310386_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

f
• I)ivisiort of Water Resources
Macinumber 3 M - ® Division of Soil and Water Conservation
O. Other Agenr
Type of Visit: O Compliance Inspection Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: `�' Arrival Time: Departure Time: County: Region: Wf�V
Farm Name: i; POwner Email:
Owner Name: i �It9rOc I\ _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design
Wet Poultry Capacity a aci
La er Dairy Cow
Current
ROD.
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current Dry Cow
D . I;oult . Ca aci P,o , Non -Dairy
Layers Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
I
Turke s
Turkey Poults
10ther
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 U4-o ❑ NA ❑ NE
❑ Yes
©RIO
❑ NA
❑ NE
[—]Yes
No
❑ NA
❑ NE
[—]Yes
Moo
❑ NA
❑ NE
❑ Yes
s[� No
❑ NA
❑ NE
❑ Yes
1 IVo
❑ NA
❑ NE
Page I of 3 21412015 Continued

Faciti Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes io ❑ 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: 1 1-1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q-Nv ❑ 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 Q.NK ❑ 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
�
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:)Yes
[U,Io
❑ 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
[J.No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
to
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
E] +W
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R:g-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�10
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:)Yes
o
❑ NA
❑ NE
18. Is there a lack ofproperly operating waste application equipment?
❑ Yes
❑'Flo
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑.Xo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
QAo
❑ 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
[9 o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑'CIO
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Yj'_'No
❑ NA
[} NE
Page 2 of 3 2/4a015 Continued
71

Facaity Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes ED NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [g-t o u 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 [].dtf ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ��A ❑ 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?
)&_ ic Jko
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes pie ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes UIMP ❑ NA ❑ NE
❑ Yes 53>cr ❑ NA ❑ NE
❑ Yes [Lj>o ❑ NA ❑ NE
[—]Yes U>oo ❑ NA ❑ NE
❑ Yes &KOI ❑ NA ❑ NE
al;pagessas *c/IessarY ' I a
T ,NS1
v�"/17
Phone: Tlp Z f 6 73 7 y
Date: %02
21412015

(Type of Visit: OrCompliance Inspection Q Oper 'on Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: l D County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Swine Capacity Pop.
Wean to Finish
I
I
Design Current
Wet Paultey Capacity Pop. Cattle
I Layer I Dairy Cow
Design Current
Capacity Pop.
Wprrto Feeder
INon-!�ayer
I
Dairy Calf
feeder to Finish Q
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
Design Current Dry Cow
Dry P,ouIt , C*_a PAC AN Pao , Non -Dairy
I Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
er
Other
HTthe—urkey
urke s
Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Z rNo❑
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
❑ N
0 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
0 Yes
VN
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: IDate 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 Structure Z, -) Structure 3 Structure 4 Structure 5 Structure 6
it/
S t4(L^ Nar t.,'V44
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Zn
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 ff/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
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 fNE
(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 Z/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 dNE
❑ 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
[34�E
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
dE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NANE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
Ej NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
eNE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
25NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA
Page 2 of 3 21412015 Continued

lFacility NLmber: JDate of Inspection:
24. Did 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 0 No
the appropriate box(es) below.
❑ NA I/J 5E
❑ NA f�V
❑ 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 ]V
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No �lA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA JZ<E
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 VfNo ❑ 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 L _'NE
permit? (i.e., discharge, freeboard problems, over -application) jam"
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA O TE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? *es eFNo
NA [] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes NA ❑ NE
Comments (refer_: to question;#):- Explains any YES -answers' and/or"an ' additional reco nmendataonsor any,oth'er-cdmments -"
Use drawings of facility:to better..explain situations -(use additional pages as necessary,).,,
G C. (it VI P7 ('� �, r Gam • O/l A Ir �rJ
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: T 177% MY
Date:
21412015

Type of Visit: om iance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 011outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 2 y Arrival Time:Li Departure Time: County: U�
Farm Name: /c��v�1� �r� Owner Email: �-
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone:
Integrator: Aj,, /,#I�,
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Region <—%V'
Design Current
Swine Capacity Pop. Wet Poultry
Wean to Finish La er
Design Current
Gapaeity Pop.
Design Current
Cattle C**specify Pop.
Dairy Cow
Wean to Feeder Non -Layer
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder D , P.oul..
Farrow to Finish Layers
Design Current
Ca aci P,o
Dry Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other I
Turkeys
Turkey Poults
10ther
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)
❑ Yes [,—.PNo ❑ NA ❑ NE
❑ Yes
-En-No
❑ NA
❑ NE
❑ Yes
JD -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 Lallo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes allo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes To ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
21412015 Continued

Facility Number: - Date of Inspection:
-Z,
Waste Collection & Treatment
4. is storagerapacity (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 [ ' o
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: j 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):`
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ..2 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 rf No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes C2-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 0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [�j No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes allo
❑ 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 .0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2]'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ®' No ❑ NA ZNE
acres determination?
17, Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [MNo .❑ NA 2j NE
❑ Yes *No ❑ NA A� NE
❑ Yes *No
❑ Yes Wo
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o
❑ Waste Application ❑Weekly Freeboard El Waste Analysis ❑Soil Analysis ❑Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ,gig -No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes WKo
❑ NA NE
❑ NA &NE
❑ NA ONE
❑ Weather Code
❑ Sludge Survey
❑ NA eNE
❑ NA ❑'NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Wo ❑ NA �NE
25. Is the (facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes � ❑ NA ONE
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 ZNE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes WNo ❑ NA ZNE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ED14o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes .12'No ❑ NA ❑ NE
❑ Yes `�No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [Q-No
❑ 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 �0 0 NA ❑ NE
Comments (refer to question #): Explain.any YES answers and/or any additional recommendations or any other comments..
Use drawings offacilityao betterexplain situations (use additional pages,as necessary). v
SI C Ucz1tiG ,//YIC [on 5 I nos
0 0 `r
Reviewer/Inspector Name:/(�V t ,1 Phone:
Reviewer/Inspector Signature: Date: Z— ZZ �6
Page 3 of 3 2/4/201S

