310369_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

i�
4
i�i'sion of Water Resources
tcility Number �a✓ - Srro Q Division of Soil and Water Conrvation
© other Ageorcy
of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
in for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 11 Arrival Time: ; Up 1 Departure Time: County: Region:
Farm Name:Owner Email:
Owner Name: _-Elle I T - Phone:
Mailing Address:
Physical Address:
Facility Contact: rlc-�— C,(Jr fr1-v Title: ,�.c�iv�— Phone:
Onsite Representative: Integrator:
Certified Operator: -re -— Certification Number: 1;590:3
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
11-ayer
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pap.
Dairy Cow
Wean to Feeder
1
iNon-Layer I
Dairy Calf
Feeder to Finish _ D(T
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry, PNEIt .
Layers
Desigu Current
Ca aci P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Uther
Other
Turlce s
Turkey Poults
Other
Discharges and Stream Imaacts
1. Is any discharge observed from any part of the operation?
[:]Yes
&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[�,No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
,&No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: jDate of Inspection: I
It
Waste Collection & Treatment
�. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in):L _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
EXNo ❑NA ❑NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes �ZNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
[-]Yes
RNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[-]Yes
I No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[5� 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 QjNo ❑ 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): ! a / vr11- Za4262 c-
13. Soil Type(s): pA—/-i f tom, I
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? WYes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes K[ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑Yes [ZNo ❑NA ❑NE
❑ Yes FA ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [-]Yes 7❑,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. RYes ❑ No
❑ Waste Application ❑ Weekly Freeboard Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [&No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? .❑ Yes ONO
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: —
` 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CAS No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ZNo ❑ 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 allo ❑ 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?
any
❑ Yes DQ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NEB
❑ Yes Aq No ❑ NA ❑ NE
❑ Yes Lallo ❑ NA ❑ NE
❑ Yes ® No
❑ Yes No
❑ Yes ELNo
1 - )�
j_) �uI GCS
,��- � s r�� s L� 4, ��� W -& r-
p0j, 1
Reviewer/Inspector Name: 5 y Z--�
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE,
❑ NA ❑ NE
Phone:
Date:
21412015

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Z ? Arrivaijime: Departure Time: County: /ram Region: CZ/.a
Farm Name: �j Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
JNon-Layer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C+urrent
D , P,oult , Ca aci P.o ,
Layers
Dry Cow
Non-Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other,Turkey
Other
Turkeys
Pouets
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 eNo ❑ NA ❑ NE
❑ Yes
eNo
❑ NA
❑ NE
❑ Yes
J21Wo
❑ NA
❑ NE
❑ Yes JZ No
❑ Yes
❑ Elm -
Yes L No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

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

Facility Number: jDate of Inspection: 121
24, Did the_facitty fail to calibrate waste application equipment as required by the permit? ❑ Yes Eno ❑ NA ❑ NE
25, Is the facility'out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E 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 E]' No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ;a -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?
Ll-e_� ice✓ 2L16
❑ Yes L2-No ❑ NA ❑ NE
❑ Yes ;'No ❑ NA ❑ NE
❑ Yes ;21<o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes P^No
❑ Yes n,No
❑ Yes [ o
i¢�rif -nnv
P full � oev
l
Reviewer/Inspector Name: Phone:
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

V
Facility Number
4"ivision of Water Quality
fO,bivision of=Soil andMWater Conservation
Q Other Agency:
Type of Visit, ,C,00mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit fi Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 1,r,ivai Time: Q® Departure Time: County: Region: 6"_ t r
Farm Name: 6 =.I c 6an Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �0&%���',c 44,
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = I Longitude: = ° 0 6
Design Current
Swine _ Capacity Population Wet Poultry
❑ Wean to Finish ❑ Layer
Capacity- Population, Cattle
z` ❑ Wean to Feeder
❑ Non -Layer E
❑ Feeder to Finish"'
_
❑ Farrow to Wean
,DPoult ry ry
❑ Farrow to Feeder
-
= ❑ Farrow to Finish
` ❑ Gilts
Ot1ier
❑ Other
El Layers
El Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cy alf
y Heifer
Cow
IL I Beef Feeder I I IF-1
Nur
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 2rNo ❑ NA ❑ NE
❑ Yes
,I No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
ONo
❑ Yes
o
'7No
❑ NA
❑ NE
El Yes
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Date of Inspection *br
Facility Number: —
,Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 2Wo
❑ 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,,Mo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ;2 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 PMo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ NA ❑ NE
maintenance or improvement?
"P*o
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ;'VV
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ 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 12rlZo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes ET No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes 14
❑ NA
❑ NE
t8. Is there a lack of properly operating waste application equipment?
❑ Yes ;No
❑ NA
❑ NE
Comments.(refer to questionc # Explain any YES answers and/or any recommendations or any other comments ^ ti
Use drawing s of facilityto beP
ttcr explain situations. use additional pages as necessary)
e ` a
Reviewer/inspector Name T� Phone:
Reviewer/Inspector Signature. Date:
'age 2 of
Continued

(Type of Visit: PrCompliance Inspection O Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: (2fRoutine 0 Complaint 0 Follow-up Q Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: '2 Departure Time: County: Region: "AL_Farm Name: �ei Owner Email: 11 f�GLY,rQ/rl �°'``
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phorne,:
Onsite Representative: �/tQ� 6A4z4j17 Integrator: / / 4
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
I
Design Current Design
Wet Poultry Capacity Pop. Cattle Capacity
I Layer I Dairy Cow
Current
Pop.
Wean to Feeder
I
INon-Layer
I Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Ca
D . P,ouI aci P,o , Non-Dai
JLayers Beef Stocker
Gilts
Won -Lavers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
OtherAIL
keys
Turkey Poults
Other
DischarLFes and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier:
Spillway?:
Structure 2 Structure 3 Structure 4 Structure 5
;D-No ❑ NA ❑ NE
6No ❑ NA ❑ NE
Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ,2jNo 0 NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes I!j No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes '[27No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes j'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes ErNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ,fNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Er —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):
l4. 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 f] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
L2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JZ''No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
17] + o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
4
r—l-NTo
❑ 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 .[2rlTo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

