,1 �r�c{.� �`e�e�. Ape Alnav�.�c dRR�z �p,rw.� ��ntUt�J b� 1uSeea �r
Pl \'`� t �'r Str•d t� Lt'�r.�r��°C�W�
5 �"n { ov�S. S kt s` `tintls�0.�c, .� G is It L.x`.s 1 �?< �o Frc�a� itS e,1 b\ermuc�a —
[31h3ir�e -�n fO�nA�:rrnTt[r1 Glivtioktc �oy{�tnl.c�n�d n11 l.)[l�l�ar:k- $et)�.3
Reviewer/Inspector Name
Reviewer/Inspector Signature: ^ � F`�� ' ,� %� Date: _ 1116/99

Li
^ �y .a ::x.-a. �.. :Y-
�,�]p��se •;t �
,� 3�
�Xt
`�t� L-A Division of Soil and Water Conservation
O Other Agency
Wiviston of Water Quality
y
ICK Routine O ComDl'aint O Follow-un of DWO inspection O Follow-un of DSWC review O Other
Facility Number
0 Registered ViCertified E3 Applied for Permit © Permitted
Farm Name: '. lc�Qoroj -�
.............. .........................................----....------
Owner Name: n"cS'k�
..............................................................................
Date of Inspection
Time of Inspection F1'Tq3___1.24 hr. (hh:mm)
[r Not Opera Date Last Operated: ..........................
Count
........ ..... . ....: p......................................................................
........ Phone No:..... g ram.\ ............................................
Facility Contact: ... Title:
11
Mailing Address: a' /....... ..l�.l.. l`��� ----------------------
(7nsite Representative:.... .... �. ..... lntegratnr:.....''.....................................
Certified Operator....................................................................................................._.......... Operator Certification Number;.........................................
Locatioq of F rm:
..,-....-................:1{..............................................................................................................................................------.--------.--
Latitude 000' 0" Longitude • 0& 0"
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes [9 No
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes [�rNo
❑ Yes
0 No
❑ Yes
[VNo
❑ Yes
0 No
❑ Yes
MNo
❑ Yes
UNo
❑ Yes
9No
❑ Yes
No
❑ Yes
No

Facility Number:3 — r3c
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 0 No
Structures fLaeoons.Holdine Ponds. Flush Pits, etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 0 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
.....................................................................................................................................................................................
Freboard(ft): ............ '3 ....,t............... .................................... ................................... .................................... .................................... ....................................
......
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenanedimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP��, ]or runoff entering waters of the State, notify DWQ)
15. Crop type....... .rg...
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?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Onh,
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
13• No violations, or deficiencies. were, noted- during this. visit. You Oil receive-_ irro-hirthe
::•etirrespQndenceab:ou>rihis:visit:�::�::�:�.:.:: ; .::.•:-.• -.�; :�.:�.:.:.�::; :�:::�
❑ Yes ONO
❑ Yes KNo
Ik Yes ❑ No
❑ Yes 0 No
❑ Yes (9 No
❑ Yes 0 No
❑ Yes 10 No
OYes ❑ No
❑ Yes 9NO
❑ Yes 9 No
❑ Yes CgNo
19Yes ❑ No
❑ Yes (d No
❑ Yes El No
V-ki-6 re . Y�ye� {aLe► l +� 'l vi,�' �` <,4- I&
�, T a�� spa I.— ?aft5 � 1�sc��c+-� ���s� , -t�,� �c \tide,
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t =Uy.mot
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�Y
k, 1;� s , �s� 7125/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

s
Facility Number: ,. .. —.3 Date of Inspection: OIL
AdditioaaI Comments and/or Drawings
do '�7 mac` h��] �T�►'t�5�`� T�`'� �2.�1�"'�5 � �r-v�f/"-t'�• mac `
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r
�,� If .. (1.l0) GA. aoTl
4/30/97