Type of Visit: —0 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up 0 Referral Q Emergency O Other O Denied Access
Date of Visit: 7 Arrival Time: ' O eparture Time: Countyo
Farm Name: (l��¢ �f/'i/'jYJ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: �1. ) C ay 8 C'o cL Integrator: yrt /.Z!!?
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Swine C*apacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
D P,ouitr,
ILayers
Design
Ca aei
Current
P,o ,
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkcy Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
J. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ,EfrNo ❑ NA ❑ NE
❑ Yes
Ej No
❑ NA
❑ NE
❑ Yes
�2'No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
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 �3 No ❑ NA ❑ NE
s� a. If yes, is waste level into the structural freeboard? ❑ Yes OfNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f 7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 242i
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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 Z No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes PNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:)Yes L2No
❑ 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 J] No
❑ NA
❑ NE,
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 53'*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 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EyNo ❑ NA 0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0No ❑ NA ❑ NE
acres determination?
l7. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
[,,,] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
W No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E2 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
E:],No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes JZ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ON
❑ NA ❑ NE
❑ Weather Code
El Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facifi Number: - S.Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes L'No ❑ NA ❑ NE
25. Islthe. &Airy out of compliance with permit conditions related to sludge? If yes, check ❑ Yes PNo ❑ 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
in No
❑ NA
❑ NE
❑ Yes
Vf No
❑ NA
❑ NE
❑ Yes 6 No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [ /�' No ❑ NA ❑ NE
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 [�f No ❑ NA ❑ NE
Comments (refer to question_ :,Explain,any.,YES answers and/orany, addrtibu41recdmmendations or anyvother comments
w
Use drawings of facility tabetter explain situations (u"se additiionalpages is'. necessary) � _
]het ,L7 t lja'l/
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:

da
Type of Visit: ompliance 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:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: d eparture Time: County: Region:
Facility Contact: Title:
Onsite Representative: _s��� ��ki
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 17319
Certification Number:
Latitude: Longitude:
1111�111D�16sig Current
Swine Capacity Pop.
Desigu Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Non -La er
Design Current
De. P,ouI Ca acity P,o P.
Layers
DairyCow
Wean to Feeder
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
Cow
Non-Da'ry
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -Layers
Boars
Pullets
Othe
Other
Turke s
urkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the,waters
of the State other than from a discharge?
Page 1 of 3 j
❑ Yes E?-No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ;21'No
[—]Yes ff No'
[:]Yes Plo
IN;
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued

Facility Number: -n Date of Inspection: t2zl 4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes WNo
❑ 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 No
❑ NA
0 NE
(i.e., large trees, severe erosion, seepage, etc.)
�0
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes �No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[] Yes j2No
❑ 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 C;j'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ff 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 Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes J"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes J2+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 PNo ❑ NA ❑ NE
❑ Yes [jf No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0No ❑ 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 L2No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [-]Yes eNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: Z f
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes PrNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Eno ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
;aNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�ZNo ❑ 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?
T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�, o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
TT
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
PrNo ❑ 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
�' o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZfNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E6 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
&No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
lrc- /Al &_ '' c� rlt - G��or�j
l/a6%�3 /, d,/ e ors erdd ade��
_ g
> >6
7�� 113 6 .17 3— Ql . .a rvl.c vic
- � r�t-ord 5 L
Reviewer/Inspector Name: Phone: 'l%""b 7Y3o�-
Reviewer/Inspector Signature: ; Date:
Page 3of3 2/4/2 Il

►r'
Type of Visit: U Compliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: f�Routine O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
V_% t . /4
Farm Name: I A! i I I l A 1V 1 M ra , K I' Is t 0'1 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: J� f j (`n �,� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Design Current
Cattle C►apacity Pop.
aig Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Il . P,oul Ca aci P,o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes VNo
❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

FaciliV Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? A�sE
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f V�
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
reat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZNo. . ❑ NA
❑ NE
maintenance or improvement?
/No
11. Is there evidence of incorrect land 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 Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
7 ❑ 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
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E)Mlo ❑ NA
❑ NE
Required Records &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No ❑ NA
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
2fNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey -
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No ❑ NA
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No ❑ NA
NE
Page 2 of 3
21412011 Continued

Facility_ Number: 't - Date of Inspection:
�— .. - �r----Y-
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ❑ No ❑ NA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA VNE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes N ❑ NA ONE
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 o ❑ 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 VN(o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Y VNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? Yes ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
5
- 06A Ind- FeaoijTPP)6- tee, 9-
k4 TO
tkvc
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
M
Phone: ! 0 —91 -
Date:
2/ 011

rr,
- - �vi'sion of -Water Quality
Facility Number 3 j - ,�j� Division of Soil and Water Conservation
O Other Age�y
Type of Visit: j0rCompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: 2 Arrival Time: Peparture Time: County: �(1�%��.� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: t_2ffAj2fd E f Oc e Integrator:
Certified Operator: Certification Number: 7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swlne Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish I
ILayer
I
Dairy Cow
Wean to Feeder
INan-La
erEA
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Desi
u en
Dry Cow
Farrow to Feeder
D , P,aui
Ca aci
P,o
-
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharges and Stream Imaacts
1. Is any discharge observed from any part of the operation?
❑ Yes E�rNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ErNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes Ef"No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes E5"No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

Facili Number: Date of Inspection: l! Z
L
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 -fTNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z ��
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes,,E�'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes---ffNo
❑ 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 � No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes -ETNo
❑ 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 �o
❑ NA
❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes,'o No ❑ NA ❑ NE- -
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes XI 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 jEro ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EfrNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes _'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes -allo ❑ NA ❑ NE
❑ Yes ,,2'No ❑ NA ❑ NE
ReQuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yesf~No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ED 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-'EE' Vo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facifl Number: 3 1- - Date of inspection: `j -
24. Did the facility fail to calibrate waste application equipment as required by the perm? ❑ Yes ZNo
r'•
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:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes EErNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 3-No
Other Issues
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes',[allo ❑ 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 F-,Mo ❑ 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 JD14o [] NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ YesTo ❑ 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 �. o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. ,
Use drawings of facility to better explain situations (use additional pages as necessary). - ..
• u. f� ,c 11 �� ` ,
1//biz
ReviewerAnspector Name:
c>. 7 C/
0• co
Reviewer/Inspector Signature:
Page 3 of 3
`t
Phone:
Date: !l Z
4/20 1

'Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (j"outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / L Arrival Time: L1_C Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Q
Certified Operator:
Owner Email:
Phone:
Phone No:
Integrator• _j* Z&
Operator Cer fication Number: 1.4 3
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: 0 c ❑ t Longitude: = ° = I =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ T ❑ La er
❑ Non -La er
Dry Poultry
Non-L
Pullets
IL-1 Turkev Poults I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: =1
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes J'No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
[]NA
❑ NE
❑ NA
❑ NE
❑ Yes ,0 No
❑ Yes E No
❑ NA
❑ NE
❑ Yes [ 'No ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑%To
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
ZNo
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: / Z.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Z —2o
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
fffNo
❑ 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
E2-No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
JZ'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
�?&o
❑ 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
RTio
❑ 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
VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E'J No
❑ NA
❑ NE__
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
<o
❑ NA
❑ NE
Comments (_refer to question"#) Explain -any YES answers�and/or an y;recommendatio_ns oriany other�co ents
Use drawin s of facili to. better egplain.situations. (use addition
r g ty al pages as necessary)•
AL
Reviewer/Inspector Name
.... Phone: % Ae
Reviewer/Inspector Signature:
Date: �t L
Page 2 of 3 12/Z8/04' Continued

Facility Number: — Date of Inspection
Required Records & Documents
19!• Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �3<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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
J�2 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZNo
❑ 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
O'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E�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
0 Yes
PTNo
❑ 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
ZNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes
�f No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
IQ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
l.• O r
U, ?%
3 S1U �� Z
71;lla
Page 3 of 3 12128104

