310424_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qua!

Type of Visit Q Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine 4 Complaint 0 Follow up ❑ Referral a Emergency Q Other ❑ Denied Access
Date�of Visit: Arrival Time: Departure Time: County: Region: �Ab
Farm Name: Ne--S— Owner Email:
Owner Name: phone:
Mailing Address:
Physical Address:
Facility Contact: --++�� Title: Phone No:
Onsite Representative: 4d cJO'�QS/ ` integrator: oOh 23
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= e 0 6 = fl Longitude: = ° =
DesignMC- u rrentl
design Current
Design Current
Swi:te Capacity Pop11hitiQn
WRAW!oultry Capa�Ity Population
Cattle Capaclty Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -La er
❑Dai Calf
❑ Feeder to Finish A
WiEX Heifer
❑ Farrow to Wean I
Dry poultry
❑ Dry Cow
❑ Farrow to Feeder
ElLayers
❑ Non -Dairy
❑ Farrow to Finish
El 13eef Stocker
❑ Gilts
❑on -La ers
❑ Beef Feeder'
❑ Boars
El Pullets
❑ Beef Brood Cow
❑ Turke s
Other
❑ Other
❑ Tur ey Poults
❑ Other
Number of Structures:
F .
Discharges & Stream Imnacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is the?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?
r�
Page 1 of 3
❑ Yes P-No ❑ NA. ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
r ❑ Yes
❑ No
❑ NA
❑ NE"
❑ Yes
❑ NA
❑ NE
[2TIo
❑ Yes
;2"No
❑ NA
❑ NE
[--]Yes
RrN.
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment '
4. Is storages �e capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes eNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [ZN❑ ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'? [--]Yes
JZIVo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
ZrNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
;2'No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
F
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes
❑ NA ❑ NE
maintenance or improvement?
J�lNo
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
7No
❑ NA ❑ NE
maintenance/improvement'?
1 1 • Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
PNo
❑ 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
E(No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination•7
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
&O cl .so �/ -Ics� 40
wA 1-eGo�
Reviewer/Inspector Name - � e, �' Phone:
-
Reviewer/Inspector Signature: Date:
Page 2 of 3 12 8/04 Continued

Facility Number: 51 — 6? Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,2No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑ ether
21. Does record keeping need improvement? If yes, check the appropriate box below, 13Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard PWaste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
J[2 No
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,rNo
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,'No
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ZN❑
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P"No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
, �{
L'J 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
Z No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, aver application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PfNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional Ca invents-andla llraW hgs „
f� j'o
1p
Y
l ,rI IIn
.�
64
it l vs -col
. (0'wy ��� Q�e
.�
ep1
Page 3 of 3 12128/04

Division of Witter Resources
Facility Number ©- a Division of Soil and Water Conservation
Q Other Agency
Type of Visit: 7-compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Q Routine Q Complaint Q Follow-up p Referral Q Emergency Q Other p 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:
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
Integrator: /t4j/3
0
Certification Number:
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
ry rourtry 4-anacaty E•o
Non -La
Pullets
Turkey Puults
Other
Discharges_and Stream Impacts
1. Is any discharge observed front 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 DW R)
2. Is there evidence of a past dischUTgC 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.
Daia Cow
Dairy Calf
Dairy Heifer
Da Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [�No ❑ NA ❑ NE
❑ Yes
6 No
❑ NA
❑ NE
❑ Yes
EfT No
❑ NA
❑ NE
❑ Yes Z No
❑ Yes ZNo
❑ Yes eNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

[Facility Number: 17-S2 jDate of Inspection:
Waste Collection & Treatment A.
4. I9 storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'D No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 'Fe] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): pf�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes J2 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, ctc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes JZ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
/[zNo
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, cheek the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ;'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes Z No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
Yes 2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes J2 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ;No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 2fNo
❑ 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 ;3,&o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: -V,2L Date of Inspection: .42
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes oNo ❑ NA ❑ NE
25. I's the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �?No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e„ discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field [I 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?
ienta;{refer�tn;gpestion� #)tExpl�inany
t
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑Yes 2]No []NA ❑NE
[] Yes P�No ❑ NA ❑ NE
[] Yes ;2rNo ❑ NA ❑ NE
❑ Yes j�? No ❑ NA ❑ NE
❑ Yes J;?No ❑NA ❑NE
[]Yes No [] NA ❑ NE
❑ Yes No ❑ NA ❑ NE
r,.n d- rt* Co rd5 4d + J an d t
Phone: II77� 7.3-2
Date: l2 rL
21412dl S

Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation a Technical Assistance
Beason for Visit: p Routine Q Complaint Q Follow-up_ 0 Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: W` Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: (5�ii
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Region: �!
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Gurrent
Design Current
Swine Capacity Pop,
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pap.
can to Finish
airy Cow
Wean to Feeder
Non -La er
I
ai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
design
Current
Dry Cow
Farrow to Feeder
D . P,ault .
Ca aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Pouits
Other
Other
Discharas and Stream Imaacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes jn No ❑ NA ❑ NE
❑ Yes zi No
❑ Yes Vf No
❑NA ❑NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [] Yes ONo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes Z No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes WrNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued

Facili Number: 31 - Date of Inspection:
t OF
_Waste Collection &_Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ONo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
ONo
❑ 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
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ZfNo
❑ 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 OWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
;a No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Arc there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ONo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
,❑ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ET�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[?-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
JoNo
❑ NA
❑ NE
18. Is there a lack of property 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
,E5 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
2rNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists 0 Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes ONo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes CTTo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[]NA ❑NE
Page 2 of 3 21412014 Continued

Facil[ Number: - Date of Ins ectlon:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes .fNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZINo
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 .EffNo
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ETNo
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? ❑ Yes ONo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �2 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes JZ No ❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes ZrNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
Comments (refer;to'question #] iplain any.YES;answers;and/oe;dny�addltinrial recbmineridatirins'or. any:ether'cgniments.s.l
Ilse drawings:of facili to lieftcr ex'lsiln sitnatlons;(use'aiiditivnal: a es as necessar ) s` s si .y i o' _ ;, 4 , ; ; : g
No
-.7
0/60 j- rc_cords loo),,'� S6cd
61, X// y /I ro
f )_2_1,y 9c
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: �•z
4/2014

Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Q Departure Time: County: V c-t �� Region:� !
Farm Name:,yt ��' _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
t
Facility' Contact:
Title:
Phone:
Onsite Representative: rr—epr Integrator: -
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
esign Current
Swine
Ca acity
Pop.
Wet Poultry
Capacity
Pop.
Cattle0 ELLuqaj
pacity
Pop.
can to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
)design
Current
Dry Cow
.r
Farrow to Feeder
Or P,oultr.
Ea acit
P.o
Non-Dairyr
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Pouits
Dther
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes eEj1No ❑ 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 JE]rNo ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes �3 ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �No NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Iti10 ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Facility umber: IDate of Inspection: ❑
24rDid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes A�j No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check [:]Yes ZfNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Z No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [Ej No ❑ NA ❑ NE
❑ Yes •d No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
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 reviewlinspection with an on -site representative? ❑ Yes �ff No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 0 No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to��betlIter explain situations (use additional pages as necessar }.
�1
� ?/V/// 3 /"j V
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: � ` ' 7X�
Date: eeze,
21412011

Facility Rumber: 7 7- Date of Inspection: C]
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
Struck Structure 2 Structure 3
Identifier: 7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4 Structure 5
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?
Z No ❑ NA ❑ NE
WNo ❑ NA ❑ NE
` Structure 6
❑ Yes r� No ❑ NA ❑ NE
❑ Yes �J!j 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 No [] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yesjo No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Ycs,,Z No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes A!5No ❑ 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?
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
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes Z No ❑ NA ❑ NE
❑ Yes jfNo ❑ NA ❑ NE
❑ Yes,,ffNo ❑ NA ❑ NE
❑ Yes J2 No ❑ NA ❑ NE
❑ Yes ,2fNo ❑ NA ❑ NE
❑ Yes -No ❑ NA ❑ NE
❑ Yes �ONo ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 'Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes g No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Type of Visit: p Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Q Voutine 0 Complaint D Follow-up Q Referral ❑ Emergency 0 Other Q Denied Access
Date of Visit: V - Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:l'jp_�'
Certified Operator -
Back -up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator: Aolqa
Certification Number: 6
Certification Number:
Longitude:
I
Design Current
)Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
ILayer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
IDry Cow
Farrow to Feeder
D . P,oultr.
Ca cit
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Puults
her
Ljother
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
[] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes �Na
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes � No
• —
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes �Noj
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes❑
T?()
NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: JDate of Inspection: Q
Wa to CAkction & Tireatment
4. Zs 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
E No
❑ NA
❑ NE
Strut u I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
PrNo
❑ 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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes PNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 4 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 7fNa ❑ NA ❑ NE
maintenance or improvement?
Waste Aanlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;2No ❑ NA ❑ NE
maintenance or improvement? T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes PrNo ❑ 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; t No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes X1 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes gNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes �fNo
❑ NA
❑ NE
Required Records_ & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ONo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes ZNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other;
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 o ❑ 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

Facill Number: -00 jDate of Inspection: Z
24..Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes 4No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes )ZfNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA 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 ONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes CJ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [�rNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ZNo ❑ 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 ONo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [—]Yes ZNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 01, No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [—]Yes VNo ❑ NA ❑ NE
Comments (refer to..4uestion #): Explain any;Y)ES answers and/or,, any.additional recommendations or any�other.;comments.
U drawin s_of facilf to better.ex lain sltuations.(usi .ailditibnt;l;' ages as:riecessa ):3 ;�:.:i; ; ,:R.=>,; :.,;, ;•�.:; ... ,_;:; v,...:.;=.s:::..; .;.,.P r., ; ,. ;
1�
0190
0 o4
C"I16"',Awj �A rs
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
V1
Phone: VCR' L' f r
Date:
2/4/20II

ivision of Water Quality
Facility Number 1 3 - 0 Division of Soil and Water Conservation
1
f
❑ Other Agency {
Type of Visit: ompliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: erRoutine Q Complaint Q Follow-up Q Referral Q Emergency D Other 4 Denied Access
Date of Visit: z Arrival Time: ' Departure Time: County -DU
Farm Name: [�-eol�Q�� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 6?44�os_
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
Phone:
Title:
Latitude:
Phone:
Region:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
]Non -Layer
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:
Design Current
Cattle Capacity Pop.
Daia Cow
Dairy Calf
Dairy licifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes J2'No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes EfNo
❑ Yes dNo
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Condnued

Facili Number:- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3"k0 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 2]�No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Frccboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes XNo ❑ 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 ;a"'No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 2rNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes P'No
❑ NA
D. 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 J2"No
❑ NA
❑ NE
maintenance or improvement?
Application
_Waste
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes �TNo
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes �'No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes �ZNo
❑ NA
[] NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes P'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes PNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes L2*'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ,[allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes FZrNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2f"No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes ZNo
NA ❑ NE
Weather Code
Sludge Survey
NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: 3
24. Diu►the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes , f No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �Z No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes J"No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZN❑ ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 2T'No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes .Z No
❑ NA
❑ NE
jr 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
J21 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E" No
❑ NA
❑ NE
❑ Application Field [3 Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[] Yes
No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ZI No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
JZ(No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any. additional recommendations or any outer comments,.;.
Use drawings of facility to better explain situations (use additional pages as necessary)......
° ;'y'
N
n
�YK � rec oath rho o� 30 r
3/�L1n
/0//Q�D
Reviewer/Inspector Name: Phone: - 7
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