10 Routine Q Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection i : ss1 24 hr. (hh:mm)
Total Time (in fraction of hours �--�
Farm Status: Wegistered ❑ Applied for Permit (ex:1.25 for 1 hr .15 min)) Spent on Review
Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:.... ..._ ....._
Farm Name: .._...... .... __.. ik�..... ....._.
Land Owner Name:.._._.._.... _ .. _.R� D�I° � .... .._.....
_ .._. _....._
Facility Conctact:
Title:
County:. � A.. ......
. _... __.... �Y..l. .
51a
Phone No:. �}� ...Q.".— .... ................
Phone No* ... a10..:.... `.5'7 ........
Mailing Address: .+K�.._..��:......_............ ............... ._..... .....
.Zl��e... 1:.+.1.d.� .......... � �....
Onsite Representative:.... ..... .... ......... .._....._ Integrator: Ar J
Certified Operator- ........__.... ....__...... �_. Operator Certification Number: Z'. .... ..... __....._. ,._ ..
Location of Farm:
Latitude Longitude 7 7 • �"
Type of Operation and Design Capacity
Design Current+ kk DesignCurrent�Des�gn Current
�Swrne n h Ca`'acr l?o alatian �Pouliry �> Ca aci Po...nlation Cattle Ca aci Pa ulairon F`.
❑Wean to Feeder x; ❑ La ❑ Da .ry
.
Feeder to Finish of ❑ Non La er ❑Non -Dairy
Farrow to Wean r # x i3 a a •s
s Farrow to Feeder T€>tat Design}CaPA.
Farrow to Finish
Tota1�SSLW�
❑ Other , a
,
... .... ......... -.W.
mliB
r rl
Number of ]I.agoonsyI Hdldmg Ponds: E ❑Subsurface Drains Present
� , � � `� � ^.:` g � �,w ❑Lagoon Area �,� [] Spray Field Area �`�� „ ,
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 19 No
2. Is any discharge observed from any part of the operation? ❑ Yes ®No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water`? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ®.No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ®No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 0$ No
4/30/97 maintenance/improvement?
Continued on back

Facility Number
s-
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
N�No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
StruOures aa-wons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
9 No
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
10. Is seepage observed from any of the structures?
❑ Yes
® No
11. is erosion, or any other threats to the integrity of any of the structures observed?
& Yes
❑ No
12. Do any of the structures need maintenance/improvement?
R'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
J& No
Waste Uplication
14. Is there physical evidence of over application?
❑ Yes
Z.No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ......... ......... .._............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
[--]Yes
`® No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
'® No
18, Does the receiving crop need improvement?
91 Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
19 No
20. Does facility require a follow-up visit by same agency?
KYes
❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
t,No
For Certified Facilities -Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
®.No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
24. Does record keeping need improvement?
JR Yes
❑ No
Comments:{refer to'questloi #) `Explain°any YES -answers and/or;any recommendations or any other comznepts ,
Use drawings of facility to better explamsituat�ons: (use add�rional. pages as necessary} a
=41,� il ...
I t. S e v % em s a ra S 10.-. p Ya L L¢.,...� w-a.+r a att a C.) %J t' t o­%. w a l l
4
IZ �S a L. " V I
v e o i-a t �' v -2 -o v`'��r - S E-a le l, S l�¢,� • I`^ add l i o �.. r eN �-q i a 1 a l i ° ("t tea. r
ie V_V- -C
is. L o a. s {-'I V- d�S 0 1 e.. es�I. i-.5 L, : ,,. ve
. 0 't� t o V— V_V s t q•e k a A$ C S++, S
.
/a � 4
c ei►- S {-� erd �w.... TL•3c v � 0 4t Y e_ r �
V w� iaJs.✓$ S V VS e & C ►n � 1 +r �' c� a� F-I 0 "�i .
l •, d d d I �i o +^lr ►� o v w. S r rC c e +�! 5 T� tri r,.. B-S o r s�cF-c. S n..N.tw't p,..
f s o ti.riL�S . l 4 yr ,J L C C t S a —
Reviewer/Inspector Name
ReviewerlInspector Signature: 1 Date: l
cc: Division of Water Quality, Water Quality Section, Facilitv Assessrn t Unit 4/30/97

Facility Number: ,, .j.... ---.. ( Date of Inspection: 1-0-
A
4/30/97

r�
U
so
Site Requires Immediate Attention: ✓
Facility N r
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANEAAL FEEDLOT OPERATIONS SITE VISITATION RECORD ,
DATE: �3 , 1995 2
Time: 3
Farm Name/Owner:
Mailing Address: Z C. 6#Ajc 0 4— 2 VJ i s �$51
County:
Integrator r
On Site Representative:
Physical Address/Location:
Phone:
Phone: 2 S9 - 3510
Type.of Operation: Swine L1_11' Poultry Cattle
Design Capacity: 2440 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 34- ° '50 " Longitude: —11 ° S4' ' (•ff " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: A_Ft. C) Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Ye or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or io none
Crop(s) being utilized: N e- �f P.W RaG 1*1 + f berm uj� lb T_j an+Qc_� 29..32ac-
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No C2`i Ne,
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ot6No�
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes oz_No)
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o<9 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Ye or No
Additional Comments: KVO . V 720e_+ 2 bVe U & J T2G i L'%
Inspector Name
S ignature
cc: Facility Assessment Unit
Use Attachments if Needed.