Type of Visit Cyd-ompliance Inspection O Operation Review Q Structure Evaluation . Q Technical Assistance
Reason for Visit�Routine O Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
51
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Time: L.G_r {�I Departure Time: County: K-4'L�1`�- Region:
Facility Contact: Title:
Onsite Representative:.��a f�
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certi /leati'on Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = ' = Longitude: = o = 1 =
AZ
Design Current
Design Current
Current
Rft,
P645pa.
Swine Capacity Population
Wet Poultry Capacity Population
Cattle opulation
❑ an to Finish
❑ La er
❑ Dairy Cow
❑ an to Feeder
Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry poulte�°
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
El Non-Laylletsers
El Beef Stocker
❑ Beef Feeder
❑ Gilts
❑ Boars
El Pullets
❑ Turkeys
❑Beef $rood Co
Other
❑ Turkey Puults
❑ Other
Number of Structures:
❑ Other
Discharees & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
VNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
El No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Ef No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12178104
Continued

i
r
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
Scture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -2—
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 [I 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 0 o El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [I Yes <<� No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LQ No ❑ NA ❑ NE
maintenance/improvement? 6
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo
❑ 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 Drill ❑ 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
9rNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
[INE
18. is there a Iack of properly operating waste application equipment?
ElYes
7No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
iUse drawings of facility to better explain situations. (use additional pages as necessary):
ReviewerlInspector Name Phone: /
Reviewer/Inspector Signature: 11"Date: ze Q-
12/2.4/ Q C'nnlinuad

Facility Number: , ' Date of Inspection G
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 41 o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ANo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[]Yes
6No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
ElNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
No
❑ NA
El 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
A 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
o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ 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
ElNA
ElNE
If yes, contact a regional Air Quality representative immediately
fff
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 reviewlinspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[)No
❑ NA
❑ NE
ZI
r
SY
IMI-6 I 1z
'V 41
�A 7"l f/s /1-4,
e r/-rrtf
Page 3 of 3 12128104

«0 Division of Water Quality
FacZuty Number J 0 Division of Soil and Water Conservation
_
0 Other Agency
IType of Visit @tompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit w1koutine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: -3 /(/E;{ Arrival Time: Departure Time: County: Z4 Region:
Farm Name: ��noY'� 7� f 0CIL G,f-Aik' Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: �� Title: Phone No:
Onsite Representative: W � � 11(X 1/n �lr S CaG)r , integrator:
Certified Operator: Operator Certification umber:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =e 0' Longitude: =o 0, = "
Swine Capacity. Population n Current Design Current Design Carrent
r"3 Wet Poultry Capacity Population Cattle Capacity Populatiou .
❑ Wean to Finish T ❑ Layer
❑ Wean to Feeder ❑ Non -Layer
Feeder to Finish ,
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
ElTurkey Poults
❑ Other
❑ Dairy -Cow
EjDairy Calf
❑ Dairy Heifer
❑ Dot Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ,ETNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
VfNo
❑ NA
❑ NE
❑ Yes
[Mo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection L
W+3ste'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: aC
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c! _�3: C.3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes '[JNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ff No ❑ NA ❑ NE
❑ Yes [2'No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes /ffNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [I Yes ONo ❑ 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 E] Yes PNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E] No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ 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
(a 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
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
I] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V3 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 K Phone:
Reviewer/Inspector Signature: Date:
Page 2 of IM28104 Continued

Facft Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ W`Up ❑ Checklists ❑ Desig
n El Maps El Other
❑ Yes ❑-Ko' ❑ NA ❑ NE
❑ Yes _E]-No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
L&
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EfNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
J6 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
21 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 4 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:
Ze�r
5 sly o� f.5e /moo
P
Page 3 of 3 12128104

IType of Visit jgCompliance Inspection O Operation Review Q Lagoon Evaluation �
Reason for Visit /Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 7 4 Tune:
Not erational 0 Below Threshold
iff Permitted PrCertified 0 Conditionally CerMM © Registered Date' Last Operated or Above Threshold:
Farm Name: . X,a?2 �� l"�c- County: 4 ».
Owner Name:
Mailing Address:
Facility Contact: _ _/ Title:
Onsite Representative -
Certified Operator:T
Location of Farm:
Phone No:
Phone No:
Integrator.
Operator Certification Num r:
_ I -W
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude "
Diselmmes & Stream Imp acts /
1. Is any discharge observed from any part of the operation? ❑ Yes INTO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (incites):
l2/l2/03
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 21'§o
❑ Yes Zo
❑ Yes Je°
Structure G
Continued

Facility Number: Date of Inspection 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes ;!No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancefimprovement?
❑ Yes )&o
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes ;Z<o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes )a�<o
elevation markings?
Waste Application
10. Are there any buffers that need maintenanoeltmprovement?
❑ Yes 00
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes ] No
"
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Cop/per and/or Zinc
/'
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes No
14_ a) Does the facility lack adequate acreage for land application?
❑ Yes �No
b) Does the facility need a wettable acre determination?
❑ Yes jK No
c) This facility is pended for a wettable acre determination?
❑ Yes ��Z`No
15. Does the receiving crop need improvement?
❑ Yes PNo
16. Is there a lack of adequate waste application equipment?
❑ Yes ZNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes CWo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes U?rNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNa
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 ZNo
Air Quality representative immediately.
a
/jai 6y
ReviewerAnspector Name
l�.s%
Feld Cove ❑ Final Notes
%&2 �/& // VI Gah 71/
G 1%�
e5--"W�J_ 17 47'
Reviewer/Inspector Signature:
Date:
lb/LL/VJ W1JAIilLCa

Facility Number: Date of Inspection v
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes �No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes AO
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes
❑ 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 X No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes XNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes )2�No
27. Did Reviewer/Inspector fail to discuss reviewfmspection with on -site representative?
❑ Yes RfNo
28. Does facility require a follow-up visit by same agency?
❑ Yes �No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes �No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
)dYes ❑ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 100
32. Did the facility fail to install and maintain a rain gauge?
[:]Yes ZNo
33. Did the facility fail to conduct an annual sludge survey?
[:]Yes Ja'No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes P,%
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes )YNo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ No violations or deficiencies were noted dnriing this visit. You wUl receive no further correspondence about this visit.
.3- .2 / Tieo
14-el,
1;07
/?560-07
l/<c' camas a rZ e-
12112103

r 7
Type of Visit 0-compfiance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit 6 Routine O Complaint O Follow up Q Emergency Nofification O Other ❑ Denied Access
Facility Number
[late of visit: / d Z Time:10 y 3Q
3 3
Not Operational 0 Below Threshold
O Permitted [3 Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name �) �Ilrn^� �a(1.,�4rd �r�G� ✓'"� County:
Owner Name: i e- C f t Phone No:
Mailing Address:
Facility Contact: p Title: Phone No:
Onsite Representative: t-j j j ey-D `�'G�� f 6e�� � �� ��� Integrator: EroW n2 0 (' eA-0 La ;
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0 L� " Longitude 0 0•
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste 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: 2 ® J,
Freeboard (inches): 3 9 28
❑ Yes ''No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes -Q-No
❑ Yes ❑ No
❑ Yes O'No
Structure 6
05103101 Continued