Type of Visit Q4155m" pl lance Inspection Q operation Review Q Structure Evaluation ❑ Technical Assistance
Reason for Visit_,�utine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ denied Access
Date of Visit:
❑ Arrival Time:
♦ [j %
Departure Time: �] County:
Farm Name:
(-_30&.0
;T Owner Email:
Owner Name. -
Mailing Address:
Physical Address:
Facility Contact: --�� Title:
Onsite Representative: ��iP _Jr_,P%0 S
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: J
Location of Farm: Latitude: Q e = t = " Longitude: Q 0 = 1 ❑
11
Des€gn Current
Design Current
Des€gn Current
Swine
Capacity
Population
Wet 1'vultry Capacity Population
Cattle
Capacity
Population
❑ Wean to Finish
❑ La er
Dai Caw
❑ Wean to Feeder
-on-Layer
Da—.-iry Calf
❑ Feeder to Finish
Dairy Heifer
❑ Farrow to Wean
pry Poultry
D Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
La ers
❑Beef Stocker
❑ Gilts
Non -La erg
10 Beef Feeder
❑ Boars
❑ Pullets
10 Beef Brood Co
Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number Qf Structures:
Discharges & Stream Impacts
I. is any discharge observed from any part of the operation?
❑ Yes
ONo
❑ 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? (Ifyes, 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
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
PKo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNio
❑ NA
❑ NE
other than from a discharge?
Page I of 3
1217&V4
Continued

Facility Number: — Date of Inspection yen
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes Prl4o
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes PNo
❑ 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 �Ao
❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes VNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 9No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ;No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yes P(No
❑ NA ❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes)ZNo ❑ NA ❑ NE
❑ Excessive Pond ing ❑ Hydraulic Overload ❑ 1:roaen Ground ❑ Heavy Metals (Cu, Zn, etc,)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes )?fNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RfNo
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
ZNo+
El NA
❑ NE
17. Does the facility lack adequate acreage for land application`?
❑ Yes
l�l No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;Ao
❑ NA
❑ NE
Comments [reIII DKfer to question #}i Explain any YES answers and/or any reco►nmendatians orany other comments.
Use drawings of faculty to better explain situations. (use;additional pages as necessary):
qV
Reviewer/inspector Name Phone:
ZI
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 ' Continued

Facility Number: Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2fNo ❑ NA ❑ NE
the appropiiate box.
❑ WL]P ❑Checklists ❑Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes DAo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis El Sail Analysis ❑ Waste Transfers (❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
/VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
7No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
FNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�fNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ONo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
eNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
Z
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
No
❑ NA
❑ NE
eldditlana��Cti`ritriierits,aitdlur L7rAwingg: ,� � '' � .',;��,s
zp%
0-0" �G
i0l I., lol
Page 3 of 3 1212&0¢

ti
Type of Visit JUCompllance Inspection 0 Operation Review D Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I ' Arrival Time: I%Q (77 Departure Time: County: Region:
Farm Name: C?,�CIt'Y-C'� L _[Zl2�S %�Ll Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: —� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator: 4
Operator Certification umber:
Back-up Certification Number:
Latitude: 0 0 = I = Longitude: = o = 1 = 1I
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish C d
EJ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
Pullets
Poults
Design Current
Capacity Population
D iry Cow
❑ Dairy Calf'
EjDairy Hei fei
❑ Da Cow
Non -Dairy
El Beef Stocker
❑ 13eef Feeder
❑ Beef Brood Cowl
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ,2-N❑ ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ YesO
No
❑ NA
❑ NE
❑ Yes
f No
❑ NA
❑ NE
12128104 Continued

1Facility-Number:—J�yjpate of inspection / o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
rI No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Struc)ure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �% r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�TNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
2rNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
T Do any of the structures need maintenance or improvement?
❑ Yes
qNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0-No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
o No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required bult'ers, setbacks, or compliance alternatives that need
❑ Yes
PNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application:? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window. ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �] C Gu p
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ZrNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ETNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
ONo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
EfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
eNo
❑ NA
❑ NE
Reviewer/inspector NameeL2 :..: Phone: O— 2�
Reviewer/inspector Signature: L_ Date: G S
12128104 Continued

Facllity�$iumber: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 2 Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists PDesign [:]Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [No ❑ NA ❑ NE
❑ Waste Application [:]Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis [:]Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
�TNo
❑ NA
❑ NE
❑ Yes
[PNo
A NA
❑ NE
❑ Yes
[:]No
gNA
❑ NE
❑ Yes
❑ No
2rNA
❑ NE
❑ Yes
0 No
[I NA
❑ NE
❑ Yes
;`No
❑ NA
❑ NE
❑ Yes 2No ❑ NA ❑ NE
❑ Yes „Lj No ❑ NA ❑ NE
❑ Yes ;]-No ❑ NA ❑ NE
❑ Yes �?Slo ❑ NA ❑ NE
❑ Yes
[2rNo
❑ NA
❑ NE
❑ Yes
PI'No
❑ NA
❑ NE
Ad dltl6nal;C6tnments andlar. Drawin s;
p 0
a� � r�.� �� s N�� Suaf�
ylce (_C)
,.ti � 5
-F-)n Moi>
12128104

IType of Visit 0 Compliance Inspection O Operation Review Q Lagoon Evaluation I
Reason for Visit 0 Routine D Complaint ❑ Fallow up D Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit:
Permittedertified © Conditionally Certified 0 Registered
Farm Name:
Owner Name: _._ _.. _...... .............
MailingAddress: ». _ ».»........_............ »... »_.». _ » ....._ _ __...__ _-___...
Time: Q
Not Overational 0 Below Threshold
Date Last Operated r Abov Threshold:
County: _ Z4` ............... .»......... _......
'Phone No: _.__.__.._... _ . w._....»...».....» .. » __...__..... .
Facility Contact: _...___..»...........».................. _—_Title: �PJhone No: ........»_.....» »........ .
Onsite Representative:..,�,�' ,�, .».,.�,t!j.,.»...» »..» , .» ...» . ............ Integrator._
e�
Certified Operator: __.. _ _ .._ . .�.__._ Operator Certification Number:
Location of Farm:
4&
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �` �«
=+' . De;<t CA.
rirat'' L.1iu :.w;.,:
z c^;.
Swine Ca Po" ulaboa:. �� Ponitiy. Ca act Po trosi' Cattle ' C
1]aCityr; A P tY:' t
Wean to Feeder�C�Noon-La�y:er
�A,
Feeder to Finish
Q
Farrow to Wean
El
Farrow to FeederEl
Farrow to Finish;
_
4: ;. i,a:. '��; • ;`i
Wit. 7
Gilts
Boars,.-+
'M.11�EIt��i$�UOnS.r:ie:
-. ,.'t�Atft*Yltr �AffI�C�'I..�fLtlf��-TIYff'1
Discharees & Stream 1mDaM5
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?
r -'-I-q
O01 �L .
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
5trur 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier 1
.,P Cnrrettt .
❑ Yes ,moo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
dNo
❑ Yes �No
Structure 5
Freeboard (inches):
12/12/03 Continued