Facility Number: - ` Date of Inspection: j
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? 0 Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 'T
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes n 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) i
9. Does any part of the waste management system other than the waste structures require [] Yes No 0 NA ❑ NE
maintenance or improvement?
Waste ADDIiCatiOn
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IM No El NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes V
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 deer from those` designated in the CAWMP?
❑ Yes
❑ No
❑ NA
I NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[:]No
❑ NA
Y" � NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
qNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[] No
❑ NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Wea er Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [] Yes ❑ No ❑ NA 10 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No ❑ NA NE
Page 2 of 3 2/4/2015 Coy
teed

"-i
Faci Number: ' - '� n I Date 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 ❑ Yes ❑ No ❑ NA NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
r
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes ❑ No ❑ NA 0 NE
and report mortality rates that were higher than normal? I `
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 [DNA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [] Yes ❑ No ❑ NA NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No © NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 1z No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional -re ontmendations or any other comments,,
Use drawings of facility to better explain situations (use additional pages as necessary).
��fiY k cu 1,-I W-
c4) IVI VPA [ ay- cA- r 0 o r
6A C �e rt 4r f V-14 W11 .5 _k WC' J��
IT k" I. n
Gam` G. } r'�G W Suit 'CSC. A1/J
Reviewer/Inspector Name: -� / ' , �`l ! ;� C 9 `-4hone: - 3 j7
Reviewer/Inspector Signature: `Date: 4
Page 3 of 3 T
21412015

ow 4
Miguez, Kristin
From: Powell, David C
Sent: Friday, June 8, 2018 5:43 PM
To: Miguez, Kristin; King, Morella s
Cc: Meilinger, Michael J; Allen, Trent; Lawson, Christine
Subject: RE: [External] Observed Waste- Flight 6/6/18
DWR WIRO visited 31-366 today. No runoff, discharge or overapplication was viewed. Seems to be a type of pollen or
algae in the wetland/pond at the end of the field that has a reddish color. Farmer was asked to ensure to fence cattle
away from the wetland/pond to ensure water quality standards are not violated. Didn't see any other issues and farmer
seemed happy to comply with this request.
Thanks
David Powell, Environmental Specialist
North Carolina Department of Environmental Quality
Division of Water Resources
Water Quality Regional Operations Section
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405-3845
K D__
Water RelO t vS
..rrVy�srWn, r.
Tel. [phone]
Fax [phone]
For any emergency, which requires immediate reporting after normal business hours, contact must be made with the
Division of Emergency Management at 1-800-858-0368.
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and
may be disclosed to third parties.
From: Miguez, Kristin
Sent: Thursday, June 7, 2018 11:45 AM
To: King, Morelia s <[e-mail]>
Cc: Powell, David C <[e-mail]>; Meilinger, Michael J <[e-mail]>; Allen, Trent
<[e-mail]>; Lawson, Christine <[e-mail]>
Subject: RE: [External] Observed Waste- Flight 6/6/18
Based on the coordinates, it appears that the first two are in the Wilmington region: 31-366 and 31-17. And the third
appears to be in the FRO: near 82-216.
Thank you,
Kristin Miguez

From: King, Morelia s
Sent: Thursday, June 7, 2018 11:00 AM
To: Miguez, Kristin <[e-mail]>
Cc: Powell, David C <[e-mail]>; Mellinger, Michael J <[e-mail]>; Allen, Trent
<[e-mail]>; Lawson, Christine <Christine. Lawson@ ncden r.gov>
Subject: RE: [External] Observed Waste- Flight 6/6/18
Thank you Kristin.
Morelia
Morelia Sanchez King
Wilmington Regional Office: 127 Cardinal Drive Extension; Wilmington, NC 28405
morel [e-mail]; (P)910 796 7218 - (F) 910 350 2004
--":"`Nothing Compares
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Miguez, Kristin
Sent: Thursday, June 7, 2018 10:53 AM
To: King, Morelia s <[e-mail]>
Cc: Powell, David C <[e-mail]>; Meilinger, Michael J <[e-mail]>; Allen, Trent
<[e-mail]>; Lawson, Christine <[e-mail]>
Subject: Re: (External] Observed Waste- Flight 6/6/18
I will be back to the office shortly and will investigate and see what Farm this is.
Sent from my iPhone
On Jun 7, 2018, at 9:33 AM, King, Morella s <moreIla.sanchez-lc ing(a—)ncdenr.gov> wrote:
Continue with your plan.
Morella Sanchez King
Wilmington Regional Office:. 127 Cardinal Drive Extension; Wilmington, NC 28405
morel Ia. [e-mail]; (P)910 796 7218 - (F) 910 350 2004
<image001.png>
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Powell, David C
Sent: Thursday, June 7, 2018 9:31 AM
To: King, Morella s <morella.sanchez-kineCcncdenr.ov>
Cc: Mellinger, Michael J <Michael.Meilin e� [e-mail]>; Miguez, Kristin
<[e-mail]>; Allen, Trent <[e-mail]>; Lawson, Christine