-I Facility Number: :7 ] —
Date of inspection IN147OZ4
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type 13err -d el Co►-+4 rol cr'd.z e , sv%'Ne )
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?
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other 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?
❑ Yes ,ET -No
El ❑ Yes O'No
❑ Yes'ONO
❑ Yes ONO
❑ Yes ❑ No
❑ Yes 12'No
❑ Yes ❑ No
❑ Yes 0'No
❑ Yes 'ONo
❑ Yes �No
❑ Yes Z`No
❑ Yes RrNo
❑ Yes iEj`NO
❑ Yes ;'&0
❑ Yes O-No
❑ Yes �`No
El Yes XNo
❑ Yes j2'No
Yes ❑ No
❑ Yes �No
❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
❑ Field Copy ❑ Final Notes
22 . `T6.e e6oard ✓ec.11ydc.� qJ 1. � �f I!1�, Z s�
-fee/ C/ 6, ,'y.Ckc��
,r,,P -Freeboard 1'-i PotrGL, 2-0021-. --rf ; x 44ei1\- ate,
proV,d'Zd -�a �� e Rea;pact 1 J6`/r ce aF �GreS
nan eo mp IeVl5 _T w;ll ClIeC k fl4e 0l41 c, 66,5C . 1.4 yoott
iS K-ce,u,'-epf �o l,zve Z0,z ,M61e5 n-vt lo5oo-, 2-4e Lt..ave 30s��, �
ReviewerAnspector Name I J .Q
Reviewer/Inspector Signature:
Date %' 1 }I .O Z
05103101 Continued

Facility lumber: 1 -3 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation? V
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (Le. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
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.)
31. Do the animals feed storage bins fail to have appropriate cover?
32_ Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes 'ONo
❑ Yes J2'�lo
❑ Yes Pvo
❑ Yes ZNo
❑ Yes ❑ No
❑ Yes ❑ No
Additional : Comments ,2nd/or.Drawings:
�esr�h ih Fa�r��-f ioYt . A r1o�%cP and e�Fo ✓GP.►-��n.-1" Ac-�"G^
be -44 e n6pi-cet"l,'aw� � 1a�dan j�vels
-
q. }Pjease ensure qka� flee 12ilooh rJ-gvger YlieL,� +fie
�^a�o p n-t �t�C ;.,^� r G� ; �► i +r+a v �+-� I ► f u f 'd ] e vC I s G1 e e-, !
Y"A r k"'1 n kl 5 at V9 e,0 -
4o be ek Sv"e dI Aw\o +� P4 op w,,1 -Fe ; n �1 e
�a i�e Gq -e�� 1 tJ h Py s�v �a 7 ► y 4 M on ;4,o t4
G(10S-el cnpf nV0'W Yoe and ✓'uno��-
!�. P%eO15P keep heeds ccrnPelled I" Sa►lle A etas Ac�ass 41le
raad ,L4 "s- vim 1a6 b a c( le f 6 u' l de, 110;4 1W Ac,-.
c v'- -�c �e 41e -r6 ld .
641e r 44e h �Ar<e- i4 e m r n e 4 ed a bo ve-1 4Ae- '-P cord s4� --e
rr1�a-� �� �e�� grld �l,er� is Ac? e�ICce�Je�� 6er�lyd� c+''o� a•�
411 OP 44" a pp j nl l ot'l Oel e ld s . P) ea bc .rv"-e 4a
rvtQ naGte la5�ovr 1 evE�s 6e.�e„ i h �l�e �'��`�'U�e ►� c Ci{f�i� �C.'�
14.
05103101

Type of Visit , ' ompliance Inspection O Operation Review O Lagoon Evaluation j
for Visit ,O'poutine O Complaint O Follow up O Emergency Notification O Other I ❑ Denied Access
Facility Number 31 ;y Date of Visit:
13 Permitted 13 Certified 13 Conditionally Certified Or Registered
Farm Name: �.. �.:..I. I a'', C t1 W a rd 13 ro C, K '0. r v'1
........... ...................... .....
Owner Name: LJ' 11; Q �t Cot ,&, 4 � �o G I C
...........................................................................................................................
01 Tune: E
Not Operational O Below Threshold
Date Last Operated or Above Threshold: .........................
County:..... 2 yr ! "'t
Phone No: _ .......................................
FacilityContact: ............................................................................... Title:................................................................ Phone No:
MailingAddress : ........... ..... ...... ..............................................................................................
Onsite Representative:. ., IU.....r-, W af.�^D� 13.•o Gtt, Integrator. n S ._.._.... vo�i
Certified Operator: ................................................... ............................................................. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �` 14 Longitude • A 16
Des�gis Current
Twine -Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
❑ Boars
Nunibei'o[ Lagoons
- :.Holding Pc►nds /solid -Traps_
gist. ` .Current Design Ctari'eat
Poultry. —Capainty Po ulation ._ Cattle Ca cr ' _ Po elation:;
❑ Layer [IDairy
❑ Non -Layer ❑Non -Dairy
❑ Other -
Total Design Capacity
`Total SAM
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System =
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes RrNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ,,O No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 13'No
c. If discharge is observed, what is the estimated flow in gal/min? )i lQ
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ONo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 7No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PrNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes J'No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................ ................................................................................................................................. .................... C........................... et^�
Freeboard (inches): 33 33
'''z 5100 Continued on back

I
Facility Number: 3 —3 Date of Inspection E
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
closure plan? ❑ Yes ANo
(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 j2'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONO
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes .ETNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes eNo
12. Crop type r3e v rn t,,d t Co^4 TI (, rgze
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes EfNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ZNo
b) Does the facility need a wettable acre determination? ❑ Yes ONO
c) This facility is pended for a wettable acre determination? ❑ Yes )2rNo
15. Does the receiving crop need improvement? ❑ Yes ,,,dNo
16. Is there a lack of adequate waste application equipment? ❑ Yes 0$10
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
.Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
Z�No
(ie! WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
1VrYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
.0 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
EfNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
O No
(ie/ discharge, freeboard problems, over application)
❑
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
J�No
24. Does facility require a follow-up visit by same agency? ❑ Yes ONO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? P Yes ❑ No
•yi0Jaii#ijs.or dgficienctes ware pote# . (tring this;visit; • Yoh wiii tebgi*e 1io fur t� .
correspondence about this visit. - • - • . . ... ...... .
U ngs drawiof farhty to better explain sitnahonc: `(ase additional
f 7, 7 Li, It Ser4 1 l-.. 13.--ock 41w . newc4 Ce*"c0f CouC- 'q:'id
;r «f- •1
i -Flj e +'r eebo,., r-d jQ ve! /_co r-oj k or 01 read y 'o - NOle- ►ryn be r 1 I
zoo) -ro - l a�joas. oCG JrreJL . Idesd -{a
k -I rteGur e' eecor4s y
25 . T i em if All 01/`ect tw4, L-44 4�e erect o� Pulls I 1 47 l 2 Acd Jib v to 44
4i,—efn-d ► ,-. Sror,l` iitd"CodeA he Sko-- -ens 4e pu#S 4v AVA-4 4kc
ReviewerAns for Name 4—
Reviewer/Inspector Signature: l Date: 8 B t 5/00

