310413_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Qual

Type of Visit: �—ornpliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: U Routine 0 Complaint Q Follow-up O Referral Q Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: `r r i Owner Email:
Owner Name: f�Phone:
Mailing Address:
Physical Address:
Facility Contact: � LW
Title:
� Onsite Representative: k@,f kV11
Certified Operator:
Sack -up Operator:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number: r L�-6 I_
Certification Number:
Longitude:
DesignMG
Swine Capacity Pop.
iinDesign
W et Poultry
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Farrow to Feeder
Dr. P.oult
Design
Ca acl
Current
P,o
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
Pullets
Turkeys
Turkey Poults
Other
113eef Brood Cow
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?
h. 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?
[ 3 Yes EfNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
)ZNo
❑ NA
❑ NE
Page I of 3 21412015 Continued

acili Number: 9 Date of Inspection:
W t C ll t' &T t
at
s IV ee Eon rea men
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2j No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes gNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] YesNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 'A 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, c c.)
❑ 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 oi'Approvcd Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available:?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 1 XNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ElYes 7XNo ❑ NA ❑ NE
Page 2 oj'3 21412015 Continued

facility Number: V I JDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes V�10
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ;
Z"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 provide documentation of an actively certified operator in charge? ❑ Yes/0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes T�,No 0 NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
1Cothen%(refer4o question:#) U0lain.any,'VYES:answers and/or+any,additional recommenditttons ar:, ny other;comttients:, °. ,x "'�
L]§e drawings of foci/ityltn.betEer.eitplaiti;situiition's (use addEtior%aI paes:as,neccssatyf� ; °;; , `� +r P:; x ; _'•_g _,'R�I�''��
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
P(NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 o, f 3
❑ Yes '2� No ❑ NA ❑ NE
❑ Yes ;ZfNo ❑ NA ❑ NE
❑ Yes ;Z(No ❑ NA ❑ NE
❑ Yes jZfNo ❑ NA ❑ NE
{ Phone: l I Q _7�&
r� Date: Ojtj
2/41201;

Type of Visit: Q C pliance Inspection 0 Operation Review ❑ Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine ❑ Complaint ❑ Follow-up ❑ Referral ❑ Emergency ❑ Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: c )6UP- 1
Certified Operator:
Buck -up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current IJesign Current
Wet Poultry Capacity Pop. Cattle Capacity Plop.
Layer Dairy Cow
Non -Layer Dairy Calf
airy Heifer
Design Current Dry Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dr. Poultr Ea acit Po Non -Dairy
l.a ers Beef Stocker
Non -Layers Beef Feeder
Pullets Beet' Brood Cow
7 urke s
key Poults
Other
Farrow to Finish
Gilts
Boars
F—Fo—ther
[}the
Discharves 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 D W R)
c, What is the estimated volume that reached waters of the State (gallons)? `
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
Z. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑N(
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes o ❑ NA ❑ NE
El Yes o DNA ❑NF
❑ Yes No ❑ NA ❑ NF
Page I of 3 21412015 Cominued

Facilit Number: - Date of Inspection: 3
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? [] Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA [] NE
Structure t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA 1 I
Spillway?:
Designed Freeboard (in): T
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes YNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a ❑ Yes 2 No ❑ NA ❑ NE
waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation Posey an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
S. 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 ERN/o ❑ 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 or improvement?
11. is there evidence of incorrect land application'? If yes, check the appropriate box below. [:]Yes 2 'y , ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ 1leavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ 'Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into flare 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?
ElYes
WN ❑
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E_
❑ NA
❑ Nf?
acres determination?
17.
Does the facility lack adequate acreage for land application'?
❑ Yes
ZN o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
E(N o
❑ NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
0 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 N❑ ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit'? ❑ Yes dNo C] NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge2 if yes, check: ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes O/N❑ ❑ NA ❑ NE
Other Issues
No
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [/] ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection raid the facility pose an odor or air quality concern?
❑ Yes Z/No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ❑ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Yes eNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0"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 YNo ❑ NA ❑ NE
Comments`(refee;to..question #). Expluin;uny. Y.ES:answcrs:and/br any additional recommendations or any, other comments:;
:: srz•a•.��g "
Use;drawiti s,uf facility to:better explain situations.{use additional'"pages: necessary]
Reviewer/inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: k 1- J
Date: 0
21412 J15

Division of Water Resources
Fqj f j1_ ty N7M_ MR1 D D€vision of Soil and Water Conservation
� Othcr Agency
Type of Visit: CF Cpliance Inspection 0 Operation Review Structure Evaluation 0 Technical Assistance
Reason for Visit: a Routine a Complaint Q Follow-up ❑ Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time; 1 DepartureTime: County: QJa(Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
/'
Ons€te Representative: .�uN1G' FkAo) f4:11-1-CCU, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I W t�
Certification Number:
Longitude:
Design Current Design Current Design Current
Sw€ne Capacity Pop. Wet Poultry Capacity Pop, Cattle Capacity Pop.
Wean to Finish Layer Dairy Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish J
Dairy Heifer
Farrow to Wean
Design Gurrent Dry Cow
D . Eoult Ga ac€ pop. Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Dther
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 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 [a No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[] No
❑ NA
❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes L 'yam ❑ NA ❑ NE
i
❑ Yes a4o ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facilif Number: -Ll 1= jDate 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 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -f�;v I ,,l Z--'
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_ q U
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [!f 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 environmenta threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes FZ/No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2No ❑ NA ❑ NE
matntenance 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 [D 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
EN o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
FZ/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
WNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design []Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [3 Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspecti❑ns ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N. ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

117ac€1€ Number: - ❑ate of Ins ection: --Ao
24. LY the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes zl� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes 94o ❑ 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 YNO ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. aid the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 4rNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes � "° [] NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes ETNo ❑ NA
❑ Yes ❑ NA
[—]Yes LZ(o ❑ NA
❑ NE
❑ NE
❑ NE
ICornrtecnts;(refer".tu;.question;#) ;Explain anyEYES ;answcrs`and/or.;any Additional recommendations or viny:other romrnents. j:: 4 s t
Use,dr wIii of & Ility;to better'explain situations, use additional pages as,neeessary}:;L
Reviewer/Inspector Name:
Phonk IN) i% — (�
Reviewer/Inspector Signature:
Date: K 1 V-0I I i�
Page 3 of 3 / 21412915