Facility Number: ' Date of Inspection
5PAre
there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
❑ Yes JE Ro
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes ,B'No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
'
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancehmprovement?
❑ Yes ,12-No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
[J Yes „B No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes j2No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes lawo
11. Is there evidence of over application? if yes, check the appropriate box below,
_ 3' es ❑ No
r
❑ Excessive Poonndi-ng E]PAN ❑/Hydraulic Overload ❑ Frozen Ground Copper and/or Zinc
/❑
12. Croptype �r C �! ,�l.L��l� •f
--
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVW)?
❑ Yes ENO
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 Z14o
16. Is there a lack of adequate waste application equipment?
❑ Yes ,P.No
Odor LKsues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ Yes ;a -No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes °Q No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes O'fo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes ,0Vb
Air Quality representative immediately.
�^. .n�- r. rr�nrisar x 1. ...1.'.i"'^Y.::hi :••:.•�.@�"- J "ryC"'i.":J1"='C"n:iF.i'N' A. q;l4'•':i:^Y!e G'.Y.l,.-'a`-•'n" .
CAmment3 (re%r. n � � Ieln 8n5N'lr8 AA1T1f1Y �� "", `' °;;� to,,gctrsbia ,]s_ Eacp, any YES =� rc�o�mimiaetaidatians orany other; mm�t:n �" -�`!��`_�, �; ;
.ai. ir. � '�:r?� - � '�;Sd 3Po°%�i ::,,y�s"A�i• �;s3ii iw.!:r ..:• •:.Kx`:�.irsa,^' .: M1: ,.i•--- - �r..:...:.:.tir+rrr:,..ww.+w•�...•.+. �im'�i�r. ¢.
�i3st; drs of i3�cili W`bettlT;cx�Iltin siiiaalaiVaS u� additional Rs � ��
Y.� _ �.. tY�:=� . i . � 1,. _]')= ��` ❑Field Copy ❑Final Notes ; . ,��,���: i i r
a _ :i':., .,.. ^f'`1�[:�;�` ;"`:,t,�:s�-�s€sz3,�±€;�p��y �;; s:r.,:a�i Z:a'�!��'i„s?' ''�;' `h�•' :�;��Es' €i:✓r�at 'icw'+' [� /Z5 oel 1 I.3,0/ ��'�1 f6.S I'd'ccym, •� G,.;
CU �
Reviewerllnspertor Name ;
Reviewer/Inspector Signature:
?1n0J)n2
Date:

Facility Number: Date of Inspection LJ
w '
ReAuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
0-No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel Wi]P, checklists, design, maps, etc.)
❑ Yes
_ZNo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
'014
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Q-No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑-No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) -
❑Yes
j�No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
M-No
28. Does facility require a follow-up visit by same agency?
❑ Yes
ONO
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
.ONO
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, ship questions 31-35)
❑ Yes
12 No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1",Rain
❑ 120 Minute inspections ❑ Annual Certification Farm

I i
6i5i6n`6f Water Quality-
.0 DN1is,0 tgoil and Water Conservation. A.
Rr, Other gency
F h
w. -Y
Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0� Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other [] Denied Access
Facility Number Dateorvisit: ❑ Time: Printed on: 7/2.1/2000
1- [0 Not Operational 0 Below Threshold I
[3 Permitted [3 Certified 0 Conditionally Certified [3 Registered
Farm Name:
6 .. . . ..........................
Owner Name: amF . .........
.. . .......... . ..... . ........ ................................
Facility Contact.
Title:
Date Last Operatcd^r Above Threshold; ..
County: 441 .................
Phone No:
Phone No:
MailingAddress: ................... .......................................... .............................. ......... ............. .................................... ...........
Onsite Representative: ...... - pu)./.j tru-� .......4....... ......... ...... 4 .... 44 .... 44 ............... ... 4 ...... Integrator: .4WP
Certified Operator; ............... 44 .................... . .................. 4 ........... .......... 4 ............ 4 ...... Operator Certification Number:.............. 4.1 ... .....................
Location of Farm:
ASwine [3 Poultry [] Cattle [] Horse Latitude 0 A 64 Longitude 4 t4
..... .. Design Current
CoDadtv Population
w:
Wean to Feeder
Feeder to Finish
"M Farrow to Wean
4N.
Farrow to Fccd(!t
Farrow to Finish
Gilts
Boars
Design Current 'Design
)4:Agn . -Current
C
Poultry Capacity Population Cattle, apii4Ipu ii6u
on
[I Layer ❑ Dairy
10 Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Totid.
�Ilm 0
4,-ql k4 tz 4o
illetg p4qz &in
r[:] Subsurface Drains Present
Lap
-onn Area 10
Spray Field Area
-Jim
No Liquid Waste Management Systern-
N,
Discharges & Stream acks
1. Is any discharge observed from any part of the operation?
0 Yes A6 No
Discharge originated at: [I Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
C] Yes C1 No
b. If discharge is observed. did it reach Water of the State'? (if yes, notify DWQ)
❑ Yes ❑ No
u. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon systern? (if yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
E] Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? [J Spillway
[I Yes RfNo
Structure I Structure 2 Structure 3 Structure 4 Struc(urc 5
Structure 6
Identifier: ............ ........................... --- . ................... * ............. ............................... .................... . ..........
....................................
Freeboard (inches):
5100
Continued on back