[Facility Number: - Date of Inspection: f
24. Did the facility fail to calibrate waste application equipment as required by the pe t? ❑ Yes 2fNo ❑ NA ❑ NE
9.1the
s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA 0 NE
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 '�TNo ❑ NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes PrNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes VrNo ❑ 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 VrNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes eNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes m No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [jNo ❑ NA ❑ NE
Comments refer to question ft Explain any YES answers and/or any, additional recommendations or an other.
" .
comments:;
asnecessar3)'Use drawings of facility,to befer ex lain situations (use additional pages
..
w'�' �`-' o ey►' i I Stec s < uoc r_ { +8
qlo 35a Boa � ar
f�evjfil. eowfGGiJCCPU'Ir. ar!
l � �9'r.►-� � r� ca�a�s r n ard�
Reviewer/Inspector Name:
ReviewerAnspector Signature:
Page 3 of 3
Phone: j< ��
Date:
l/4/2 I4

alityWater
Divisionoi,S d and:pQ
Ea-_'c'flity_N4ifiber 0 Conservation .. v.
— —� — — — — 0 Other.Agency _}
IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
rrival�Time:
1 7" parture Time: County:
I &(. a23 Owner Email:
Phone:
Physical Address:
Facility Contact: j Title: Phone No:
Onsite Representative: �lGil Lr %O Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number: _
Latitude: = 0 0 6 = Longitude: 0°
Design °Current" Des
Capacity Populahon�z Wet Poultry :-'Cape
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
mW M$
Other.
urrent �;;
Cattle"
ipulation� "
MIL-j Non -Layer I 1
❑ Layers
IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
rrival�Time:
1 7" parture Time: County:
I &(. a23 Owner Email:
Phone:
Physical Address:
Facility Contact: j Title: Phone No:
Onsite Representative: �lGil Lr %O Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number: _
Latitude: = 0 0 6 = Longitude: 0°
Design °Current" Des
Capacity Populahon�z Wet Poultry :-'Cape
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
mW M$
Other.
urrent �;;
Cattle"
ipulation� "
MIL-j Non -Layer I 1
❑ Layers
ElNon-Layers
ElPullets
ElTurkeys
Turke Po
Hl
Other
uIts
y Cow
Cy alf
Heifer
Cow
LJ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
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?
Region: =
WIm
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

FaciliNumber: - Date of Inspection:
baste 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 'pa -No ❑ NA ❑ NE
Structure l 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 _ETNo ❑ 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/,Pa'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes p3'Vo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes P�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes �1,+10
❑ NA
❑ NE
maintenance or improvement?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes o
❑ NA
❑ NE
maintenance or improvement?
T
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, eta )
❑ 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?
❑ Yes0-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
o
❑ Yes 2,17
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes �o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes �o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes .0'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
NE
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yesr�No
❑ NA
❑ NE
Page 2 of 3
-"
21412011 Continued

Facili Number: - _ Date of Inspection:
2A. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes )2TNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes /E�rNo
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 stmcture(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 )EF No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C'No
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes I o ❑ NA ❑ NE
and report mortality rates that were higher than normal? 7
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [;�No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [;],No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Application Field ElLagoon/Storage Pond ❑ Other: T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes P" To ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes PNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes L:Ko ❑ NA ❑ NE
Comments (refer to,,question4): Explain any YES answers-ind/or any additional recommendations or. any other comments`.
Use drawings of facility to better explain situations, (use :additional pages as necessary). _;,, ;-
,S
160k
Reviewer/Inspector Name: .1calzn
Reviewer/Inspector Signature:
Page 3 of 3
6os
Phone:
Date: L l Z
2 44 II

Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation p 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 Region:
Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pap.
Design Current
Wet Poultry C►specify Pop.
Layer
Design Current
Cattle Capacity Pap.
Dairy Cow
DairyCalf -
Wean to Feeder
Non -La er
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Desigil
Il P,oultry Ca acNon-Da'iry
I Layers
DairyHeifer
D Cow
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
ll Other
JS
Turkeys
Turkey Pouets
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)?
❑ Yes �3 No ❑ NA ❑ NE
❑ Yes
[6 No
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
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?
D. Yes
Q No
❑ NA
❑ NE
❑Yes
0No
❑NA
❑NE
❑ Yes
W] No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: eg 1 71 jDate of Inspection:
24. Drid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [:]No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
�26id the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No
❑ NA VNE
❑ NA V NE
❑ NA NE
❑ NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA [A NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [:]Yes [:]No ❑ NA NE
permit? (i.e., discharge, freeboard problems, over -application) 0
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA [7 NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations(useadditional pages as necessary).
/t Ce
GJ aS P01766alae7es
,t'C�Ss1 ✓6 o/ty//IS GtJR�s o i<S'�� v85' �ra � 740 rC�c
47L-
I `
Wa,5 lel qf
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: W" / K— 7X 76
Date: 3 % 2-
214 OII

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ENo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [�j 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 10 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 17 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ff No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0 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
PExcessive 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 [Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes V1 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(6 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[::]No
❑ NA
ONE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
E5NE
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 �3 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 [�j NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA B' NE
Page 2 of 3 21412011 Continued

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Techal Assistance
Reason for Visit 0 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 Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:A�AN 6A -L.A
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator
Operator Certification Number:
Back-up Certification Number:
Latitude: [� 0 0 d [= Longitude: = ° = g =
Design C+urrent Design
Current
Design Current
Swine Capacity Population Wet Poultry Capacity
Population
Cattle Capacity Population
❑ Wean to Finish ❑ Layer I
I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Dairy Heifer
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non
-Dairy
4
❑ Layers
❑ Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
❑ Turke s
Other ❑Turke Poults
❑ Other ❑Other
E
Number of Structures:
Discharties & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes FWo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes -�TNo
❑ Yes —ffNo
❑ NA
❑ NE
❑ Yes _�INo
❑ 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 1 Struspfre 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question-#): , ExplainanyYES answers and/or anyreeommendations or any other comments }'
:Use drawings_ of facility.to better. explain situations."(use additional pages as necessary)
Reviewerlinspector Name '� a Phone:
Reviewer/Inspector Signature: G Date:
Page 2 of 3 12128104 Continued