Facility Number - 0 Division of Soil and Water Conservation
r 0 Other Agency
Type of Visit: (3 Cliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: C 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: Departure Tlme: EM� County: PQe= Region:
Facility Contact: Title:
Onsite Representative: joJ,p,-� -- ���rL
Owner Email:
Phone:
Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
ELa er
Non-Layer
Non-L.
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation`?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Longitude:
I$09G
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[] Yes EZ /No ❑ NA ❑ NE
[] Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑Yes t ❑NA ❑NE
❑ Yes 1z No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Ins ectian:I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes D No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
}}
Identifier: � 1 CA(ym�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
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 env ronmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
[:]No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C3"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
ZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
C�/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?
❑ Ycs
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
yl�
❑ NA
❑ NE
lb. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[Noo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
o
❑ NA
❑ NE
the a riate box
pp p
❑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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA [] NE
Page 2 of 3 21412014 Continued

Facility Number: I - JDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 6YNO
a
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
o
❑ NA
_ ❑ NE
❑ Yes
5No
❑ NA
❑ NE
❑ Yes No [] NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [J ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ YesN ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑Yes o ❑ 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: recntnmendations;or any other'cornments,
Ilse drawings of f tellity.to better explain situations (use.additional pages as necessary)
Reviewer/Inspector Name: V6N L_ Phone i O
Reviewer/Inspector Signature: Date: �1
Page 3 of 3 21412
RAM

Type of Visit: Q Coltipllance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance "
Reason for Visit: Routine Q Complaint ❑ Follow-up Q Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time: If 2.10.J Departure Time: County: M�J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: ahl ►%-r A A-o rnZ' '_GrL Integrator:
Certified Operator: Certification Number: 1 4 6 i 6
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars I 1 1101 Ipuilets
Other
Certification Number:
Latitude: Longitude:
Poults
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?
Dairy Cow
Dairy Calf
Dairy Heifer
❑ry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
C] Yes C7 No [] NA ❑ NE
Yes
No
NA
❑ NE
Yes
No
NA
❑ NE
�] Yes ❑ ❑ NA NE
Yes N NA NE
Yes No [� NA NE
Page I of 3 21412011 Continued

FSCiIi Number: - Date of Inspection: {'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 ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: UG'60■ i LA &oj E
Spillway?. -
Designed Freeboard (in):
Observed Freeboard (in): Ll2)
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
EYes No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
S. 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 VflNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �31No ❑ 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? ❑ YesV
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes N ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes N ❑ NA ❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 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 ZNo ❑ 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes r�No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes u�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes C]�No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
❑ Yes [;3*N-o ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
2(No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface rile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
21"No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I__I ' o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
WN 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 explaln situations (use additional paces as necessarv).
Reviewer/inspector Name: b I� NFtqjg0a_,A,/,Phone; 00 p 4
Reviewer/inspector Signature: Date:
Page 3 of 3 214 011

& ytlirtxtvn of water 14uatity
Facility Number - 0 Division of Soil and Water Conservation
*� Q Other Agency
Type of Visit: Q Co liance Inspection Q) Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: d Routine 0 Complaint Q Follow-up Q Referral Q Emergency 0 Other D Denied Access
Date of Visit: Arrival Time: Departure Time:® County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: &Jaky nl'ck ' .- .--__ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
'Faceder to Finish o
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number: 19691
Certification Number: 18 b 1R(P
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Pullets
Turkev
Other
Poults
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c, What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
—Dry
Cow
Non -Dal
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: 31 - 213 jDate of Inspection.
Waste Collection & Treatment
4.,Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ ❑ NA ❑ NE
a. if yes, is waste level into the structural Freeboard? ❑ Yes No ❑ NA ❑ NE
Structure
l Structure Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1w,Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):��
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes N ❑ 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 [DNA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or ens nmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes VN
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ 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 °"' ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes UNo
0 NA
❑ NE
maintenance or improvement?
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 dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes ❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes❑
6/0
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes JN
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes YNo ❑ NA ❑ NE
Page 2 of 3 2,14,12011 Continued

(111
lFacpIty Number: -Ll 1 15 Date of Inspection:
24.-Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ❑ NA ❑ NE
2Y. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box belaw.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or OAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
❑ 10
[]NA
[]NE
[:]Yes
10
❑ NA
❑ NE
[:]Yes
Io
❑ NA
[:]NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes Q "- ❑ NA
❑ Yes ❑ NA
❑ Yes No ❑ NA
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or a
Use drawings of facility to better explain situations (use additional pages as necessary).
CC W VJ
U r�l�. CAS G r
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 q f 3
❑ NE
❑ NE
❑ NE
--
'��;L ir— Date: 9tr
?I4 011

143 Division of Water Quality
Xaeility Number - ❑ Division of Soil and Water Conservation
❑ Other Agency
Type of Visit: 7Routine
pliance Inspection Operation Review 0 Structure Evaluation ❑ Technical Assistance
Reason for Visit: Q Complaint ❑ Follow -tip Q Referral Q Emergency ❑ Other Q Denied Access
Date of Visit: - Arrival Time:® Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: J 0 P`Tkii ryL1L(_�n-
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
ether
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude: .
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
[+Layer
Non -Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkev Poults
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other. _
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Daia Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑ No 0 NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ NO [DNA ❑ NE
❑ YesgNo
' ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

F'acili 1►iumber: 51 - Date of Inspection: "i 11
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3
Identifier: LA(voorj ,,:J Z---
Spillway?:
Designed Freeboard (in):
Structure 4 Structure 5
Observed Freeboard (in): rl u2
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
2/N o ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes E!rN/o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or Zyes
men#al threat, notify DWQ
11. is there evidence of incorrect land application? If yes, check the appropriate box below. Yes No ❑ NA ❑ NE
Excessive Ponding ❑ Hydraulic Overload ❑ Froxen Ground ❑ Heavy Metals (Cu, Zn, etc.}PAN ❑ PAN> 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into $are Soil
Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
maintenance or improvement?
7. Do any of the structures need maintenance or improvement?
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑Yes �o
❑ NA
[] NE
{not applicable to roofed pits, dry stacks, and/or wet stacks}
9. Does any part of the waste management system other than the waste structures require
❑Yes ❑�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑'yo Yes I3
❑ NA
❑ NE
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes ErNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? EYes [1 0 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Ek4o ❑ NA 0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
f
❑ Yes B_ o ❑ NA ❑ NE
❑ Yes L_ N0 ❑ NA ❑ NE
Required Records & Documents
14. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q10
❑ NA
❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
El -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
Q-1°
[DNA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® io
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E34o
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facllit Number: 113ateof Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, aver -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?
3 No ❑ NA ❑ NE
Io ❑ NA ❑ NE
1' ❑ Yes {j No ❑ NA ❑ NE
[:]Yes 0 No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
[:]Yes El -No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes Q'-N ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes El No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or: any other,comnaents:,nlf*1! ,
[]se drawin s of facility to better explain situations use additional a es as. necessary)..
6; Sawircff D Cc►MOL
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
/4 , L) FAR 0 (--v�--
Phone:
Date:
21412011