Facility Nnmber: j -- 3B0 Date of inspection 1 1 D
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below �( Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �No
28. Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes JZNo
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 2-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 JO No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 9 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
AAditional.Comments an or rawtttgs:
a_ .. ...--.; ..
=r
w
Z.S. we4 q✓"eix1 eylr. ne--ds 4o
erA.
wtAke 4t& 0l OL o1est'*C15e
:-F. t`-f 1 s +oo Wef
4tiek o4txer'
FJ115 S�oLtiJdi e Used AKA
j l i2 Sl<,QLt[
e VSeLi
W��t^ �r y �noiu�k - o �+�► 4
�vtl��5
LtT
rapm, j he cl&f3 aye
oa"oLA, VXof 4tAC
}h 9ao� Gprtdy�ic✓t
G1''�Gt! �,��
ke f

Type of Visit O Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number 31 386 Date of Visit: 11-8-2001 Time: 11:40
NNot Operational Q Below Threshold
® Permitted ® Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: - ._ __ -. -_
County: I?gG!111x......--............................
Farm Name: )?['il,U, aEdw.8rd.Rrork.>farm................................................WIRO ......
Owner Name: lY iW4M_._ - --------._ Jlri►sJc------------------ --------- Phone No: 4�.4�?fi J.QSZ---------------- --- ---------
Mailing Address:.J'asturtK.Jira��J►.RA�sI ............................. ftwariJl�...lY....................................................... MW ..............
Facility Contact: ........................................................... Title Phone No
Onsite Representative: 'illi�m_l�d arsl�CQsJc--------------------.------- Integrator:0xow&!s-vf Car_4WtasJ[---------------•
Certified Operator:! clissa.$ ............................ ......................................... Operator Certification Number: 1.7.319.............................
Location of Farm:
Vorthwest of Chinquapin. On west side of SR 1953,1 mile south of SR 1961.
® Swine ❑ Poultry' ❑ Cattle ❑ Horse Latitude 34 S2 ' 41 fG Longitude 77 52 1 33 u
Design Current
Swine Ca©acity Population
❑ Wean to Feeder
® Feeder to Finish
4560
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Soars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 4,560
Total SSLW 615,600
Number of Lagoons -2 ® Subsurface Drains Present ©Lagoon Area IN Spray Field Area
Holding Ponds 1 Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes N 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 gaVmin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes N No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes N No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes N No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes N No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier- ........... ..........•-----•--•--•------------------------------------•---------------------------------- -------•--------•----------
Freeboard (inches): 33 33

VJ/VJ/V�
Facility Number: 31-386
Date of Inspection 11-8-2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenanceArnprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Bermuda Control Graze
uuntsnuea
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes M No
❑ Yes M No
❑ Yes M No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes N No
b) Does the facility need a wettable acre determination? ❑ Yes M No
c) This facility is pended for a wettable acre determination? ❑ Yes N No
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 or other 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 N No
❑ Yes M No
N Yes ❑ No
❑ Yes M No
N Yes ❑ No
❑ Yes N No
❑ Yes M No
❑ Yes M No
❑ Yes N No
❑ Yes Co No
® Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer;to.question #): Ezpiain any YES answers andlor any_ recommendations or:anyother coinments
Use drawings of facility to better explain situations (use additional Dages as necessary) ❑Field Copy ❑ Final Notes
17.1 will send Mr. Brock the newest Certificate of Coverage and General Permit if U have available in my files.
19, The freeboard level record has already been made for November 11, 2001 for lagoon 2; this date has not yet occurred. Need to keep
ccurate records.
5. There is an area at the end of pulls 11 and 12 that stays wet at times and Mr. Brock indicated he shortens the pulls to avoid the wet
area. Mr. Brock needs to make the entire pull as designed. If it is too wet, then other pulls should be used and these pulls 11 and 12
should be used when dry enough to make the entire pull.
Note: Mr. Brock has a neatly kept farm. The crops are in good condition and the area arould the houses and lagoon is wel kept.
ReviewerlInspector Name Stonewall Mathis entered by Bette Rose
Reviewer/Inspector Signature: Date:

0r/03/01 Continued
Facility Number: 31--386 Date of Inspection 1 11-8-2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below N 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 N No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes N 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 N 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 N No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes N No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No

Davnsion of Witer Quality -
_ r_ - r =
-Q Dwision of Soii and Water_Conserat�on N
M Q OtherAgency,
(Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number 31 386 Date of Visit: t1-8-2401 Time: 11:40
O Not Operational O Below Threshold
® Permitted ® Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name:
........... County:litl,Flia..........-•--.-••--•--•--•-
S'.4'i11]4�11U.E(IW.*xsi.l3rQi�k.k'ar.Pp................................................ -•--•--. WIR0 --•--•
Owner Name: 1'E'�m----------------- irk---- ------------------------ Phone No: ---------------------
Mailing Address: 'kQ. hS1Ul ;. x4�t�1]L1iA s1............................................................ ftwayi11p..N.C.............................. ....... 2185.1.---..........
......... ..................
Facility Contact: ........................................................... Title: Phone No:
Onsite Representative: �yiUi�m�>'d ardl���sJc---------------------------- integrator:Hxowu:s_af
Certified Operator: KrIiIS a.B. ............................ S'';tll1��............................................ Operator Certification Number: 1.7.319..... ........................
Location of Farm:
northwest of Chinquapin. On west side of SR 1953,1 mile south of SR 1961.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 • 52 ° 41 u Longitude 77 • 52 f 33 f°
Design Current
Swine Canacitv Ponulation
❑ Wean to Feeder
® Feeder to Finish
4560
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 4,560
Total SSLW 615,600
Number of Lagoons 2 ® Subsurface Drains Present ❑ Lagoon Area 10 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 originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is obsen�ed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ----------- ald........... .......... -.......... ---------__-__.-------
Freeboard (inches): 33 33

vaiu31ul
wrsiu:ueu
Facility Number: 31-396 Date of Inspection 11-5-2001
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
N 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
N No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
N No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
N No
12. Crop type Bermuda Control Graze
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
N No
b) Does the facility need a wettable acre determination?
❑ Yes
N No
c) This facility is pended for a wettable acre determination?
❑ Yes
N No
15. Does the receiving crop need improvement?
❑ Yes
N No
16. Is there a lack of adequate waste application equipment?
❑ Yes
N No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
N Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
N No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
N Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
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?
N Yes
❑ No
E3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments .(refer toquesticin #). ,Explain -any YES answers and/or any recommendations of any -_other comments
Use drawings of facility to better explain-sttuatinns (use additional pages as -necessary) �� Field Copy ❑ Final Notes
17. 1 will send Mr. Brock the newest Certificate of Coverage and General Permit if U have available in my files.
19. The freeboard level record has already been made for November 11, 2001 for lagoon 2; this date has not yet occurred. Need to keep
ccurate records.
5. There is an area at the end of pulls 11 and 12 that stays wet at times and Mr. Brock indicated he shortens the pulls to avoid the wet
area. Mr. Brock needs to make the entire pull as designed. If it is too wet, then other pulls should be used and these pulls 11 and 12
should be used when dry enough to make the entire pull.
Note: Mr. Brock has a neatly kept farm. The crops are in good condition and the area arould the houses and lagoon is wel kept.
Reviewer/Inspector Name :Stonewall Mathis entered by Bette Rose
Reviewer/Inspector Signature: Date:

O5103101 Continued
Facility Number: 31-386 Date of Inspection 11-&2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ® Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28. Is there any evidence of wind drift during land application? (Le. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ®No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ®No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No

C
-- Dtvisian of Water Q�altty
Q°DEvtston of Soil -an a#er Conservation
x-
0ther-Agency := -
(Type of Visit O Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit O Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 386 Date of Visit: 11-&2001 Time: 11:4t1
Q Not O erational Q Below Threshold
®Permitted ®Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold: - _..... -_
Farm Name: S'.hilliamEdward.l3rQ9k.Faruu................................................ County: I?uAAilx....................................
Owner Name: iUiat)lIS1Ck----.-._._.-------._._.---- Phone No: ?JQ-?5-]Q2------------------------------
Mailing Address: Z 4!}.PAj urcJKrajaCh.l QAd............................................................ B.CU 8..yj1k...XC....................................--- .......................................... 285.1.8 ..............
Facility Contact: ...Title ...................... Phone No: ......................................
Onsite Representative: Willi,opp_)adlyardl£rQCk____________________________ Integrator: Oxowu_!s of
Certified Operator: tftjjssa.0 ......................... wallac.c ............................................ Operator Certification Number: 1.7.319.............................
Location of Farm:
Northwest of Chinquapin. On west side of SR 1953,1 mile south of SR 1961. +
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 52 41 a Longitude 77 5Z 33 u
Design Current
Swine Canacitv Ponulation
❑ Wean to Feeder
® Feeder to Finish
4560
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
EE
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 4,560
Total SSLW 615,600
Number of Lagoons 2 IN Subsurface Drains Present ❑ Lagoon Area IN Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ®No
c. If discharge is observed, what is the estimated flow in gaUrnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ®No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ®No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ----------- old ........... .......... am -----•--•---•--•--•--•--•--•-----•---•--._....................
Freeboard (inches): 33 33

i
I
1(t:e/J/Vl'
Facility Number: 31-386
Date of Inspection l I-8-200I
Uunrrnueu
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum Iiquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Bermuda Control Graze
❑ Yes ® No
❑ Yes ® No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes ® No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes M No
c) This facility is pended for a wettable acre determination? ❑ Yes N No
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 or other 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 N No
❑ Yes N No
M Yes ❑ No
❑ Yes M No
N Yes ❑ No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
M Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
CoEoments (refer to question #j Explain any Y-ES answers andlor any -recommendations or any other c©innnents :" -
Use drawings of fac�hty to better explain sitnateons (use: additional pages as necessary) r�
Field Copy ❑ Fuial Notes
T
17. I will send Mr. Brock the newest Certificate of Coverage and General Permit if U have available in my files.
19. The freeboard level record has already been made for November 11, 2001 for lagoon 2; this date has not yet occurred. Need to keep
accurate records.
5. There is an area at the end of pulls 11 and 12 that stays wet at times and Mr. Brock indicated he shortens the pulls to avoid the wet
area. Mr. Brock needs to make the entire pull as designed. If it is too wet, then other pulls should be used and these pulls 11 and 12
should be used when dry enough to make the entire pull.
Note: Mr. Brock has a neatly kept farm. The crops are in good condition and the area arould the houses and lagoon is we] kept.
T
Reviewer/Inspector Name Stonewall Mathis:. ... entered'byBette Rose
Reviewer/Inspector Signature: Date:

y
O5103101 Continued
Facility Number: 31-386 Date of Inspection TI-45 41
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ® Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No

of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number UTDDyLi Date of Visit: JS 0 Time: Printed on: 7/2112000
Q of -operational Q Below Threshold
Permitted 13 Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold- /�w
Farm Name: ............
..... -11 & .. .....J.. � � `c-:.........,1.. `'...r .................. County:........... ..i�1. ..� 1^
............. ...
Owner Name: ----..--
Phone No:
FacilityContact: ..............................................................................Title:................................................................ Phone No:................. ..........
MailingAddress:............................................................. .....
XOnsite Representative. ...........................T...W {� integrator:
Certified Operator:
Location -of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��� Longitude
- Dese _ Current Design Current' Design Carreat
Capacity Po tilation Poultry Ca ci Po elation Cattle
Wean to Feeder ❑ Layer ❑ Dairy
eeder to Finish ❑Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder ❑ Other -
Farrow to Finish Totsl DesignCd Cl.
Gilts pa ty
= Boars TotalgsjL
N er_ai Lagoons ❑ Subsurface Drains Present ❑ Lag'WM Area Spray Field Area
. HolEdiing Ponds / So1rd Traps= ❑ No Liquid Waste Management System
Discharmes & Stream Impacts
1. Is any discharge observed from any part of the operation?
[]Yes ANo
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 I
Structure 2 Structure 3 Structure 4 Structure 5
Z ��.....
Identifier : ................... .._...-.....-....
....Z.,
.� ............ ............. -.............................................................................................
Freeboard (inches):
5100 L
❑ Yes
❑ No
❑ Yes
[-]No
❑ Yes
No
❑ Yes
No
❑ Yes No
Structure 6
Continued on back

a - a, ,
[Facility Number: Date of Inspection Printed on: 7/21/2000
5. Are there any ini ed ate threats to the integrity of any of the structures abse ved? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.) \
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes G�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes �No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes PNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need main ten ance/improvement'? ❑ Yes { No
11 _ Is there evidence of over applicatio,0 ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �No
12. Crop type I? G
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?
r
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?
❑ Yes jitNo
❑ Yes KNo
❑ Yes RNo
❑ Yes VNo
❑ Yes 9,No
❑ Yes kNo
❑ Yes �No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes i�No
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes JNo
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 T .No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) El Yes �lo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes `121`1'tlo
24. Does facility require a follow-up visit by same agency'? ❑ Yes EM
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes PfNo
13: �o vi...... .. clef c.. ...were noted ilirring �his:visit; ....will r. e. . . . R.... .....
: ' rorres�6fide"' about; thi visit.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. -
Use drawings of facility to better explain situations. (use additional pages as necessary):
bveweseecC't-� V-w; toewx- dzy,-L
a1
vS i ,,,� ; L�. r— �ati,.�.t,, ►lam �.. �v�
A t— w I bexLk e w Q)
Reviewer/Inspector Name i'Zliy� d_� r`e i
Reviewer/Inspector Signature: (a !/ 1 ,Yf fjfjJ]/ Date: A —Is 5/00