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10, Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over applicati n? ❑ Excessive Ponding ❑ PAN [I Hydraulic Overload
Irr, W i. n 11A
❑ Yes No
❑ Yes ONo
❑ Yes No
❑ Yes No
❑ Yes d No
❑ Yes PNo
❑ Yes �dNo
12. Crop type .17 f LI Lei-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Rertuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel 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 review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0' �� •fti��►���:ai' ��f ������� •vt�re M��� ��t�� #��:'�i��t: • Y:a� �+'��i•s�i�� �Q �f th��' • .
ctiri�esporidence a�ou> this �#s�t...... —
❑ Yes No
❑ Yes No
❑ Yes X—NO
❑ Yes No
❑ Yes A No
❑ Yes gNo
❑ Yes 9 No
❑ Yes No
❑ Yes No
❑ Yes GrNo
❑ Yes g No
❑ Yes evNo
❑ Yes PrNo
❑ Yes A No
❑ Yes.No
1q) W}Sf Itn��Gy5�5 GDD,D J&Ab
�v��►��5 �,2z�rz o I��© >Fr��P
�►�'G''FG�I� Lpar�_5 Zeqofs„Q
r
Reviewer/inspector Name
Reviewerlfrtspector Signature: /1�(l if, (�_ /, tom Date: 900

16 Facidit� Number: — Date fit Iusp ctlon j 1 '�, 1'rinted on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at./or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J No
roads, building structure, and/or public property) I
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [ IN
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 )2�No
31. Do the animals feed storage bins fail to have appropriate cover`? ❑ Yes XN 0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional.Comments and/or Drawings: _ ._. �,F • t ;
NO !.V r��F Z&AVRIJ5
a
A
`r L
5100

ldivisiati'uf'Watec unlit
W ..... ,.x .... _.
Q y
-....: .,,, ..,• :, j. �:- (� Di�isian'of Svil and•Water Cnnseii=vation'
i
1,.�..,.,.:: �..:, ..-.... rr....,.... �:- her: A
.yJ_
14'L;;: _ v'�:�Vii`:..Nr..4 ..a �e...�.ulr k .• . •.a'.• re' _ ^:Y _ _ I ,� J ` _.— r � �, � ,.. . .. .. .__i ,..?,' . eve ��..�. �,, kf.
Type of Visit Qj Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit 1 O Routine O Complaint O Fallow up O Emergency Notification O 01her ❑ Denied Access
Facility Number a Bats: of Visit::
0 Permitted © Ce fired © Conditionally ©3Registered
Farm Name: . .: ................... .'..4�. ..........S..c[.l..h/,` ..
OwnerName: ................................................... ........................................................................
Facility Contact:.............................................................................. .I ltle:
='rirnt: j0 �(� Printed an: 7/2112000
Not Ouerational O Below Threshold
Date Last Opera r ribose Threshold: .............. ........
County:..... Sri(.I.. .......................
Phone No:
Phone No:
JPidailing Address:..................
........................................ jj
:-r
Onsite Representative: ��.6.................................. Integrator:........Cr�rri .. .........................................
14
Certified Operator: .... •.................. ...... Operator Certification Numbs
Location of Farm:
.,
{swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �° �•° Longitude •
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
® Feeder to Finish Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 10 Subsurface Drains Present 110 Lagmin Area I0 Spray Field Area
Holding Ponds I Solid Traps JE3 No Liquid Waste Management System
Discharges & Stream Irnpact5
1, Is any discharge observed from any part of the operation? ❑ Yes U�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is obscrvcd, was the conveyance man -roads? ❑ Yes ❑ No
b. If discharge is r}h�ervul, did it reach Water of the State'? (if es, notify DWQ) (] Yes ❑ No
c. II' discharge is observed. what is the estimated Ilow in gallmin? 1y -
d, Dees discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ElYes No
Waste Collection R 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes *0
Su-MAure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Idcnii firr: ................................................ ........... ................. .................. ............... .....................
........................ ...,........ ........................
.......
.....
Freeboard (inches):
5/00 Continued on back

1
Facility N ber: -- Date of 111spection �� Printed on: 7/21/2000
5. Are there any immediate thre is to the integrity of any of the structures vbse ed? (iel trees, severe erosion, ❑ Yes N0
seepage, etc.)
6. Are there structures on -site which are not properly addressed andlor managed through a waste management or
closure'plan? ❑Yes kNo
(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 KNO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes r 0
9. Do any stuetures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application f(`
10. Are there any buffers that need maintenance/improvement? ❑ Yes o
11. Is there evidence of ov application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes o
12. Crop type
13. Do the receiving crops dif er with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes <No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes o
b) Does the facility need a wettable acre determination? ❑ Yes o
c) This facility is pended for a wettable acre determination? ❑ Yes a
15. Does the receiving crop need improvement? ❑ Yes Wo
16. Is there a lack of adequate waste application equipment? ❑ Yes kNo
Reouired Records & Doctiments
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
K No
18.
Does the facility fail to have all components of the Certified Animal Waste Management PIan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
1�10
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
Cl Yes
KNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design''
❑ Yes
KNo
21.
Did the facility fail 10 have a actively certified operator in charge?
❑ Yes
IKUo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
5rNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
RINo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
Q ►'i4l''a idns.or. r1 , c}envies •►l g r- Iiq�L'[7 dot ir�g �. s.vjsjt!• yoji Wii� ree�Ve ilU 1Fi1��1i�C.'
COIresv6fi�ei 'e.a?tJut.t�ti15.V151t.'.'.". ........... ........ .. .'.'.".'. .'
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):
r�]
UV�
�,G�. 517 ova w. fILX
Reviewer/inspector Name
Reviewer/Inspector Signature: l 2� % 1 ll_,t A- I ;[Lzg_/ _,, Date:

ti
Facile i umber: —L11
J1, date of Inspection Printed on: 7/21/2000
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge AYor below ❑ Yes QNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes0
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
roads, building structure, andlor public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes o
32. Do the flush tanks lack a submerged fill pipe or a peimanentltemporary cover? s- ❑ No
5/00