Q Division of Water Quality
Facility Number ' j 3 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit 'Corliance Inspection ❑ Operation Review Q Structure Evaluation ❑ Technical Assistance
Reason for Visit (YHoutine ❑ Complaint ❑ Follow up ❑ Referral ❑ Emergency Q Other ❑ Denied Access
Rate of Visit: Arrival Time: loav Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: A114
Certified Operator:
Back-up Operator:
Location of farm:
Title:
Owner Email:
Phone:
Phone No:
integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ ❑ = ' = Longitude: = ❑ ❑ 0 0 "
Resign Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ can to Feeder
Feeder to Finish o
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other .-- - - - -- --- ___
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ UTkey Poults
❑ Other
Discharees & Stream impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
[:]-Rry Caw
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cod
I
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)?
Number of Structures: 01
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} Nu ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
Cl NE
❑ ElNA
ElNE
❑ Yes
ClYes
,❑
U No ❑ NA
ON I,
❑ Yes
YN o ❑ NA
❑ NE
Page 1 qf3 12128104 Continued

Nacility Number: —
Date of Inspection
Waste Collection & Treatment
4s Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I1 Structure 2 Structure 3 Structure 4
Identifier: LAG�+r�W i LA&,md 2-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 2No ❑ NA ❑ NE
❑Yes El No El NA El NE
Structure 5 Structure 6
❑ Yes Ld'No ❑ NA ❑ NE
❑ Yes P 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 Zo
o ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit'? El Yes ❑ 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 ENo ❑ 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'?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [I Heavy Metals (Cu, Zn, etc)
❑ PAN ❑ PAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? Vyes
es
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18, Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
No ❑ NA ❑ NE
WN�o El NA El NE
o ❑ NA ❑ NE
.. •..._:Y..�Firie."'.`:`t.:.•:..�.,�.:,.C.Y':;r.,,
Cornments (refer to:question #):./Explain any YES: answers.and/or any.recommendation s or any:othe ' co°
mments?: •s f.
.
Use drawings.of facility to better explain situations. [use additional pagesAs necessary): `
r�) 06f n LOk� F#A- cX-W-r 56U14v yC4fl-- X'�-1 &04/, K6FR TrCK6Ir
Reviewer/Inspector Name - -— rr. �'`"" `" Q L
:�.. �";�: •:���':3,: -� ��,�:: �� Phone: -1 Q
Reviewer/Inspector Signature: Date: It lit 11-D
12/2&104 Continued

racility Number: 31 — tS Date of Inspection !
Reauired Records & Documents
4
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Dcsign ❑Maps ❑ Other ,..�
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LJ 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
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes YNo ❑ NA ❑ NE
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
24.
Did the facility rail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;4
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
o
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
eNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,,��,,//
["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
040
❑ NA
❑ NE
General Permit? (ie/ discharge, frccboard problems, over application)
32,
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
Yes
ElE?
�Q''�c
No
❑ NA
❑ NE
Adit.i.�o-�'nf.aL'U .�C"' a..e rn•:m'-IY eB.na tS.du- 'Dr,.R� n.. 's.. ,.exam 1am
�
T
Page 3 of 3 121128104

q
Type of Visit (?I C pliance Inspection Q Operation Review Q Structure Evaluation a Technical Assistance
Reason for Visit Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: 17275� Departure Time: County: arJ Region:
Farm Name: Owner Email: '
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: `-"�p 1'tA� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ e ❑ ` 0 « Longitude: = e
r III
Design
n':b
Currcntr
:6..
Design Current
Design Current
Swine
d
Ca acit}•
1;,
Po u tttign
p
Wet Poultr. Ea acit Po ulntian
Y �y p
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
Dairy Cow
❑ can to Feeder
❑ Non -Layer
Dai Calf
Feeder to Finish
El
Dairy Heifer
❑ Farrow to Wean
Ury Poultry
❑
Dry Cow
❑ Farrow to Feeder
Non -Dairy
Farrow to finish
❑ La ers
Beef Stocker
❑Non -La ers
❑ Gilts
❑ Pullets
10
Beef Feeder
❑ Boars
❑ Turkeys
Beef Brood Cow
Other
❑ Tlurkey Pouets
❑ Other
Numor of Structures:
❑
Other
Discharges & Stream Impacts
1, Is any discharge observed from any part of the operation'?
❑ Yes
El No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
N
Z. is there evidence of a past discharge from any part of the operation?
❑ Yes
2
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
L Zo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

acility Number: 3 1—
Date of Inspection
W� 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: CA&06 )l L46V71'y
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 G 7 7
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 2 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No ❑ NA ❑ NE
❑ Yes lJ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental grunt, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �1] No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ 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 ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need Cl Yes ENo ❑ NA ❑ NE
maintenance/i m pro verve n t?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LaNNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Lr No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�L.�
El o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ET/No
❑ NA
❑ NE
..�.. ... :. •. ......:!'.Y'�.a'::'i'rti• %r':: �4�ii-]'n,�i'i=��:Y�i.Yi��gsv+i: :H'". •�..i.K�':. :.x,'_': y.t': ��
Comments (refer.:tu question #}: Explain and YI;S;ansriers aridlnr any recRmmendaionsoanysother coaments:_�f ,;
��
geCL'99aCy}:8ry�
Use drawings of facility tU better explain situations.JUse additionnl pages,.as
� �,;h ���.�•
.���i
Am'
LZA E
ReviewerlInspectnr Name [+i�A�IItJ�r
`�"'` Phone: �. G
Reviewer/Inspector Signature:
Date: i ?-3 d
12128104 Continued