< Christine. [e-mail]>
Subject: Re: [External] Observed Waste- Flight 6/6/18
We will be riding with a consultant and have a full day of inspections and are behind and cannot
alter due to biosecurity. Do we need to go do inspections or do we need to come back to the
office and prepare for this and then go back out? We are currently above Warsaw.
Sent from my iPhone
On Jun 7, 2018, at 9:28 AM, King, Morella s <inorella.sanchez-kinaLa)cdenr. ov> wrote:
Good morning all;
I received this complaint yesterday evening. The letter refers that the flight was
over Sampson and Duplin counties. I only saw one set of coordinates:
34.8491230,-77.898839' (near Chinquapin). David/Michael: try to check this site,
if you are nearby.
Thank you,
Morella
Morelia Sanchez King
Wilmington Regional Office: 127 Cardinal Drive Extension; Wilmington, NC 28405
morel la.sanchez-kingPncdenr.gov; (P)910 796 7218 - (F) 910 350 2004
<image001.png>
Email correspondence to and from this address is subject to the
!North Carolina Public Records Law and maybe disclosed to third parties.
From: Patrick Connell [mailto:[e-mail]
Sent: Wednesday, June 6, 2018 5:11 PM
To: King, Morella s <morella.sanchez-king~@ncdenr.gov>
Cc: Christian Breen <[e-mail]>; Kemp Burdette <[e-mail]>
Subject: [External] Observed Waste- Flight 6/6/18
Good afternoon Ms. King- Sanchez,
A flight was conducted today in Dupiin and Sampson County by Cape Fear River Watch. Questionable
hog waste management was observed. Attached are documents and timestamped photo's (geotag in
metadata) addressing our findings.
CPS Coordinates:
Ponded Waste l:
34,8491230
-77.8988390

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Division of Water Resources Air
Facility Number "3 - © �O Division of Soil and Water Conservation F
jr '0 Other Agency
Type of Visit: jo Compliance In ton Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Q Routine Complain Q Follow-up Q Referral O Emergency Q Other O Denied Access
Date of Visit: 2 7 Arrival Time: Departure Time: f County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title:
Onsite Representative: 'SCI & 1 1-1"... 1—, [ E
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
® Design Current
Non-L,
Pullets
Other
Poults
Design Current
Cattle, Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharzes and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
n 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
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
rN
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continuer!

Facili Number: Date of Inspection: -z t
Waste CoUction & Treatment
4. Is 5toragt capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [—]Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 01 o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments rest, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes ❑/ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O/No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
® Yes
❑ NA
© NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
L'J NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
�NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑ Yes
❑ No
❑ NA N;
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA Ef'�E
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
r
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall
Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA 1
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [] No ❑ NA
Page 2 of 3 21412015 Continued

IFacility Number: - 3 jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ,
❑ Yes
a No
❑ NA �1
25. Is'lie facility out of compliance with permit conditions related to sludge? If yes, check
© Yes
❑ No
❑ NA �NE
tht appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No
❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
Ej'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 No ❑ NA ❑ NE
❑ Yes [rNo ❑ NA ❑ NE
❑ Yes [J No DNA ❑ NE
❑ Yes
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ No ❑ NA
CJ NE
❑NA
❑NE
,❑ NA
VNo
0 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 pages as necessary).
0 1/- r`L J1 0 F �k
Reviewer/Inspector Name: �--�/j V� Phone: \0 { ()
Reviewer/inspector Signature: Date:12- ( /L7
Page 3 of 3 21412015

N.C. DIVISION OF. WATER QUALITY
Water Quality Section
Complain tlEmergen cy Deport Form
WILMIMGTON REGIONAL OFFICE
Received by Y
Emergency Complaint L—' City
Report Received From
Agency
011
1112 f7 Time
County.
Phone No.
Address Phone No.
Check One: Fish W11 _Spill Bypass Animal NPDFS N.D.
Stormwater Welland Other, Specify;
Nature of Referral
Time and Date Occurred
Location of Area Affected
Surface Waters Impacted
Other Agencies Notified
Investigation Details
Classification
Investigator Date
SAW=314ELLSIREPORT. SHL
EPA Region IV [phone] Pesticides 733.3556 Emergency Management 733-3867 Wildlife Resources 733-7291
Solid and Hazardous Waste 733-2176 Marine Fisheries 726-7021 Water Supply 733-2321 Coast Guard MSO 343-4881
127 Cardinal Drive Extension, Wilmington, N.C. 28405-3845 0 'telephone [phone] Fax [phone]

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