Facility Number-,31 Date of Inspection D
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. ❑ W Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
21, Does record keeping need improvement? If yes, check the appropriate box below. [J' I'es ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ 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"andlor Drawings: -
s
�*/t/7e /d, X��a AGO
Page 3 of 3 12128104

Type of Visit 1>ftmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for VisitRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
a-?,
Time: Departure Time: County:
Facility Contact: f Title:
Onsite Representative:"/art
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator
Operator Certific tion Number:
Back-up Certification Number:
Region:%
Latitude: ❑ o = 6 ❑ Longitude: = ° ❑ , ❑
Design C►urrent Design Current
Design Current
Swine Capacity Population Wet Poultry C*apacity Population C►attle
Capacity Population
❑ Wean to Finish
I0 Layer
I
I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
❑ Non-Dai
El Farrow to Finish
El Layers
El Beef Stocker
El Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
Cl Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turke Pouets
❑ Other
❑ Other I I !lumber of Structures:
Discharges & Stream ImRacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [?'�o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Ol
El NA
❑ NE
El Yes
No
❑ NA
❑ NE
Page I 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 Pono ❑ NA ❑ NE
4
a. If yes, is waste level into the structural freeboard? ❑ Yes L 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 ATNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes_/ffNo
❑ 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 ;;j'1Vo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes )2Mo
❑ 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 ,T No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Po
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2Mo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
21�o
❑ NA
ElNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ETNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
O No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
No
❑ NA
❑ NE
Reviewer/inspector Name �i� s �` �'� Phone: ' 3
Reviewerllnspector Signature: r Date: / Page 2 of 3 12/28/04 Continued

.C.
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes yo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VrNo ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Pexaste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes
;ZNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
5'No
❑ NA
❑ NE
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
/No
❑ NA
❑ NE
2� 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
B No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P}o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
ENo
❑ 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
Z 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
[;2'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
VNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings ,. -
,
/ V
j� /UA '00"ftf k"
Y
3F
doog
Pledtcr
yie-
Page 3 of 3 17r .._�2/28/04

Facility Number
Division of Water Quality
Q 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: f Q Arrival Time: Departure Time: County: 17
Region.
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 'Title:
Onsite Representative: �i<�ti L��/C 4
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certific 'on Number:
Back-up Certification Number:
Latitude: 0 0 0 g= u Longitude: =°= g 0 n
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
EFDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Dumber of Structures: ED
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 �Ko ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
P fqo
❑ Yes
❑ NA
ElNE
ElYes
/Po
Z No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes P'1Vo
❑ Yes ❑ No
Structure 5
El NA El NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ,Q 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 ❑�To ❑ NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �2No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 13'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
11. I 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 Drib ❑ 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
.;Wo
❑ NATE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes ONo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
❑ NA
❑ NE
1$. Is there a lack of properly operating waste application equipment?
❑ Yes ZrNo
❑ 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):
NDCA+4CCC�0A lecor& U111 be
Reviewerfinspector Name Phone: C71a-
ReviewerAnspector Signature: Date:
1
Continued

.r I Facility Number: - Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes f �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ayes ❑ No ❑ NA ❑ NE
the appropirate box. XWUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
.� "aste Application ❑ Weekly Freeboard ; 'aste Analysis PSoilAnalysis ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concem?
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? (iel discharge, freeboard problems, over application)
32. Did Reviewerlinspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ,e'No
❑ NA
❑ NE
'es,l?'No
❑ NA
❑ NE
,,FeKes ❑ No
❑ NA
❑ NE
❑ Yes J2'1`io
❑ NA
❑ NE
❑ Yes JMo
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
J'1gE
❑ Yes ;9No
❑ NA ❑ NE
❑ Yes ZNo
❑ NA ❑ NE
❑ Yes /M—No
❑ NA ❑ NE
❑ Yes _j2No
❑ NA ❑ NE
❑ Yes _[�'l�o
❑ NA ❑ NE
❑ Yes J;;Ko
❑ NA ❑ NE
Additional Comments and/or Drawings:
4C.
a
r �iyLIGZ 1 �
' //G S
_ S �� $ �,
�� om l L Gr �.3 r� f�-� 1 L�e� r� Cam' J
►o N� �,�c�Q ov, -�s OrCcord53
s�
la
C (Lle�
A
\A, fCCGI-j
12128104

Type of Visit ortompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ORoutine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ denied Access
Date of Visit: / Arrival Time: 1 //'w 1 Departure Time: County:4,051-111--t Region:
1 /--7-2 A 7— �J
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Owner Email:
Phone:
Phone No:
Integrator• Yirl
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ 0 0 6 = « Longitude: 0 ° ❑ ` ❑ "
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry
@opacity Population
C+attle Rkopacity Population
❑ Wean to Finish
❑ Layer I
1
I
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Feeder
10 Non -Layer I
ceder to Finish
L❑
Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑Turke Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
0
❑ 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
Condinu .