Facility Number: — Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or hplow ❑ Yes 1KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
2& Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes PiVo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes AMNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 111 o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ' No
Additional Comments and/orDrawings:
5100
5100

��. • .
'Division of Soil and Water•Conservation = Operation Review
�_Divisiiin of Soil and Water Conservation - Compliance Inspection
Division of Water Quality"- Compliance Inspection
", Q Y ' P P
_ El Other: Agency - Operation Review.
Routine 0 Complaint 0 Follow -top of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 3 Date of Inspection �� lG 9ggg
'Pima: of inspection 24 hr. (hh:mm)
Permitted 1ACertified © Conditionally Certified © Registered 0 Not O eraiional Date Last Operated:
Farm Name: .......... W!�Vsfi�++�...... Ut a-A....3{��tDCk _.-_ tlucYt`................................ County: .......�-6tLnC................................... ---- ••---.........
OwnerName: ............................ 1' .t.4lf!�........uKUG ............................................_.. Phone No: ... ��!ON.. ..1�...i�} Z.........................................
Facility Contact: Title: Phone No:
i!•lailing Address: Z
...... as.�i�rc......�,ra,�cSr,............ c�:................................Qeu.�. Vd.L..1... ...... l.g.........
Onsite Representative: �i'; avvc . Integrator: t................................
..........�...... \fi.lan,........................................................ K • .......�Y.tS.Lt]Xl:.tip..........................
Certified Operator:................................................................................................................ Operator Certification Number:
Location of Farm:
....:c?.,.......Ia1P .4� ....a. R...._l.gs3. �i.....:...so.._ R....1.a.(x.1...................I.......
i
Latitude Longitude
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I I JCI Non -Dairy
❑ Other
Total Design Capacity y ;4p
Total SSLW
Number of Lagoons Z JQSubsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes tRPNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & "Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1 Z
Freeboard(inches):...........3d.................. .............. ....................................................................................................................
❑ Yes 9 No
❑ Yes
Cg No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes N No
Structure 6
1/6/99 Continued on back

F- tuber: 31 — 3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need 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 top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
l 1�
❑ Yes P No
❑ Yes W No
5d Yes ❑ No
XYes 2 No
❑ Yes Q�No
❑ Yes MNo
11. Is there evidence of over application'? ❑ Ponding ❑ Nitrogen ❑Yes MNo
12. Crop type .................. Y.Y± �V.e�.rw....... r'R�......................... lnr 1..... q YAi try.............................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes (O No
14. Does the facility lack wettable acreage for land application`? (footprint)
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 certified operator in responsible 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?
0 N4).vialations or deficiencies were noi6d during Niis:visit:. You ill.rereive no ftiriiier...
:: corresporidehice:about:thisvisit ............:•:•:•:•:•: ...`..•.•.`.•.`.`.`... .'.• ` .
❑ Yes ) No
❑ Yes ® No
❑ Yes ® No
❑ Yes W No
Yes No
❑ Yes No
❑ Yes M No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes No
Comments.(refer to question,#): Explain any YES answers and/or any' recommendations or any other comments r.
Use drain wgs of facility to better explainAituations. (use additional pages as -necessary)
V4 c IONV-k, (Jeftt►5 _
�,r w Ulf S koo tc) 6, i " AVO,
Reviewer/Inspector Name
Reviewer/luspector Signature: ti_ /Ai -_ __ Date: _3 J f1111q t 1/6199

"N' - ime of Farm/Facility
Lagoon Dike Inspection Report
31- 3 $(
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,:cH:IV
Names of Inspectors 1118P
G vti(
`C � Freeboard, Feet
I LtC�2� Top Width, Feet 959 .� -
3 i ! Downstream Slope, xH: I V
Embankment Sliding? Yes L----No
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
�� Tk$,Yes No ! ff,�
Yes �o
VPir
y Yes
No If Yes, Depth of vertopping, Feet
C_ / ,$ )v�t;«3
Yes C_-,_�, o `
Yes L�- No
Is Darn Jurisdictional to the Dam Safety Law of 1967? Yes LI- No
Other Comments sec 5 1

Lagoon Dike Inspection Report
:,,•` Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,:cH:I V
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Names of Inspectors
Freeboard, Feet
Top Width, Feet _ 5
3 - l Downstream Slope, xH: l V / ;�
kr[ �M
r
Yes No
A�,� 4-D
VYes No Lc%Ci•�_ Cy��a'7 �1-7r
S-T�
Yes
No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes [/ No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments So ►-Y►�e__
L r -
_�a UCt��hC& _

_ Q DSNN,C Animal Feedlot Operation Review
DVN;Q Animal Feedlot Operation Site Inspection
v .
iZnutine O Cum taint ' O Follnm--up of D%k Q inspection O Follow-n of D_1;WC rcviem- O Other
Date of Inspection
Facility Number 3 Time of Inspection 6! 0 24hr. (hh:mm)
© Registered tMCertifted 13 Applied for Permit 0 Permitted 113NotOperational 1 Date Last Operated:
Farm Dame: 6L6k County:
Owner Name: __�.. W:1� C1ls e� _.. �iQt �C. _ Phone No:...L9P�`�4
Facility Contact: ........ _ . .......... - ...._ .. Title:
Phone No
Mailing Address:
OAstte Representative:
..—_....._G...�._.........._.—..._�..............._.._ Intenratar:,,-�4tsdcs.,[......_............................_,._........_....�
Certified
Location of Farm:
Operator Certification Number;.-.-...^.__...w _ —
Latitude ' ` 44 Longitude ' r �1 "
tVumber of Lagoons %Halding.Ponds' L� Subsurface Drains Present ❑ Lagoon Area Spray- Field Area
- .. . - ❑ Na Liquid Waste Management S�'stem
General
Or L Are there any buffers that need maintenanceiimprovement? ❑ Yes gNo
?. Is any discharge observed from any part of the operation? ❑ Yes No
Discharse ori6natad at: n Lagoon 0 Spray Feld ❑ Other
a. If discharee is observed_ was the conveyance man-made? ❑ Yes 11 No
b. if discharg:: is observed did it rLach Surface Water? (If yes. notiA-. DWQ) E7 Yes �g No
c. If discharge is observed, what is the estimated floe in ;aUrnin? � -
d. Does discharge bypass a lagoon system? {If yes. notin• DWQ) E] Yes [p No
3_ Is there evidence of past dischar=e from any part of the operation? ❑ Yes W No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes M No
3. Does any part of the waste management system (other than lagoons/holding ponds) require M Yes ❑ No
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/35!97 Continued on back