Facility Number: 11 —9131 Date of Inspection 7 n•
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑Checklists ❑ Design ❑Maps ❑ Other
❑ Yes VN❑ ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspection,.s.
[IWeather
Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
LI No
❑ NA
❑ NL'•
23.
]fselected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
E No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes�
N�o
[INA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
ON
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�a
❑ 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
❑ NA
[INC
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[IYes
ENo
E IrNo
❑ 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
ElNo
❑ NA
❑ NE
Il'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
��,,
91-I4o
❑ NA
[I NE
General Permit? (ie/ discharge, freeboard problems, over application)
�o
32.
Did Revi ewer/] nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33,
Does facility require a fallow -up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
Additional Comments andlor.lilrawingx::� , • �: '. - �s;:=; ,c::r.,.: e•;: g� �..,..K:r. - � t+:...,x.i�, .�;,
Page 3 of 3 12128104
Page 3 of 3 12128104

Typo of Visit 0 Compliance Inspection 0 Operation Review ❑ Structure Evaluation D Technical Assistance
Reason for Visit 6 Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: 6�' Arrival Time: ® Departure Time: County: APOIJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ] _ j Title:
❑nsite Representative: `J "N�'i7A►"ILL�Q
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 i Q« Longitude: 0 o Q 1="
Design Current
Design Current
Design Current
Swine Capacity
Popul motion
V�'et Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder
on -Layer
❑ Dai Calf
El Feeder to Finish
3 00)
ZVdv
❑ Daia Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
I
Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef' Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Othe
❑ Other
urkey Poults
❑ Other
Numher of Structures:
Discharzes & Stream Impacts
'No
1, is any discharge observed from any part of the operation?
❑ Yes
CZ
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
Cl 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)?
L.
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part orthe operation`?
❑ Yes
VNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
L7 No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

r
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LAP0,k) I LA(s5,60 '1-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S'Z
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 IQ No ❑ NA ❑ NF
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes [NNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes I Q 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 CNo ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
]d. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 N ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 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
o
�wwo
El NA
El NE
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
o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explaln situations. (use adMinnal pages as necessary}:
/,r,5
Reviewer/inspector Narne `'. i' Phone: I f
Reviewer/Inspector Signature: Date: I 7 6
Page 2 of 3 1 12128104 Continued

i
]Facility Number: 31 —11 Date of Inspection 7 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ ❑ ❑ ' ❑ ❑
WUP Checklists Design Maps Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections��❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
IJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E3 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E�i o
[I NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge'?
❑ Yes
U No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[3/No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
04a
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ NA
❑ NE
and report the mortality rates that were higher than norma12
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�/
E 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
El Yes
, ,�
iJ 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
E No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
� No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number
fQ Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit ('j co 7
fiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit OrlRoutine O Complaint O Follow up O Referral O Emergency ❑ Dther ❑ Denied Access
Date of Visit: /d Arrival Time: Departure Time: County: 49OLIV
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: `—���1�(__ _ ► `--G1.1;�
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = = I = Longitude: = e = g =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharzes & 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
❑
DairyCalf
❑
Dairy l•icife)
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: .
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is (lie 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 IJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
El Yes
❑ Yes
E❑N❑
E No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

IF'acility Number: 3 Date of Inspection Id 1
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the stnuctural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: G4fjVbLA(Xgp2LJ 2--
Spillway`?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑Yes dNo El NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑Yes CJNo El NA El NE
❑ Yes gl"v ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr , notify DWQ
7. Do any of the structures need maintenance or improvement`? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L7 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wct stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L`] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > i 0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manurc/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ 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
ElNA
ElNE
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 acre determination?❑ Yes
IGI No
❑ NA
❑ NE
IT Dots the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
LI 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):
Zt} u PDjq t-b aGaVl-
�A fan.- P d-N LAWNS 1�J Dtc
Reviewer/Inspector Name (­a&AZ Phone: `1 (-•
Reviewer/Inspector Signature: Date: a Z ,
12128104 Continued

Facility Number: — Date of Inspection a U
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available`? ❑ Yes 2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �o ❑ NA ❑ NE
the approprrate box. ❑ WUp ❑ Checklists ❑ Design [I Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
0 Yes
❑ No ❑ NA
❑ NE
❑ Waste Application [:]Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
El Rainfall !L1 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
ONo ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[" No ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
QNo ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
13 El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
��o❑ NA
❑ NE
Other Issues
-
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
❑eo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
3No
❑ 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
ti10
❑ 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
0<01
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32, Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
I2/28/a4

113
Type of Visit CC pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit C3 Routine Q Complaint Q Follow up Q Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: 1 4_�
Farm Name: ..
Owner ,Name:
Mailing Address:
Physical Address:
Arrival Time: Departure TIrne: L-�--�-�J County:
Owner Email:
Facility Contact: Title:
Onsite Representative: Ge d a �e-L4E b vy' _.. -
CertiIli ed Operator: _[_14�N d.olw)
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: =V 0, = Longitude: =i1= 0 11
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
RFecder to Finish ]
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pou Its
❑ other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑
Dairy Cow
❑
Dair Call'
❑
Dairy Heifer
❑
DEY Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes. notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
El Yes
[I No
El NA
El NE
El Yes
El No
El NA
❑NE
❑NA
[I NE
El Yes
El No
❑ Yes
Ld N
ElNA
❑ NE
ElYes
No
❑ NA
❑ NE
1212&04 Continued

Facility Number: ] - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure Structure 3 Structure 4
Identifier: 1..R � ! LA �cx z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 ­L- �7
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 LP4o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 7No
❑ NA ❑ NE
El Yes ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes N ❑ 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 AmAieation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes WNo
c ❑ NA Cl NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El 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 f❑�E1vidence of Wind Drifi ❑ Application Outside of Area
12. Crop typebl
s) 'J l'k)V IIN L 1' ) sm
13. Soil type(s)
N
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility tail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
15,) Co C 'qN o
V .) Vf DA-rtc
P -ur ATV
�te
Eco2 ns
❑ NA ❑ NE
El NA El NE
❑ NA ❑ NE
ZNo ❑ NA ❑ NE
ENo ❑ NA ❑ NE
....:.....:::
Reviewer/inspector Name ' . ;; Phone. 1rd a �ZA
Reviewer/inspector Signature: Date: :E- 3 a
I2/28/O4 Continued