Facility Number: — Date of Inspection l 06
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: r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the 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
l0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): 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 Phone: Old 619; 27
Reviewer/Inspector Signature: Date: j
Page 2 of 3 12178104 Continued

4
Facility Number: ' j — Date of Inspection Z l
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ZWaste 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?
Xyes;
❑ No
ElNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Q Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ 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:
/c.S`/06 0•C4
- eBC'L C_ V '--Djece Y�"k.�P_ Y4
�/ �{ sc��e-
s/ay/o&
S
_LC
Page 3 of 3 12128104

Type of Visit 7Routine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I o1 7 o S Arrival Time: KS~ Departure Time: County: 0-16A It✓ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: Ig t-C-4j Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = s 0 Longitude: a ° = r = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑
Wean to Finish
❑
Wean to Feeder
©
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Soars
Other
❑ Other -- - _
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: =
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
ElNE
❑ Yes
El o
ElYes
No
❑ NA
❑ NE
❑ Yes E 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 l Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: LA 4-VV7""' i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2g
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ffNo ❑ 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
L7 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ER 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
[` Io
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
E!rNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) t`_sU/C—_ (6) C 6 g69 x rt* G
13. Soil type(s) AZ6 'V a
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 � El NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes V El NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes L No ❑ NA ❑ NE
a j, U�OAiE CW V/Y&L' �P r2wt LJ5Nro )P/ &1Z4L 2) '/ IIPDgf CALTgRIvigJ C rqa °N I�ciEf4
CsPy Gf j4tV JyA L aA1iFs CATzo. Akl5 ,TowcMVG AecOnof , (CfMT -P
AA4C.'-"6 )42 A, 45tr- AANL_ 015 66a0 a 12A �s Presd0 Apin A Fri J'AMP1,6
bAr( C Sc- iT, vjaY Nor tovf9-6D,
Reviewer/Inspector Name i — , 10 rl A E Ci— Phone:(? 796 — 7
Reviewer/inspector Signature: ad4l 1L441 Date: / S
12128104 Continued

Facility Number: Date of Inspection
r
Remuired
Records & Documents
/
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
El Yes
7N(o
❑ NA
El NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
❑ NA
❑ NE
the appropirate box.
❑ WUP El Checklists El Design El maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
LI Yes
❑ No
❑ NA
❑ NE
El Waste Application El Weekly Freeboard L.J Waste Analysis El Soil Analysis El Waste Transfers
Certification
❑ Rainfall Erstocking EfCrop 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?
s
ZNo
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Vyy s
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L/j No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
/ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ICI NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAW-W?
❑ Yes
2 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0No
❑ 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
�Xo
❑ 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
El Yes
,�,�
L� 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?
El Yes
��-,,�
o
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
�El
L/J No
❑ NA
❑ NE
y
Additional Comments and/or Drawings:" r , _';
12128104

Type of Visit P Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Y Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number pate of Visit: *P0=NotOrerational
me:
Q Below Threshold
;(Permitted [`Certified © Con/dlittiio�nally" Certified © Registered Date Last Operated or Above Threshold: __ ._............
Farm Name: ...4 ..�i rii�,f!j.... �.�[1F1.� ... ............_......_... County:.. 411/21.. ..._._- ._ ...__ ._...
Owner Name:
. ................................_................ Phone No: ... ........................... ....................
.�.._......_......_._........_.-
Mailing Address: _ _....._.-_� -.� -- _. W. �-— ............ ................ ............ -
Facility Contact: ........ ......... .................. ....................... ...... ......... -- Tide: Phone No:
ieY 0nstRepresentative: ftl { .... . Integrator: ..///��P��...,................ ......... _ . ._..
Certified Operator :....................... ....._ .. _ ._ _ ... .� ...... Operator Certification Number:
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 00 ` " Longitude • ' "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes x No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
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 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes to No
❑ Yes ONo
❑ Yes XNo
Structure 6
Identifier : ...................................
Freeboard (inches): 7i _
12112103 Continued

• a ' Number-3/— Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ONo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/'improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markets with required maximum and minimum liquid level ❑ Yes XNo
elevation markings?
Waste Application 1
10. Are there any buffers that need maintenance/improvement? [I Yes ,rJ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes XNO
❑ Excessive Ponding ❑ PAN_ ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc,
12. Crop type Aefaman# 1407'A lk- "emf [ Ae4q.2e ) AIVW-,I �Ai,r I .
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (dAWMP)? ❑ Yes Z No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ONO
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? Allies ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ONo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes gNo
liquid level of lagoon or storage pond with no agitation?
IS. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0No
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/0110
Air Quality representative immediately.
•,CommeiaL� {refeito gnestrat�.�} , Fiiplarn any YES nswers aad/or arm rerommeadations oranyother comments. � _ '
;Use dlrawmgs of fae�ty to bettei explain srtaatioias. (t�ise�addrtYottai�pages as necessary). ❑ Field Co ❑ Ftnal Note"'
pF /7W Iy-,,09 'r�o Atggx'::� 't;q
.
�� �Z 3.2 70•�
.44
­z" Ov r Cwz FF u,� Lp��1Z �� �¢ ; ` & .
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: /% O
12/I2103 Continued

Facfity Number: T1 I Date of Inspection /i Q
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? XYes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes e4 No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes
.11ZNo
❑ 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 )j No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes )21No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes ff No
(ie/ discharge, freeboard problems, over application)
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes )ZfNo
28.
Does facility require a follow-up visit by same agency?
❑ Yes ,�lo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
"
❑ Yes INo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
tij Yes ❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes Rf No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ONO
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 XNo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
k�aevs, .
fi JAW/v
23) -
g
r41A10 t�Q 106:?,- VIP,Zoo3,
V Wd6 Z RAO,5 -;'0 GF 7 lsf,� � [ urx Sflzvay AtJP
lJUrF '. 7t� �GS� Dl�AE2.
7�1'L5
7 Swop Aurn p 44
12112103

of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
IReason for Visit OO Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 369 Date of Visit: 4/11/2002 Time: 10am
0 Not Operational 0 Below Threshold
Permitted ffiCertified E3Conditionally Certified U Registered Date Last Operated or Above Threshold: .........................
Farm Name: Ey.dyxt.Basdeft.EArm...................... County: D.up>lrl................................................ W..][1:i.Q.........
Owner Name: Fxelyxi..................................... B."den ........................................................ Phone No:
Mailing Address: 433I.1E✓.NC24........................................................................................ Be.uU,.%J11c..NC ....................................................... 185.18.............
Facility Contact:.............................................................................. Title:....................... Phone No:
Onsite Representative: iftWner.............................................................................................. Integrator: Murphy..F.an ily..F.arms.............................. _...I
Certified Operator: B.x1, Xj1.................................. W..CkIL............................................... Operator Certification Number:.1 1 .............................
Location of Farm:
East of Beulaville. South side of Hwy 24 approx. 1.2 miles East of SR 1715. Just past 2 body shops on the North side of 24.
This farm is first site on farm path. ,r
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 • 54 , 27 u Longitude 1 77 ' 41 09
❑ Wean to Feeder
® Feeder to Finish
3672
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Guts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes R 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 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................. I ................. ..........................................................................................................................................................................
Freeboard (inches): ...............29............... .............