44
Facility Number. — 3
8_ .-,re .re lagoons or stora_c ponds on site which need to by properl} closed? L7 )'es No th
Structures (LaLmo m.Holdin! Ponds, Flush Pits. etc.►
9. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
VV
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier
Freeboard (ft):
10. Is seepage observed from any of the structures? ❑ Yes ® No
11. Is erosion, or any other threats to the integrity of any of the structures observed? Yes ❑ No
12. Do any of the structures need maintenancelimprovement? 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?
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. p type ,.�..-_
16. Do the receiving crops differ with those designated in the Animal Waste Management Plant (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19- Is them a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss reviewftnspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Onlv
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted whicb cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[3 No violations or deficiencies were noted during this:visiL You .will receive no fuirther
c6rrespondence aibout -this; visit:
❑ Yes El No
❑ Yes 94 No
❑ Yes 1%No
El Yes DONo
EA Yes ❑ No
❑ Yes SNo
MPYes ❑ No
❑ Yes R1 No
M Yes 0 No
❑ Yes ]A No
❑Yes PNo
❑ Yes f4 No
3-/111- Lora avzGc� ir. sit yL�re�t *fz {=rr„r. r�U,; 2 4 eV-teK. ar hj Drs6_-cj 1�] t
LJ� cry Gco� eve C:> 1'lOt. asSiSC e- &rrr,c,�a �►� .:5 attc. gtrovro Le
II
i1./12. ro5�p ast4 S ar. `�Vvt t V\Vu^r JZV.c WaIj tc ayoV, �L Sv�avlj be.
11a
0r` c�1;1� ,, 11 S ono �l Ver rcVTPy w j . o n d %I-t ,,xr [ 1 1 c)pv,
i� �,; tih S�" ttcorl� ,+otjj� be. c,vrs�S�-e "�,{ �. �Yrir}��7/25/97
12. ire +nv r� s �-�, 1� ,.,�„� ,. �af nm� . i �
Reviewer/Inspector Name
Reviewer/Inspector Signature: - A ' Date:

DSWC Animal Feedlot Operation Review f ��
DWQ Animal Feedlot Operation Site Inspection
_
�® Q P P
. ::,. .<..:;rrr--'-�•---e.r—...,-...-�......,._...t+..w--.e:-e.a�.---%-.s...:...........wm,.:vw.v.-w+.:.s...-.,e..�>mu_.J-.....,r.t.......�-::.:.�....�n.w+. ..n......;.e' . .....
Q Routine 0 Corn laint 0 Follow-up of I)XV0 inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number 1
Time of In 24 hr. (hh:mm)
0 Registered © Certified [3 Applied for Permit ®.Permitted 113 Not Operational Date Last Operated:..... .
Farm Name:..�J.►3..I..1-11-�.-�.,.L....... �.x n.G. ... rxr:►.� County:
�.u�.................................
r
OwnerName:.....W3.11.1-v . . . n ............. ....................................... Phone No: .... h.q..?..i�..... �..�a.:.. ...�..Q. .Z...............--
Facility Contact:...................................................... p .... Title p Phone No
Mailing Address:... 2..3�.�.....�.� S.�c�t.!►�*� ...i�.k-�nn.:t�r4..I`zr.as� ....�.t�...�..uuV.s...l..�.�. /�1..G...... y....,
OnsiteRepresentative:...i,1.1 -i......t..4..+ .rt. .e. ....... ........................ Integrator:.... ..1 ,, an L........... ............................
Certified Operator,...................................................... . Operator Certification Number ..........................................
Location of Farm:
,n ....tnt.�s ...s :�.d a ...... r a fi....�.�c �.mA ................ ... K►�, �.1r-[.......,n �. r.'h .?Yn d..l�...a ......................
.................................................................................................... .
Latitude Longitude E=` "
Design Current F Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle , Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
❑ Feeder to Finish JEI Non -Layer I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity ,
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons / Holding Ponds`` �_J ` ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System
General
I. Are there any buffers that need maintenance/improvement'? ❑ Yes KNo
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Surface Water? (If yes. nolify DWQ)
c. If discharge is observed, what is the estimated flow in al/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part'of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge? +
7/25/97
❑ Yes JX No
❑ Yes ERNo
❑ Yes
CRNo
JI)TA
❑ Yes
EQ No
❑ Yes
No
❑ Yes
No
❑ Yes
Q No
❑ Yes ® No
❑ Yes MNo
Continued on back

Facility Number: — g
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures fLagoons,flolding fonds, Flush Pits, etch
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2
Identifier: Z
.................................................
Freeboard 1ftr..........................................
10. Is seepage observed from any of the structures?
Structure 3 Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes ® No
❑ Yes JM No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WIMP, or runoff entering waters of the State, notify DWQ)
15. Crop type b.tl`�. _...._ ............... ......... s.nr�.........._..........._....._..- . � _f.t.....q..+ s,!..
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
2I. Did Reviewer inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement'?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit`?
❑ Yes
R No
X Yes
❑ No
K Yes
❑ No
® No.violations or deficiencies. were noted -during this.visit.-:you.will receive no further
.. • corresportdence al}out this:visit;:: :
❑ Yes JX, No
❑ Yes 1$ No
❑ Yes KNo
❑ Yes No
& Yes ❑ No
❑ Yes ® No
❑ Yes 9No
❑ Yes K No
❑ Yes Ej No
❑ Yes ® No
❑ Yes ® No
❑ Yes Wo
Comments (refer to questibn:#) Explain any`YES answers and/or any recommendations<or any other comments.
Use drawings of Estill#y tti'better explain srtuattons (use additionsl pages asnecessary}is
ft2%
►kv.�+— o son L►�rw C soh
M- r+z..r .r+ a �t s ko u �4 V.An Q �P } 2a[ �o p ^RM t� Q �-E1 L i 0 v� �*-e .+.. D r� v 1
tL•(cov.€ LVi-Lf46 LU R �e-goo•. # �•
J V
7/25/97
Reviewer/Inspector Name f�
z
Reviewer/Inspector Signature: C�_,_U,, , Date: 10

n
LJ
•
Site Requires Immediate Attention:
Facility No. �/�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �? -13 1995
Time: / gi�5 0
On Site Representative: CLaan r-9 pn t 0 C,(--- Phone: -99 6
Physical AddresslLocation:Ma, s c rQa xs 1`[ C,� Q [moo x_�
Type of Operation: Swine `� Poultry Cattle
Design Capacity: f Number of Animals on Site: a j (0 0
DEM Certification Number: ACE DEN Certification Number: ACNEW
Latitude- 3 Y ° .� _" Longitude.7 Z _' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Oes or No Actual Freeboard: 3_Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes orcDo
Is adequate land available for spray? e or No Is the cover crop adequate?( " r No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? OLel or No
100 Feet from Wells? '& or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or�5 f
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or old
Is animal waste discharged into waters of the state by man -trade ditch, flushing system, or other
similar man -grade devices? Yes or No 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 oro
iirinnnl C'nmrnPnty 3 is 7'2 D
-ell
-
Inspe for Name Signature
cc: Facility Assessment Unit
Use Attachments if Needed.