13 Division of Soil and Water Conservation Operation Review
Division of Soil and Water Conservation - Compliance inspection' `••e• �: � ° , „`:L <: a ..:i''sii'i � i; l
Division of Water Quality - Compliance Inspection r� "
Other Agency
Ag y � Uperativn:Reyiew.
Q Routine Q Complaint D Follow-up of DW2 inspection a Follow-up of DSWC review Q Other
Facility Number Date of Inspectiot: 24- 2
Time of Inspeclion 24 hr. (hh:mm)
0 PermittedA Certified ❑ Conditionally Certified 0 Registered 113 Not U erational Date Last Operated:
Farm N:ime: ....... rs F..4r� :,... ! ? ..... i........................:.. County:...."f..................... ....[lf.I.... ..
Owner flame:.........'... .........� lF�...................................... Phone No:
.....i/p........
FacilityContact: ............:� '1.........................................Title:..............................................................,, Phone No:....,...........................................:..
Mailing Address: ....� �.4�........ 'U-<z......zl&.........................................t���.Q..................I.— .fr:[i+../....��
Onsite Representative:........ �Q .... f..r.I.................................. Integrator:.............., L� ......................................
�r� f] f i
Certified Operator;.....��,rv. y;......... .....,,�19. �r................................... Operator Certification Number:.......l! ...........
Location of Farm: [
Latitude � �' .' Longitude • �_'°
Design Current
Swine Capacity Population
Wean to Feeder
Feeder to Finish
�IQ
QQ
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Po ulativn
❑ Layer ❑Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
T6ta1 Design Capacity f oe
�� Tnt•al CCl(.W �% iL? s+�'�r3]
jNumber of Lagoons ® ❑ Subsurface Drains Present ❑ Lagaon Area JE1 Spray Field AHJ.
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream impacts
Is any discharge observed from any part of the operation?
Discharge originated au ❑ 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?
❑ Yes R.
No
❑ Yes ❑ No
❑ Yes ❑ No
d. Dees discharge bypass a lagoon system? (Ryes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 9No
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: 1 - 3
Freeboard (inches): 10 ie -3. .................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes No
seepage, etc.)
3123199 Continued on back

F :vility Number: — Date (01' lnspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'' � Yes ❑ No
(If any of questions 4-5 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? % Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximurn and minimum liquid level
elevation markings? ❑ Yes 0-No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
LA
RNo
11,
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
No
12.
Crop type
13,
Do the receiving crops differ with those designated in the Certified Animal Wastc Management Plan (CAWMP)?
❑ Yes
No
14,
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15.
Does the receiving crop need improvement?
❑ Yes
K No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
4 No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
X No
18,
Hoes the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
❑
rN
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
ElYesa
20.
Is facility not in compliance with any applicable setback criteria in effect at the tirne of design?
❑ Yes
XNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative`?
❑ Yes
XNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
ClNo
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
kNo
yMa iQi js ar idencim -yvve iPted during #h s'visit= Yau wit/ reeiyq i)Q t�ter
caries orideirce: about: this visit.
Comments (refer to question #): Explain any YES answers and/or any'recomrnendations or.:Anyo.ilter eomiments:�
Use drawings of facility to better explain situations. use additional a es as,necessary): r ; , r
P M. ( p g ry)� .. i I I
Reviewer/Inspector Name / l e-
Reviewer/Inspector Signature: 11�.�.--=- Date: 2-t~• 44�
3/23199

Facility Number: — 1)ate of lnspectivn 0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below X] Ycs ❑ 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 brNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes JXNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes k No
32, Do the 11ush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
itional Corntnents and/orDrawings: .,. ;. 1,
Ai
?. 11V&r&JC FG&k P1 P�e, t n� L/f-ovz

y ,PDivision of Soil and Water Conservation [] Other Agency
Division of Water Quality ;`''" ` _ �`
12 Routine 0 Complaint 0 Fellow•-u of DW2 ins er`tion 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 1ST ._ 24 hr. (hh:mm)
13 Registered 9 Certified 0 Applied for Permit 0 Permitted 0 Not Operational Date Last Operated:
Farm Name:.................1 "C'LIt.��e........ 5........... .. ,ra..............-----..... County:........�s1 �! ! ....................
OwnerName: ..................L .m...............................,................................... Phone No:.......... 1. 7..Z 1 `.. .` `.....•...,,,.....................
Facility Contact:
Title:
Phone No:
MailingAddress:......10.....��FtrS.M..1.l...&....................................................................... .....1 �. 1...f...�lw.......................... ........... 5 '.......
Onsite Representative:...........L7.00>............................................................ Integrator :......... .LN.p}
................................................
........
Certified Operator.................................................................................... .................... Operator Certification Number;...................
Location of Farm:
Latitude " Longitude ' 6 ff
Design Current Design Current Design:' :' Current.
i.:
swine Capacity Population Poultry Capacity Population Cattle. Capacity:` Population......
❑ Wean to Feeder ❑ sayer ❑ Dairy
Feeder to Finish Qp ' . ❑ Non -Layer I0 Nan -Dairy
❑ Farrow to Wean
t
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total DeMp Capacity
❑ Gilts
❑ soars
Total SSLW
Number of;I;agvons !Holding Ponds. I0Subsurface Drains Present ❑Magoon Area 10 Spray Field Area
_ ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes • [19 No
c. If discharge is observed, what is the estimated flaw in gal/min?
d. Does discharge bypass a lagoon system? (If' yes, notify DWQ) ❑ Yes -P No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes P3 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes [N No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7• Did the facility fail to have a certified operator in responsible charge? ❑ Yes M No
7125/97