Facility Number: 31-369 Date of Inspection 4111I2002
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes N No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ER 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 N No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Aanlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
N No
1 I . Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
N No
12. Crop type Fescue (Graze) Coastal Bermuda (Graze) Matua (Graze) Small Grain
Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
® No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
® No
b) Does the facility need a wettable acre detemunation?
❑ 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
N No
Renuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
[],Yes
N 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
N No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
N No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
N No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
N No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N 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 N No
® No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Field Cony M Final Notes
Farm & Records in good shape.
Reviewer/Inspector Namealtene.
Reviewer/Inspector Signature: Date:

O5103101 Continued
. •r
Facility Number: 31-369 Date of Inspection 4/11/244z
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [] Yes tR No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? [ Yes 0 No
28. Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt, ❑ Yes 0 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 0 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, mussing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
AJ

a
Division a, Water Qaahiy
t ' Q. Division of Soil and`Water Conservation
Agency_
Type of Visit j2Mompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit eRoutine 0 Complaint O Follow up O Emergency Notification O Other 0 Denied Access
Facility Number Date of Visit:
© Permitted E3 Certified © Conditionally Certified [3 Registered
Farm Name: St:. L) �ci �• �+-.
............. F v..........................
Owner Name: ............... �4 r....... G ~....
Ij (n 01 Time: f: :' 0 Printed on: 7/21/2000
0 Not Operational Q Below Threshold
Date Last Oper3ted or Above Threshold:
vp1Ii,
Countv:
Phone No: ,•..................
Facility Contact:.............................................................................. Title:................... Phone `o: ..
'failing Address:....-...............QQ................-...._...--........................-...--...........---•----.-.-...................................--................-.....-................--....................... ..........................
Onsite Representative:.......Il/.'`*.`.G' ... Gt 1.......... --.......... 1....... .--1- ............. Integrator: J"'W ...............................................
......-.
Certified Operator : ................. .................................. ............................................................. Operator Certification Number:..................
Location of Farm:
❑ Swine ❑ iPoultry ❑ Cattle ❑ Horse Latitude • 4 44 Longitude 0 A 99
Design Current
Design Current Desrget Coteau
cPo elati
PteonCa Ca Po ' tion
Wean to Feeder
❑ Layer ❑ Dairy
s Feeder to Finish
10 Non -Layer I I[] Non -Dairy
Farrow to Wean
Farrow to Feeder
❑ Other
Farrow to Finish
Total Design Capacity
' Gilts
=' Boars
Total SSLW
,...
Subsurface Drains Present FOLAgran Area U3 Spray Meld Area
'''hhh��a
Y Pomts / sg8 i,tdtTrep
Nod si uid Waste Mana ement Sem _
:. :: , • ;
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 DW'Q)
e. If discharge is observed. what is the estimated flow in gallmin"
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure ; Structure 4 Structure 5
identifier: ............. I .... ................. ..-................................ ...................... .............. .................................... I............................
Freeboard (inches): 38
5100
❑ Yes ONo
[]Yes ;2rNo
❑ Yes O'No
!'
❑ Yes ,ETNo
❑ Yes YNo
❑ Yes ;'No
❑ Yes ONo
Structure 5
Continued on back

Facility P�mber:.71 -3LDate of Inspection l D Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes 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 maintenancetimprovement? ❑ Yes PrNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 7No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes gNo
a Waste pplication
10. Are there any buffers that need maintenance/improvement? ❑ Yes /J No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload 1 ElYes J�No
12. Crop type Fes -cue �. 2.�', QC�"KvL>(�► t�-�,%Z!', k 6rgze /
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? e�es ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes.0No
b) Does the facility need a wettable acre determination? ❑ YesNo
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 IETNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ZEfNo
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 )�Ko
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 gNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes A'No
23. Did Reviewer/Inspector fail to discuss reviewtinspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ YesXNO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes❑'No
10 vi¢ialiigris:oir• def ciendbi -were potted. during this:visit; - Yoi} :will -tee iye riot #`urther /_
.. Cori�es orideitceI out this visit .:.:............:.:. :. _ .:..... .
AL
i c, p!o r.ci tr S IL4 /0 i G i f e t d 3 } �i u4 V—gAt U r1 _<tto ✓1. (C( 6 e ; "l
is- nJecA 4o mrvrc Jvod s}�,.1d i'u� a �%�d3 '-� -� aunt�Isa
�ri_svrc o t? d b e ,.�-� va�c� 4ci n d nJ t,J e.t i - h eel 4co S�Li�
�v» a, ; n s0VII\C gr'echT -
°I 6C' Sv%'Io it5-e of e -A- 4- W1,4tt `1 Ip�Glctys �' r 1,6 q;o� ..
Reviewer/Inspector Name
. n
} 7r # ' y�
Reviewer/Inspector Signature: lhtLl Date: it 6 0L_ 5100

J,VacijitijNumber: ,31 ZO Date of I uspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [] yes [] No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? 0 Yes eNo
28. Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt, [:1 Yes _'No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes Z No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) 0 Yes QNo
31. Do the animals feed storage bins fail to have appropriate cover? El Yes lErNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? El Yes El No
Additional, Comments and/or,:Drawings:

Ti �. -
wCj I3iviS69i of;Soil and.Water Conseirvahon `;Operation Review ry
Division of Soil and Water.Conservation .Compliance Inspechon i Y =`
Other-
Agency Ope
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection ® 24 hr. (hh:mm)
Permitted Certified [a Conditionally Certified [3 Registered R3 Not Operational Date Last Operated:
..........................
t
FaunName: ......... ., .....' ................... County• .................. .......................
OwnerName:........................................................................................................................... Phone No:..
Facility Contact: ...Title:
Phone No:
MailingAddress: ................. .................................................. ... ........................... ..........................
. ...............................
Onsite Representative:.-_-- ... w!-� ............. .. Integrator............ ✓ ...........................
....................................................................................
Certified Operator: ................................................. : . ......................................................... I ... Operator Certification Number:..........................................
Location of Farm:
i
......................
........ ... ... ..................................................... .. ................ ........... ...............................................................
Latitude Longitude �• �` C�«
Design.. ; ' .Current Design Current = Design � Ciiftent
Swine Ca aci = Po p ulation Poultry Ca acity, Population Cattle ;:Ca aci Population
❑ Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total'Desigt CapaCiity:.
❑ Gilts
❑Boars '.To61-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?
Discharge oriuinated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): .........,0(,
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes gNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
EkNo
❑ Yes
D'No
❑ Yes XNo
Structure 6
❑ Yes NNo
Continued on back

V
Facihjy Number: Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(I€ any of Questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Ex essive Pon ling PAN
12. Crop typeinlLl���
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This "facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with'on-site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes KNo
❑ Yes b(No
❑ Yes b(No
❑ Yes XNo
❑ Yes XNo
❑ Yes A'No
XYes ❑ No
❑ Yes XNo
P(Yes ❑ No
❑ Yes ❑ No
}Yes ❑ No
❑ Yes P(No
❑ Yes XNo
❑ Yes ;<No
VYes ❑ No
❑ Yes IgNo
❑ Yes ANo
❑ Yes )d No
[:]Yes XNo
❑ Yes )<No
❑ Yes XNo
0 �'Vq yigtaticjns or deficiencies were nQtew7 during �hi5:visit: Yoil wiil i.eeeiye Rio further • :
corresporideitce: about this visit: .. .... . . •
Comments refer. io uesho
u
( qy n #): Explain anyYES answers and/arany recommendations oeaay-other comments � _ _
Use :drawings of facility to better „explam situations (use�additiohal pages as necessary}
w U PS, 5 v wcly e�, =��',� e� L• 1� �...� r l �r�
Reviewer/Inspector Name 3cf evw
Reviewer/Inspector Signature: Date: 45 —��—

*I.FaVity Number: — Date of Inspection QC�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below V'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 9No
2& 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)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes KNo
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 P(No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes KNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [FNo
AdditionalComments and/orrarnngs:. =. = _. .;::__ r... -• s = ri _= _. r.
... ._._.... _ ..... ...._ _._... ._. .. ...._ ..
q.
t20
T 45i'
[
J
KQ -N JZ4, - l 1
Pam` GL-,- -+> -
h-�-3' � dver l
cam.
l Q ,� - ``
Rt�eVV ��� �r i���L,, ��o w gyp►-��►cQ ,

�. 0 Division of Soil- and'Water Conseryat.an -'_Operation Review = s _
v -
[3 Division of Soil - and WateirConservaban -.Compliance Ir�spechon -
�Division of Water Qualtty Comphanee Inspecttop17
-�
�.Otlier Agency. Operation lt+v�ew r r r �, r�s'
Routine OComnlaint O Follow-u❑ of DWO insaection O Follow-un of DSWC review O Other
Facility Number 1__.� Date of Inspection
Time of Inspection 24 hr. (hh:mm)
© Permitted Wertified 0 Conditionally Certified [3 Registered 113 Not Operational Date Last Operated:
:,-� ' Farm Name: � County:...............................................................
OwnerName:............. Phone No:.......................................................................................
Facility Contact: ... �C� ................ Title:.....L.tt`G•` !� ......................... Phone No:.-..f. ��..t.o...7�...- 9_9 .........
MailingAddress: .............�►}c.............II......,.......................................................................... ............................................................ .--.---.................. .........................
Onsite Representative: '-...,V�' ........................................................ ..
. Integrator: a L
}......................................................
Certified Operator: ............................................. ..... ............................................................. Operator Certification YNumber: ..........................................
Location of Farm:
w
.................................................................................................................................... .---.. ...
Latitude �� �` Longitude �•°°
Design Current u.= Design Current Design Current .
Swi7-7
ne Capacity Population Poultry Ca achy::. Po ulation Cattle . Capacity Population `
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ElNon-Layer❑ Non -Dairy
❑ Farrow to Wean -
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total -Design -'Capacity
❑ Gilts
❑ Boars , Total'SSLW
lNumberof Lagoons �❑ Subsurface Drains Present ]I❑ 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 b(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 C'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes NNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure C
Identifier:
Freeboard(inches): ........ ..?.......I............................................................................................................................................................ I .................... ........
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes UNo
seepage, etc.)
3/23/99 Continued on back