Facility Number: '3 j Date of Inspection Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Y ❑ No El NA ❑ NE
20. Does the facility fail to have all components of the CAW readily available? If yes, check Yes ElN❑ ❑ NA ❑ NE
the appropirate box. ❑ WUP El Checklists Design ❑ Maps ❑ Other
21. Does record keeping need improvement? [l'yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ We ly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
El Rainfall El Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections� El❑ E3 Weather Code
❑ ,
22. Did the facility fail to install and maintain a rain gauge? Yes ��o NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes 2 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ElNA ElNE
25, Did the facility fail to conduct a sludge survey as required by the permit? ElYes El No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ER No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern'?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit'? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/[nspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes ❑ No I?NA ❑ NE
❑ Yes
L;I No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
rN
ElYes
❑ NA
❑ NE
El Yes
9/No
❑NA
❑NE
❑ Yes
E! No
❑ NA
❑ NE
❑ Yes
�/No
❑ NA
❑ NE
121?8104

0
Type of Visit 10-Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit ;12� Routine O Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ denied Access
Facility Number Date or Visit:kL d t'imc: 2
N Below old
0 Permitted © Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: m i 4_ 3 iGf4n County: ❑ ...,_
Owner Name:
Mailing Address:
Facility Contact: + Title:
/,
Onsite Representative: t_7 "A �,i/1
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator: _ e- �_ _ uwtaa�d ..,.._.
Operator Certification Number:
❑ swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' �6 K Longitude ' & 0
Design Current Design Current. : Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca aci Po ulution
❑ Wean to Feeder i JE1 Layer I ❑ Dai
❑ ® Feeder to Finish Non -La er ❑Non-Dai
❑ Farrow to Wean - ---
❑ Farrow to Feeder ❑Other
Farrow to Finish Total: Design Capacity
❑ Gilts
❑ Boars Total SSLW
Subsurface Drains Present Lagoon Area Spray Field Area
= ; Nuinber,of.Log6ons `2.• ❑ ❑
Iioldiil`rig:Ynnds 1•Sulid Traps :[No Liquid Waste Management System
I�J
Di�e5 & 'tr am 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 Slate other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Stricture 3 Structure 4 Structure S
Identifier: I 12►
Freeboard (inches): 2q _ 3.5_
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Stricture G
Continued

Facility Number: �� Date of Inspection �s
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If anyof questions 4-6 was answered yes, and the situation poses an
❑ Yes
El No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
'� Yes
❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Analication
14. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding El PAN ❑ Hydraulic Overload
❑ Yes
El No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAIT MP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Requlred
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ R'UP, checklists, design, maps. etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie' irrigation, freeboard, waste analysis & soil sample reports)
®Yes
❑ No
20,
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively- certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional D«'Q of emergency situations as required by General Permit?
Oel discharge, freeboard problems, over application)
❑Yes
❑ No
23.
Did Review•er.'Inspector fail to discuss reviewnnspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted w•bich cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
4© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
r-^I•. pW�oL {'8 ' - ^:«..'':i"' `f.5x657d"'e' :.yM4xCl:^T[M' p:5!Y' w'-V. "::r^:iA'9Fi 7M+ri+w-"'i1C-:"Yct`Ts.i. ::i.:s.'s"4' .:�;'7�.;� : '�vF Yny
Connmeuts {refer fti tiuestioiii #j: Eirp]siii any;YES adgwers and/or.any recommendations or.anv other,commea►ts
.. : Notes
Use drawings of facllity,to better explain situation's use additional�pagesias necessary `_1 "' l Field
' � �: �'` „''` � ❑ Field Copy ❑Final Notes
7 &cll foe_ 8t L.4k lat1sok} had Im f+ nl and dc& �r� . 1r*tft6ve*'44
J[t,
1-rr6 Al 10 ins¢t- t n j [� +sf, n vt -4 work a n d: wkrf r.
1 fi l q i Ij llos 12[6 �03� 1741.1113) J[k t k r. ij �
qjV
Reviewer/InspectorName
Reviewer/Inspector Signature: Date: Z
051031VI Continued

Facility Number: 3 - qjE Date of Inspection
ins Lssu U
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. 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?
M. V+'ere any major maintenance problems with the ventilation fan(s) noted? (i.c. broken fan belts, missing or
or broken fan bladef 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 permanemitemporary corer?
J
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes ❑No
05103101

to
:
'
. . . . . ... .......... ..
16.
t t€ .., ,
ivso►t Of;!! R Cou�ga ,.jriiDvW'.z .
y.
}I .. .. ..I P..Y. _ _i.... x.. i �..I .. a. ,: ••' ... � '.I � €.::..�I�ir�.;... ��' €.... ..... .. � .,. i ..� � ... ...... ..� .....���i . «;�:i ';i:: -::? :fix' :...i G �Hi �i�
ra
Type of Visit ACompliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit �(Routlne Q Complaint Q Follow up Q Emergency Notification Q Other 0 denied Access
Facility Number Date of Visit: �® Time:
L-- Not O erational 0 Below Threshold
*Permitted 0 ]C�jejrtiffiied �1 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: .....................
Farm Name: ....... {.r!.!�.�..;F'��.`�'�..................................... County:...... k�-- l ad' ,....... ...................... .............
....._.
OwnerName: ................................................... ..................................................... . ................. Phone No: ....................................................................... .......... __..
FacilityContact:.....................:.......i....i..........i................................ Title: i............................................................... Phone No:
MailingAddress:............................................................................................................ ...............................................,........................
.......
Onsite Representative:. .................................................... Integrator:.....`�'^..................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:
Location of Farm:
❑ Swina ❑ Poultry ❑ Cattle ❑ Horse Latitude a . 4 " Longitude a 1 «
Design Current Design Current a Design : Swine Capacity Population Poultry Csiacllty Po ulation . Cattle Ca y'.
Cpt^rertt y�.
elation � `
❑ Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean LL
❑ Farrow to Feeder ❑ Other
ri" ❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑Boars Total SSLW
V.
.. .. ..... ...
Number of Lagoons ❑ Subsurface Drains Present JJL3 Lagoon Area Spray Field Area
Hol& Ponds ! Solid Traps, No Liquid Waste Management System
8 � � ❑ 9 g Y �:s � ri Ora ,i ,i;•'ii'€
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes kNo
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 ❑WQ)
c. It' discharge is observed. what is the estimated Ikrw 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 Stru re 2 Structure 3 Structure 4 Structure 5
identifier: .............. ........................................................................... ................................... i .............................
Freeboard (inches): L 1 33
5/00
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
ONo
❑ Yes
t!�No
❑ Yes PM
Structure G
Continued on back