Facility Number: 3 t w
8.
Are there lagoons or storage ponds on site which need to be properly closed?
j Yes
❑ No
Structures (Lagoons.flolding fonds. Flush -Vits. etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
0 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: I+?— 3
....................... ................................ ............... ....................
..... I., .............
..............
Freeboard. (ft): ............ Z....... ........ ...............,�...... Z...............................,.,.....,..............................................................................
.............................
10.
Is seepage observed from any of the structures?
❑ Yes
q No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® Na
12.
Do any of the structures need maintenancelimprovement?
[A Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
P No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
CO No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ........... 6w,"' .ITS k........................ us..� .�.. � i• -................................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
O�No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
MNo
18.
Does the receiving crop need improvement?
❑ Yes
N No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
[ No
21.
Did Reviewer/inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
1� Yes
❑ No
For Certified or Permitted Facilities —On]►
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
� 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
1P No
0 No.vio'latioin yr deficiencies we're,noted-duririg this.visit.• You,will rece' ve�no•ftirtlier
cofrespbindehte About this:visit:-',:
....:.......:::::...�.:.. .. ...........;..i......:: :::�: .. ....... .....i...i:::••. gee �,�3.,: .. ..:...... 4 <i
... ....
Cvtnment ;;(ref+�r to gtxestinn #): Expialn any YES answers a.... s�ny rer...... datlnns ar;pn otNteromm�ents...._ . y „
i 'E:F3 t ;^
U51 t6iwings of f�� 16 to:better explain situatioto (nse ttdsiiti tyul pages as. rtecessury)i =
:: ..; s ��sYFi 6..F. F Z
D. u1d t 60" C 'sk%VI K, y*t'q � Sea - cxk,
fz. C �z.]n►x_ e� rk 4o Ifetetk�_ t(kSoat, 6m, Wall,
ZZ • "sLr � 43 lSt kxp� j1�� h�ra� t�ulL ►Lc1x►ti�jat' 't p�il nJm�utry L/
C�r+�.�.1 110.c,�-t.��;;��jj¢.. �r �-ac,�. � u [1i try �U-►.. c ail 1c u iG�,�i � � �'�-ro+��i+� �40. �Cw,.� e ���oar�
�¢z SL�n�cf loe iA_ �Lc,„. i�z l��eu�e�S ►. Atld I i9(pffl. Cs.SLCJ_
7125197
Reviewer/Inspector Name
lv► m
Reviewer/Inspector Signature: _ �., ��..��� Date: &t2 g

-
":s.. F...
... ' .Q. F, i:,,i tis": a4(i �!� ..... • 3� E:3! 5;�::% F
':Feedlot•' rat" ��e�Iew"
.. „»f:'.ia3. . 4 '3'F fir.: •.
.,a - .: -x�:;: - :;:.., . ❑ DSWC Animal �-�.e tin R j
.:y. .y s �{, 3t ,.I€•� ;���f,. .�(� ,.S?Fi:� :i,,: seW:i..s. '�.: �`':ii3?i..1:
x t p..
•:.. :'::::::: :... ...».... ... ...... a..s...s.:.......... ...": �F� f
DVV Anim?at Feedlot o erki Site 'Ins ectinn
F, ! �( i.� F.. P : s.sb•::i
.. iistl:..::. .. :.3 u k •1:, i ::,3:?€:'i:� �:.. .�s jty33?€fsss:;::.. .. i'. s.?. ... iitt3"sfii {::. F ei s .i..Ff.ef' it �i:::r. e, F.s.. E.;»?;.;.
i,€. '�3f�:3; �'33:%c 3f� ..i' '�f:3�o.�'�o' tii;3:ts•;,..:3�.s 3t .€
$ a
.. .... 1... ... - .3� .i. ,...:.... ....... ...5. ,..,.. .. r :�!:. �:.... ia!!i!.3:.... s.:F.. '.3...3:''. ..Fs:::�ii fsi
,
O Routine O C:om laint O Follow-up of DWR Inspection O Follow-up of DSWC review O Other
Date of Inspection ZZ
Facility Number
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: 13 Registered ❑ Applied for Permit (ex:.1.25 for I hr .i5 min)) Spent on Review
❑ Certified ❑ Permitted lor Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: .... _......... ..... ........... _.... .................. ............ ....... ................. ..... »».............. _..........................
Farm Name:.... r,? 1��.... tz .... �:"^..............................»...... County:... ..... ..................
.»..,.
Land Owner Name: .».......... .... ......... .................. phone No: ..... L-1_1.m.).... 4..........
FacilityConctact:...................... .....f.....»..... ......... ................ ................ Title: ............... .._...... _.............. ... Phone No: ... ..-...... ........ ». ....... ...... .._...............
Mailing Address:..»(2- 1p-i........ i-F-.U. .S..�:. 1.........ILI-:................ _............... ...a.S?.......��.�..�..y.......N... .._................
..��`�.��.
OnsiteRepresentative:..,...................... _,........ Integrator: ..�,.,�ntY�,-..................... ........... ....................
.
Certified Operator: .............................. ...... ... . ....................... . ............... ..... . ..... Operator Certification Number:..Mi3...... ».............
Location of Farm:
Latitude '®6 44 Longitude 6
type of operation ana uestgn uapactty
........................
.............. .... ..::: �. �.. �..; ...;..... ...s ,. .:•. ...:. ... ............... ..i. .....; ?3.
::.? ..,:: �•: �. .� �. .. 3..F .. .t ...s.. ....,H as3 3;�s }� ?p.+,Ft..
.� .�... .s :: :•:...:.:::'::...... { `s :� � sF.�� t�t � t3� , f� ii � 3i�
le. F. �i.,il ... ;I .;It. 3 w.€3 .J €31f1i''.... F;.
Desi n.: Currents.::y r'''.';.:. .., 1 €€
:'
. I : Design urrent. g Desigii� Cprrent4.3;,a:., ;� ; C
?3..F� s�
Swine{'''F
Ca"aei
_ .
» 3s �•.,3a`�Ff4€F.F.
o 'Ca
Pv tilatitin=:�:��€�i;I' ultry` E„ a 'aci Po u ationF!::,� file E;Ef'..!Fjjf;fif,i:Ca ari <P ulstion'f«
:..'..A »a•, :;,...._�. �-:. �I
El Wean to Feeder
€ 3 La,. { ....Doi f:.
�; ❑
Feeder to Finish
%i' Non -La er Non-Dai
❑ ❑
Farrow to W 11
_ �x 3
:
�EF.r :x',�- is€.:?€i?€i •� 5?. s€$if?i3:'€" 3�;e t��;.=�s.ssss�'�.:'n
a s € ;.,., :f
rc:�l .. :3 8t.,5.i
I F ��� ii ii SF�?€:��•� 3� �rrF
aTotsI '
Farrow to Feeder
;: D e s i Ca aci f
.. �.FF. n;f..:y:?•
�ii
j'!
1171 I— w to Finish-_:
E ..{. i3��FfFix�E. ..Pi3F�4 `'Fs' .:C.��F:' F?fl.�,{t.>i
...3: '�"�EiF .•F.s:��Pe..�ii.{s �, ih?F3i: .1 :.:. ,P` iE<'F ei,Fi«..:N:. S: .E:?>ad;S::s
':�. . � - Pot€,•q r� `<
.
N�Eltither
.�...... ....� .: :..
..�'s3,. � .,E.y.I'.i� ��
1.
.:.s.. ..... �::... k. t'
:.. :.. .. ...................... ... ..:....
3.' '�i!.:L•ii�s€;��t :€'i�tasii! siii3�,as�!j�i.yn�.?..•.F'13:�i;3ia�i�s':,�ii���i{':'.�[�€1{€iH�i?3�F��e`.�.€�S�3i:;y-�•£ i, is €; S ; �
li. f :
um>ier: of iLagoatis�l, Hvl�ing Eonds x
& i.?.... i 3
❑ Subsurface Drains Present"
s•:k`: F:{4.:Es s �: eF....€.
A. ..
.
is�jj
e'fF:i «.:�.:is SF•
€'::.Y, .
:::';:;i
Lagoon Area Spray Field Area
$
4'sf
General
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ lather
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water'I (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/3 D19 7 maintenance/improvement?
❑ Yes
ONO
❑ Yes
® No
❑ Yes
01 No
❑ Yes
E No
❑ Yes
® No
❑ Yes
ENO
❑ Yes
RNo
[:]Yes
®,No
Continued
on back