Fac lity Number:3 —` o� Date of inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
WNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
O No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
r'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
XNo
Write Aj2Rlication -
10. Are there any buffers that need maintenance/improvement?
❑ Yes
t�No
11. Is there evidence of ove application? ❑ Excessive Ponding ❑ PAN
❑ Yes
[YNo
12. Crop type C [ S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
32'Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
ff No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONo
l & Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
XNo
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
4Yes
❑ 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 actively certified operator in charge?
❑ Yes
IXNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
No
. (ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[ Mo
24. Does facility require a follow-up visit by same agency?
❑ Yes
9No
25. Were any additional problems noted which cause noncompliance of the Certified'AWMP?
❑ Yes
WNo
o viotatigtis;or- di ciencies -Were noted• during Ns;visit: You wiil-ceeeiye tid ]Further ;
corresponc#ence. a ' ' f this visit.. . _ .. . .
Coininents (refer to questEon #) y=Explaid-any;YES'answers and/or any recommendations or:any oilier comments.
Use'drawings of facilriydo.bAfer explain=sitfuatioiis {use additional pages_as necessary)
I'
KAL,T,
�2- :Sjo►'t 5 �rr 4,Zv4
Ur j
Ae5l h es=� "14 V-5VIL-
tA> -� �, tr tvyl"f�
3 _1
Reviewer/Inspector Name �0: �-w T
Reviewer/Inspector Signature: �_ Date: _ � C { —R q
3/23/99

t
Fa ility Number-3 — Date of Inspection r
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below rXYes ❑ 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 �d No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 9No
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 D�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 b4No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes KNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Oyes ❑ No
Additional Comments an or._ rawin
&4�sl
��
c; .
3/23199

�aJ;g �� � 0 Division of Soil and Water Conservation ❑ Other Agency
s v
0
4 Division of Water Quality
M�s #'., Y
Routine O Cony laint O Follow-u of DWQ inspection O Follow-up of DSWC review O Other
Date of lnspection Z 4
Facility Number
Time of Inspection : u 24 hr. (hh:mm)
Registered t9 Certified [3 Applied for Permit' [3 Permitted 0 Not Opera Date Last Operated:
FarmName: .......... 1elrL.....aaaS w....-. r* ........................................................ Count_v:.....w�it-........ -............................... .......................
OwnerName: ........... �,U.4.�� q,.......................... ful . .............................................. Phone No: .dP). z-u'Li:rf.......-......................................
Facility Contact: .....-..- 7�1 f �L ....................... Title:......V..!f4hLt er................................. Phone No: .......................
MailingAddress:......1� .3.L....CJS 4...&y. KA....... :................... .... ........... ....... ........................................ .Z.851K...----
Onsite Representative :.......... si ix,.........yuA4........ .... Integrator:.-....... IN. �"�
Certified Operator; ............:.....................................
Location of Farm:
...... Operator Certification Number, .........................................
f1�...LS ..{yh ...utm...:. i.¢....R....... 1ibti..-......t..... Lmi...... ?+sst...7...... 1.11.......................................................•-------.............-..........................I...
..................................................................... ...-..................... .. .. ................... ......
Latitude Longitude
Swine~
Current Design :Current
y Population: Poultry Capacity •`Population :Cattle
❑ Wean to Feeder
Feeder to Finish
36z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
ter.... .
Nermher of Lagoons / Holding ,Ponds ❑ Subsurface Drains Present ❑Lagoon Area I[] Spray Field Area
• F ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon' ❑ Spray Field ❑ Other
a- if discharge is observed, was the conveyance man-made? ❑ Yes IP No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes IN No
c. If discharge is observed, what'is the estimated flow in ,aVmin?
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
V1 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
M No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[N No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes]
No
7/25/97
Continued on hack

Facility Number: 34 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeoorts Holding Ponds, Flush Pits. etc.
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft): ............),;,
10. Is seepage observed from any of the structures?
11. Is erosion, or any other- threats to the integrity of any of the structures observed?
12.. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ) '
r
i
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 Cro rye lrFL- IAL )Jl ?ne-t.
❑ Yes $1 No
i& Yes ❑ No
Stru:cure 5 Structure 0
❑ Yes 0 No
❑ Yes No
�] Yes ❑ No
❑ Yes EX-No
Yes No
Q
pp .............. . .... .........................--...............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AW;IMP)'? Yes ❑ No
17. Does the facility have a lack of adequate acrearre for land application? ❑ Yes D9 No
18. Does the receiving crop need improvement?
19. Is there a tack of available waste application equipment?
o
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 Permiite.d Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AW,MP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
0 No -violations or deficiencies wereenote'd during this. visit. - You.wili receive no further
correspondence a4obt this.visit:.: '
[Yes ❑ No
❑ Yes M No
Yes ❑ No
❑ Yes (h, No
N Yes ❑ No
❑ Yes W No
(I Yes No
❑ Yes No
Comments'(refer to question°°#): •Explain any YES answers and/or a6y recomrt 'r dations or any other'comments
p --5 - -- U f
Use drawings of facility to better explain situations.,(use additional pages as necessary): P
17— &restor. oam-% On ,KKJ-r AiU.rae.�� p� (cejQan S�,pU}(} ioe to-� rtsee�d�• $Gre UttQT S�vatl� )ate: rise
1AVO.,r a,Vt &J'Al -,61A6 be tre4wa)COft�- �t GYa S ,lt&4 S�U`� %� in i�S�c �OVV. T
K . �,e,rrrwjo_ •vim: 6{ � P
16W
tv. Sma�� h s�,vlt),e� �hv SW' o�
ll
PPSrJ is 1 5,jvt � us cc c���� Wyk 6ria*' g
t
22 . Ti- CGt�,�r P 1n�r use �4,u
�WW 1p Gao1Q 1 lc�. 5� � a s m+r'ib Vie-
c.��"mmef W 11, seta � tF�R-Z Far s4wat� bv_ r :f or trtl� ire
con- �r_��ej
sue« VNIN O ,,. atwr. +—ram- be } . � � � r:�. .. 64U, P 1--:61LA
1-
"A '%� e ��^lhvlfJ ►�- �p,r„ CDt-tfw �1f�cT 56i t lzt`✓ r dSSr� `t'�' 7125/97
Reviewer/Inspector Name; X
Reviewer/Inspector Signature: Date:

t
W.
` ❑ DSWC Animal Feedlot Operation Review {
UI DWQ Animal Feedlot Operation Site Inspection i_
•:`vim,_ 5�` " .> '�- "' .:. , : x.--.... „ ,:.,.v";� . y ..-`
Jai Routine 0 Complaint O Follow-up of DWQ inspection 0 Follo►v-up of DS«'C review O Other
Date of Inspection $'
Facility Number 3
Time of Inspection Z 04 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: [] Registered ❑ Applied for Permit lex:i.25 for `1 hr I min)) Spent on Review
IM Certified ❑ Permitted or Inspection (includes travel and processing)
10 Not O erational Date Last Operated: ............................. ........................................... ...................
Farm Name: ' r. Y ... C[autrt`:.......
b11�,1 n...........................................................
.......11i3O,t.ftcr.......L?rASAd.................. _............................
Owner Nance:.........►J.i' nef............17�SLIN.................................................................... Phone No:... ...... ............................
Facility Contact: ...... AlY...........pcxAVIC! ...... Title:. ..OWk►,t r....... Phone No:.
flailing :address:..Ld ..
5 ........�..(::....17fwy.,.;-4...................................pe. M 1. )....0...-... zOa..T..
Onsite Representative: ,..•..i ICU,1 ���. �.................I...............
.i ........... ............................................................. Integrator:.....,......
Certified Operator:...Y..i,(t,k1...... L.....................1(. W.C(Lk ...................................... Operator Certification Number%, .... il.16 .
Location of Farm:
.... TI&VTC.... kf......,�aS ...... os�.,....Qs.....&U 0. ... ..al.m.... +.s......... .L .. it.5.......om....�.......5\..1;�.... ..........................
1�....
............................T .. ............... .. ........... .............................. ... ......T
Latitude. • L - Longitude Q• C C4
Type n Design Current Design"',' Curren
of Operatiot Uestgn Curcenf
Swine Capacity; Population Poultry Capacity Population Cattle Capacity Population ,-..,
❑Wean to Feeder
14 Feeder to Finish
3k
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
�W_
Number of Lagoohs / Holdmg;Fonds •y� , ❑ Subsurface llrains Present ❑ l agoan Area ❑ Spray Field area
General
1. Are there any buffers that need maintenance/improvement'?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, w:ws 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)
1 Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30l97 maintenance/improvement?
❑ Yes 1PNo
❑ Yes IA No
❑ Yes ® No
❑ Yes U] No
❑ Yes 19 No
❑ Yes �Q No
❑ Yes E<No
❑ Yes 14 No
Continued on back

Facility Number.31 —3(`
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holdin Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4
.......... Z 2�.(t....................................................................................................................................
❑ Yes 14 No
❑ Yes [XNo
❑ Yes E�No
[--]Yes 19 No
Structure 5 . Structure 6
10. Is seepage observed from any of the structures? ❑ Yes [M 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? EK 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 bitNo
Waste Application
14. Is there physical evidence of over application? ❑ Yes R No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ..............ov:qr,t..........'tl1do...................................................................caYn............................. ...........................................................
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 JR No
18.
Does the receiving crop need improvement?
Yes
[INo
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
XYes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[RNo
For Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
K No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ERNo
24.
Does record keeping need improvement?
5 Yes
❑ No
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rrseeded. dare._ at a s s�l�t fie- "da). evb!! �n in s4oaK w. ,dr ivtrs�* S
6p pe rd
I� . Gay.s, t �t.Ylz aoa wkk-" conk 4w&lld hV
l�. CO&4A C.m s�tou�� veJ.
��l)w+d w� s �a t' . ��� IAA 1�1 e. -� t x.4,c-
S � �
r�s�o�lr�
Reviewer/Inspector Name h w � ;
os
Reviewer/Inspector Signature: �. Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention: N�
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: - Z� , 1995
Time: H3 0
Farm Name/Owner: F1 N5 (f v
-Mailing Address: 32 1 IF H r �L t1 t L J N C Z 1
County: v FL, (fj
Integrator: my (Z (7 a Phone: 90 29
On Site Representative: e U &-C�-S c P A Phone:
Physical Address/Location: _H W'i ) f 3 - a r5ey to v ( f e
Type of Operation: Swine — Poultry Cattle
Design Capacity: 2 T4:2 Number of Animals on Site: 2-4.4- 0
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3° S Longitude: 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) nee or No Actual Freeboard: _�Ft. ches
Was any seepage observed from the agoon(s)? Yes or@ Was any erosion observed? r No
• Is land available for spray adequate s Ye r No Is the cover cropadequate? r No
q Y� q e
Crop(s) being utilized: 5 �'
Does the facility meet SCS minimum setback criteria? 200 Feet from Dweilinas<YE:pr No .
100 Feet from Wells?4D>r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes i o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of4e state by man-made ditch, flushing system, or other
similar man-made devices? Yes or o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes ozLo
Additional Continents: O S *IF ►Z 01 5 P _T 1+ / ri 41._1_
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
Facility -
DIVISION OF ENVIRONMENTAL MANAGEMENT,
ANINVIAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: D ~� , 1995
Time:. —= l 1
Farm Name/Owner:_ _ 1_ �z l �(y !. iJ Cj� �F �'C / i ns tS 1 ! r�.✓
Mailing Address: 4431 iZ+ 0 �-o4 14 G E0LA V LL_C , Gt (
County:—0)1�1+�-----
Integrator. r�AAJ `� Phone: (C(10�T q
On Site Representative: iP-R V f-tZ Phone:
Physical Address/Location: i j W a , 2 evx% Q, 6 v- i - A +- ; 14 e
Type of Operation: Swiney Poultry • Cattle
Design Capacity: io`-1 �- Number of Animals on Site: 3
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:, M' Longitude: �7 ' �" 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) kesNo Actual Freeboard: 3 Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes 6DIs the cover crop adequate . Yes r No
Crop(s) being utilized: " , V_ A is c It. myD A
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es r No
100 Feet from Wells? e r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or Qo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or Wjo If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acre ge with cover crop)? Yes o No
Additional Comments:'
\'AS l
Inspector Name.
lug t p� rJ n C S)
�C
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.