Facillty Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes V 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 allo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancetimprovement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance improvement? ❑ Yes 14No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes M No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ YesNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN [I Hydraulic Overload [I Yes ,qNo
12. CroR type L'Llkt^ . SQ- Gv%'- 'vzQd
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes b�No .
14. a) Does the facility lack adequate acreage for land application? ❑ Yes PNo
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel 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?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection 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?
�814�t}Q4s er' 00finexlo -wOrp pAje$•�(Wl4g i� ls.�Jslt; Ynjx w;fil•ireeoife, 44 � r
corresporit�ence. tout this Visit. ...........
❑ Yes ❑ No
XYes Q No
❑ Yes Zj No
❑ Yes J'8�No
❑ Yes 19 No
❑ Yes t No
❑ Yes 14 No
❑ Yes M No
❑ Yes WNo
❑ Yes 2No
❑ Yes a No
❑ Yes gNo
Comments (refer to question #): t Explain any YES atiswers andlnr.' any recainmendatluns ii an other con meats. !.:'P.,
Use drawings of facility to better explain'situations: (use sddlilonal pages tts neeessary'): ; ' i::::r I} is: Pik' ' _..
l Ic1 �. �A.
15 5�.t�£►'� Oy-e-L GL +-. W\ l ` r..i2 i b►%C�i- } 5��►t' ii +-ma y
��.-. s�� alb ���+-. i 5 ��- �5 e. •��.�� �,�
�.Rcr� p1��.rpti'`►-ems `"�-,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: '] — li`( -0 [ Sloo

Facility Number: r7 Date of inspection-4---�-�_�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes O�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 16�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 *0
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes FNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? El Yes XNo
Additional
[[Comments and/or Drawings: `P '
L �i
t � � trek �
s ��� {L5
M1
5100

A(Division of Water Quality. rlj
O Division of Soil and Water Conservation
0 Other Agency F s�
15
Type of Visit O.Compliance Inspection O Operation Review ❑ Lagoon Evaluation
I........... .. -.- -J
Reason for Visit PfRoutine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Date of Visit: Hine; = Printed on: 7/21/2000
Facility Number
701perationall O Below Threshold
Permitted 0 Ce of .ed E3 Conditionally Certified © Registered Date last Op ted or Above Threshold:
�/y J ` ...... • ....
Farm Name: .......... �. ..... 1!5�. ...............1 ` '!... ... County: f...�. y.:...,,.......................................
u1�
Owner Name:.,......... ............................... Phone Nn:............................. _
,
Facility Contact: ........�..�..................�.�j.'.�.�........ Title:.....t�.�......,.........................,.,.... Phone No:
Mailing Address: ......................................
Onsite Representative:.iy.l4�........................ Integrator:
..............tri!.4+..................................
Certified Operator:...... ................. Operator Certification Number:....... .................
Location'of Farm:
Swine ❑ poultry ❑ Cattle ❑ Horse Latitude e Longitude F-70
Desitan Current Design Current Design. Current
Sw tife .`. Capacity Po uladon .
n to Feeder
er to Finish
F
w to Wean
w to Feeder
Farrow to Finish
Lilts
Boars
Poultry capacity Population Cattle _ Ca i Po elation
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity "
Total SSL W:
Nuri lyer efLagaads ❑ Subsurface Drains Present [ILog-on Area IC3 Spray Field Area].
4: Holding Poach 1 Solid Traps ❑ No Liquid Waste Management Systems
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 19.1so
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
h. If discharge is observed. did it reach Water of the State? (ll' yes, notify DWQ)
c. if discharge is observed. what is the estimated flaw in gathnin?
d. Does discharge bypass a lagoon sysieni? (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
Struct • I Structure 2 Structure 3 Structure 4 Structure 5
'�.'+ 3.0........ Ide=iti Fier: ............................................... .................................... .............................
.............. ........ ............
Freeboard (inches): � � � �� VV
5/00
❑ Yes ❑ No
—Ark —
El Yes ❑ No
❑ Yes jj*o
❑ Yes to
❑ Yes,)EtNo
Structure G
Continued on back

Facility Dumber: �_ !late of lospection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity (if any of the structures obse ved. el 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 two
(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 4'No
8. Does any part of the waste management system other than waste structures require maintenancelimprovemen(? ❑ Yes 17'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes gNo
Waste Antalication
10. Are there any buffers that need maintenance/improvement? ❑ Yes'4No
11. Is there evidence of ver a plication? Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes .4No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This Facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is (here a lack of adequate waste application equipment?
Required Records _&_Documents
17. Fail to have Certificate of Coverage & General Permit readily available'?
I Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available'?
5
(ie/ WUP, checklists, design, maps, etc.)
V-Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in affect at (he 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-si(c 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 j4 No
❑ Yes RNo
❑ Yes o
ElYes o
KYes ❑ No
❑ Yes No
❑ Yes &0
❑ Yes ,&No
Roes ❑ No
❑ Yes UNo
❑ Yes �No
❑ Yes 64No
❑ Yes NO
', ❑ Yes `%
❑ Yes XNo
0. �VQ 1'i A�iQp1s.Q ' d�FCie. .v prig. s.visat! • You wiii > ee$iye �tr �lu�ti7�r .
corres deuce: fa�vtit this visit.
.Comments (refer to question #): Explain any YES answers and/or any recommendations or any, other comments.
IL
of facilityto better ex lair( situations, (use additional pages as -necessary):: , �"
AL
1` �i� O11L &t 60 Cam. a.Q
r
ReviewertInspector Signature:

Facility Numlber: — Date of Iiislrrction � 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 ; t/or helow ❑ Yes
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes PQO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
roads, building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes If
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 , Ho
31. Do the animals feed storage bins rail to have appropriate cover? ❑ Yes fid:No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover`? ❑ Yes Io
wo;&
.Ord
3�s
'NL)A1---- C)Air
I
2Z�
F \�-S 11 �,�,zi,�. [VJ0 wc - v t
' .. �-� ? r e,-P-L--- V,.-f -p 1 -4 - rt.-4-r`V, rv►rto vim- � g .