Facility Number: ,., ..... — ..
G. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
7. Did the Facility fail to have a certified operator in responsible charge?
❑ Yes
No
8. Are there lagoons or storage ponds on site which need to be properly closed?
Strugllres_( Holding
Yes
❑ No
.agonnLud/or s]
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
®-No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure b
.:. ....... __........»............ ......................... .... ......... ........... ... _..... ..».............
........ .........
.... ».
14. Is seepage observed from any of the structures?
❑ Yes
9[,No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
9 Yes
❑ No
12. Do any of the structures need maintenance/improvement?
Q9 Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
r
❑ Yes
®.No
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 ........... krra.1 ....
�Yra,::y................. _........ ............. ... ............................ »..................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
[:]Yes
® No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
J.No
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
24. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes
® No
❑ Yes
® No
❑ Yes
No
❑ Yes
No
❑ Yes ®No
❑ Yes 9FNo
❑ Yes EINo
Commence (refer to question #):''Explain' any, YES answers andlor,any recommendations or any other eatnmen ts.:, ,
Uita`asecesryeerexpainisedrawingsoffailitygnI;F S FF EjI f4F E?FS' F
G';e-i v�-f 4y..•..`. C,r+ V 3 0 1 0 0 +1 W 1-_ . +ti dLui d„l� 1 i 4
S� o l a t ...L s a; v 4 �. , �-v o S' e ,.. a -
a u kA'V —
.: 47
Reviewerllnspector Name '
... .� R,: 2a:: ....: is :, �
Reviewer/Inspector Signature: Date: 7 Z
cc: Division of Water Duality. Water Quality Section. Facilitv Assessment Kir 4130197

State of North Carolina
Department of Environment,
Health and Natural Resources 4 • ■
Division of Water Quality
James B, Hunt, Jr„ Governor E H N R
JonathanB, Howes, Secretary
A, Preston Howard, Jr., P.E., Director
April 3, 1997
George R. Jones
George ,Tones Farm
668 Fussell Rd
Rose Hill NC 28458
SUBJECT: Notice of Violation
Designation of Operator in Charge
George Jones Farm
Facility Number 31--424
Duplin County
Dear Mr. Jones:
You were notified by letter dated November 12, 1996, that you were required to designate a
certified animal waste management system operator as Operator in Charge for the subject facility by
January 1, 1997. Enclosed with that letter was an Operator in Charge Designation Form for your
facility. Our records indicate that this completed Form has not yet been returned to our office.
For your convenience we are sending you another Operator in Charge Designation Form for your
facility. Please return this completed Form to this office as soon as possible but in no case later
than April 25, 1997. This office maintains a list of certified operators in your area if you need
assistance in locating a certified operator.
Please note that failure to designate an Operator in Charge of your animal waste management
system, is a violation of N.C.G,S. 90A-47.2 and you will be assessed a civil penalty unless an
appropriately certified operator is designated. Please be advised that nothing in this letter should be
taken as absolving you of the responsibility and liability for any past or future violations for your
failure to designate an appropriate Operator in Charge by January 1, 1997.
If you have questions concerning this matter, please contact our Technical Assistance and
Certification Group at [phone].
Sincerely,
)", #.
for Steve W. Tedder, Chief
Water Quality Section
bblawdeslet 1
cc: Wilmington Regional Office
Facility File
Enclosure
P.O. Box 29535,
FAX [phone]
Raleigh, North Carolina 27626.0535 Nvf An Equal Dppor#unitylAffirmative Action Employer
Telephone [phone]% recycles/ 10% post -consumer paper

State of North Carolina
Department of Environment,
Health and Natural Resources
James B, Hunt, Jr., Governor
Jonathan B. Howes, Secretary
George R. Jones
George Jones Farm
668 Fussell Rd
Rose Hill NC 28458
1DEHBVR
November 13, 1996
SUBJECT: Operator In Charge Designation
Facility: George Jones Farm
Facility ID#: 31-424
Duplin County
Dear Mr. Jones;
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 919/733-0026.
Sincerely,
A. Preston Howard, Jr., ., rector
Division of Water Quality
Enclosure
cc: Wilmington Regional Office
Water Quality Files
P.Q. Box 27687, j 16.
Raleigh, North Carolina 27611-7687 r�C An Equal Opportunity/Affirmative Action Employer
Voice 919-7 i 5-4100 50% recycled/10% post -consumer paper