4/30/97

Division of Soil and Water Conservation Other Agency " '
❑ ❑ is Y f,
kt
.:SM : S" : F3F€€i$S '�•i::FFiF?F: u�:.,,. v p' .
.. I�Division of Water Quality
Nnr..+m- .e?�....�.^e..• w...�.�.
I7-7 itte Q Complaint D Foll wu of DIVQ ins ection Q Follow-up of DSWC review Q Other
Date of Inspection Il F
Facility Number
Time of Inspection D= 24 hr. (hh:mm)
Registered *ertifled 13 Applied for Permit [] Permitted 113 Not Operational Date bast Operated:
FurorName:.... .c.��.. ....... .. "cl ui.............................................................. C'ounty:...... ..ail I ................................. ......... 5.5...........
OwnerName: .... .... �5................................ Phone No:......... .... .....................................
Facility Contact:....k! ►.1.. .. ................... -1. ......... TitIe:......G�s�e' ?. !e .f.......................... Phone Rio:... `7. ..L.? �a.�............
MailingAddress.....�.�%...�.D...�.....,,.53.L.:��........................................................ ...... �Mzt .......................... .......•.......+a...
Onsitc Representative:.. ....................... . �................� ��....'.................I................... Integrator:.... 7.G
7
Certified Operator......... .. 2...................... P . t k.G.............
,,...............�c7..c�,vt.......,.,........,.. Operator Certification Nttmher•,.,,, ............
T..ocation of Farm:
Latitude ' 6 69 Longitude ' 4 0"
L-
Design Current;rt"' Design Current Design '.,,Cur rent
Swine. Gapiicky Population' :! Poulltry , Capacity :Population Cattle?'!.':..;:: Capacity Population
❑ Wean to Feeder
Weeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
€Number
of Lagoons ! Holding Ponds
a
❑ Subsurface Drains Present I10
Lagoon Area
❑ Spray Field Area
❑ No l.iyuid Waste Manal;etttent System
General
1.
Are there any buffers that need maintenaketimprovement?
❑ Yes @610
2.
Is any discharge observed from any part of the operation?
❑ Yes ANo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, watt the conveyance man-made?
❑ Yes ANo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes MNo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes Zlo
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes dNo
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes �LNo
5.
Does any part of the waste management system (other than lagoonslholding ponds) require
❑ Yes,�;ONo
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes IRNo
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes ,M No
7125/97
Continued on back

I I—acility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures l(Lagoons.Holdipg j!9nds, ] lush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identi her:
Freeboard (ft) : ..........3,% ........... ..........................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes �No
❑ Yes ,2No
Structure 5 Structure 6
❑ Yes 0 No
❑ Yes allo
12.
Do any of the structures need maintenancelimprovement?
❑ Yes
MNo
(1f any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
RNo
Waste Application
14.
is there physical evidence of over application?
❑ Yes
,kNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crap type `
.. .lr-..t�1.......................................... `............................................................ w........ ................................
.........
..........
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
WNo
17,
Does the facility have a lack of adequate acreage for land application?
❑ Yes
RNo
18.
Does the receiving crop need improvement?
❑ Yes
AQ No
19.
Is there a lack of available waste application equipment?
❑ Yes
RNo
20,
Does facility require a follow-up visit by same agency?
❑ Yes
�VNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
9 No
22.
Does record keeping need improvement?
/Yes
❑ No
f2r_CeljifiCdjLr
PeMijted1♦acil'ties nl
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
JgNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JQNo
25,
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
,® No
0-No :violatioins-vr dertc 6du s were noted•durinj this. visit. You.will recei�e�rro-further
eorrespandenee dhoett :: ; ::: ; :: : ; ;
. ..:�:�. .. .. .... _. ' .:.. .b .. � �:: �.' ':'! ... .. .�.:'�i:..'.. .:i�Fi::::v:�:::::: �::iiiF:i'
�ornftlents. (refer to guestiofi #).-E7iP161h,iny. YES `ar�s►viers;an or, any reconunendalions,or unyi ottielr.,eomments. ....
.F'.FF: :s «:: :: i. :.n�..vie:. .` :;: �i .. . .� ..FF^.�Si..ksssssiisij4,,•iF.1'. :i ,:.e:4 Y°'i s• �::: Sir . •! .:F F; �,'
Use dawings:of:factfit : to.bettet'. ex la;tn,:sttuattnns. fuse additional []aas:neccssu ,)<€,€!!i ;i
Y�::.:: :. Y R�,... �,
...> . ... :,t.. ... ,...�< 1 .�e... �.. I ,F,ilEi�l':FE.:Rz'.?€-:«II€P€€F€€€Pit€€F??ft5:i�€€€€€€€€«.:F' 'E;r "slil:lt .r . ':€`:•„�•iiS.,a i.EI,.,.:.. .. i .a,f1FE'-
.. F.FiF •: .. �F.
ZZ- NQe ke-4e 5pep-y ge6,,�-45 Al 4�,W e4le-- ;a4er y�GoJE
MlriPle—ram.-
1u , Y7!'L"4' vwaL'15 -t-o 6, 44 � �� et.rv'e�--ti �7 ,.� S ��a ,.�, j �.: • c�If
a k 10 Le— A5. A Pe -4 , c
7/25197
.silt€F?`l"'"^�"' +....>,....•.—. n°�-�wi€linen »3�?.w+?FsEi°i:.t .w wi:��iP�., >.�SS .Si"`-'ffl144.�.....,..,..�.,. .,++€"�'T......
Reviewer/Inspector
ector Name aE
r + 11 N �_14
Reviewer/Inspector Signature:
Date: J`/?a

... , .:.�(•, .. ggg � ��!
.. v.a .�.,.•� .., . • `1i( ^.<«,��=Fa;F(,?.
❑ Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
•�. ...,...,..,..m....,...�bx",,..•-...rFFroFr•.»,,.«,^:F-:,,,,,:- sr'=��.,,.^�,,,,^ns=>„,:.rn+,,--` ':s.'`. «;s-•:0::'Si
ff—Routine 0 Com luint 0 Follokv-up of DWQ inspection 0 Follow-up of DSLV'C review 0 Other 71
Date of Inspection f0 z.p 7
Facility Number
Time of Inspection 24 hr. (hh:mm)
© Registered © Certified 0 Applied for Permit 0 Permitted JE3 Not t? erationxl Date Last Operated:
Farm Name: ....... K,'%, �! .... ta..4.ia....... T t onal............................ ................ County-:.... 441. - ....... I'll .... I....
OwnerName :...... WtwL'p-(... ...—t...... L.wr%............................................................... Phone No: ... 1'.giA-A-91.1..... ..................,............
Facility Contact: ..... A.4L...,.&OWa..................................... Title :.,....iown&-......................................... Phone No: L`�lB�. R%.�.I.�i.�.............
Mailing Address; ..... .R.&.e:.......345 ............................................................................... �,t.anf..y41tl.....,...b1 L....... ,,.........
.................... �.R':�.`.�1.........
rator'...-
[?nsitc Representative :...... M�lt.�.....�iiG�WA ................................................................... Into g ............. ......�G.�Rw. >�.......................
7p�
Certified Dperator;.. .;t���� .:..... r�it4................................."I.................... Operator Certification Number:.--•--�,. �....Q.................
Location of Farm:
i'a.. G....... .... �a S<.......... .......1... ►r .........c�r..txr.......� .....� 5....:a;L.t ....,x.......cz ...... z. R..! i°1�......�h s............ ;
r.. ....................... ---.
Latitude ' ' " • Longitude E --—�' ' 0"
.. i:.
orienDesi n Current: _�. es niE,
a anP6ltr suSwine Ca acit Pa ulattocity Po ulatian
Po iilatlott-li
❑ Wean to Feeder IC Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non-Dairy:1
r
Farrow to Wean ,; F,.:
❑ ❑ Other i i• 'ilia
Farrow to Feeder
�:s
❑ Farrow to Finish .I3(
Design t=
_ � n Total a al sig 'Cap ci y
El Gilts
al.�7�3ir Tot �rc r ,.
❑ Boars
,
Nuiinber of Lagoons 1 Holding Piinds: Z' Subsurface Drains Present ❑ Lagoon Area I& Spray Field Area
I
❑ No Liquid Waste Management System ,. 33 x E
Qeneraj
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
A. Does discharge bypass a lagoon systern? (.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
maintenanceli mprovement?
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 DtNo
❑ Yes R No
❑ Yes 1% No
❑ Yes ® No
❑ Yes &D No
❑ Yes P No
❑ Yes f9 No
ZYes ❑ No
❑ Yes 5d No
❑ Yes 5ZNo
Continued on hack

Facility Number: it — 413
B. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
0 No
Structures (Lagoons,llolding Ponds, Flush fits, etc.)
9, is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
JX No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: # ....A4 A7..........
Freeboard(ft):........... ;&-,,7................................h............ .......................... .,....... ............... ........ ... ........ .................................... ...........
...........................
10, Is seepage observed from any of the structures?
❑ Yes
R) No
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes
No
12. Do any of the structures need maintenance/improvement?
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 Iack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .............................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
PYes
❑ No
17, Does the facility have a lack of adequate acreage For land application?
❑ Yes
U No
18. Does the receiving crop need improvement?
❑ Yes
® No
19. Is there a lack of available waste application equipment?
® Yes
® No
20. Does facility require a follow-up visit by same agency?
W Yes
® No
21. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
N'No
22, Does record keeping need improvement?
CR Yes
❑ No
For Certified or Pennittrd Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
1�a No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
tZ No
0 No.violations'vr deiiciencie's were iio'ted'during this:visit.' Nou.will rece'ive,nn'ftirthet'
Orrt'.9pb6dekO EiVoiit this visit.
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Comments..(refer to question #)i;;< xplain any. Y ,S. aM*ers andlor any reemm�rendations:nr en oWeir e6rntrtents. t f
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7/25/97
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ReviewerfInspector Name i`"• :;;d y r
.Fi;�r:��
ReviewerlInspector 5ign.iture: &, - Date:

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr„ Governor
Jonathan B. Howes, Secretary
November 13, 1996
Mike Brown
Mike Brown Farm
PO Box 365
Kenansville NC 28349
SUBJECT: Operator In Charge Designation
Facility: Mike Brown Faun
Facility ID#: 31 -413
Duplin County
Dear Mr. Brown:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919n33-0026.
Sincerely,
A. Preston Howard, Jr., P.E., Director
Division of Water Quality
Enclosure
cc: Wilmington Regional Office
Water Quality Files
P.O. Box 27687, M-k
Raleigh, North Carolina 2761 i-7b$7 N)4fC An Equal opportunirytAffirrnative Action Employer
Voice 919-715-4100 U-27, MRAPMA 50% recyciedl10% post -consumer paper

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: - , 1995
Time: L. 1 3 QM
Farm Name/Owner: f3mvin 1
Mailing Address:
County:
Integrator: v 115 Phone:
On Site Representative: Phone:
Physical Address/Location:
Type of Operation: S wine V"� Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 4- ' S7 ' Vq5 Longitude: T S� ' S$� " 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) (Por No Actual Freeboard; —4--Ft. 0 Inches
Was any seepage observed from the lagoon(s)? Yes o No Was any erosion observed? Yes qj9
Is adequate land available for spray? Yves or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes 0&
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by than -made ditch, flushing system, or other
similar man-made devices? Yes 00 If Yes, Please Explain.
k. Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No ?
Additional Comments: MOO - Si 4e-
r
40 G.6avf5
Inspector Name
Signature
cc: Facility Assessment Unit . Use Attachments if Needed.

OPEPWIONS ERRICW - WO Fax : [phone] Jul 20 ' 95 S : 45 P. 071161
Site Requires Immediate Attention
•
�-j
a
Facility Number:
SITE VISITATION RECORD
DATE: f, 1995
Owner: Farm Farm Name:
County:
Agent Visiting Site: �_r� t AL kn ,,�L_Tr Phone: , l 2 96-2121
Operator: Phone:
On Site Representative: Phone:
Physical Address: `
Mailing Address:
Type of Operation: Swine _jam Poultry 1 Cattle
Design Capacity: 2$ .._.,. Number of Animals on Site: -- 0-b _ . -
Latitude ° -.`" Longitude; _ a
Type of inspection: Ground Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or (M) Acrual Freeboard: _ Feet ._ Inches
For facilities with more --than vrae lagoon, please address the other lagoons' freeboard under the
comments section,
Was any seepage observed from the lagoon(s)? Yes or No Was there erosion of the dam?: Yes or No
Is adequate Iand available for land application? Yes or No Is the cover crop adequate? Yes or No
Fax to (9 19) 715-3559
Signature of Agent