310425_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

ivi§ionTuf Water Rcsiiurces
Faeility Number � - !�0 Division of Suil.and Water Conservat[on
Q Other Agenc���=
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine Q Com lsint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: — Arrival Time: Departure Time: 7 County: Region: Idj o
Farm Name: r^ryt. Owner Email:
OwnerName: K�cr _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Onsite Representative: Integrator:
Certified Operator:��f��w_ Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Cap city P:ap;
Wean to Finish
JLayer
Dai Cow
Wean to Feeder
I INon-Layer___]__Dai
Calf
Tee -der to Finish
C1
--'7 —
Dai l ieiler
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D I'oultr
Ca aci
P,o
Non-Dair
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
'Iurke s
Other
Turkey Poults
❑ther
Irther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes RNo ❑ NA ❑ N E
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [] No
❑ Yes 2q No
D Yes F.No
❑NA []NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3
21412015 Continued

` Facility Number: - Date of Ins ection:
' Waste Collection & Treatment
* 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes S No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
VLNo
0 NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
10 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 ❑WR
7. Do any of the structures need maintenance or improvement?
2[ Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z 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
a Yes
[SNo
❑ NA
❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ®No
❑ NA
❑ NE
maintenance or improvement?
1 l . 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 Drill: ❑ Application Outside of Approved Area
12. Crop TYPe(s) Lsr"P ►%� r`C�I vrC uY_
13. Soil Type(s): D III
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?
0 Yes ❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[—]Yes ZNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
U Yes
to No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
S No
❑ NA
❑ NE
Reouire_d Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E }.No
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
(,No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
®.No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
[:]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
0 Yes
®.No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[0-No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: - Date of Inspection: �j 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®. No ❑ NA ❑ NE
I,
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑.No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes g No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
®.No
❑ NA
[] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[allo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Q o
❑ NA
❑ NE
Comments referto; question i. Ex lain an : YES;Answers;andlor any. additional reenmmendations Or an atlteir.cornmeiitt t.:; i { ' ":.;i'; 1.
q. ) p.. Y, y.
... Vic..,... . .i.: ..
...E Ali• :..: i. �{ .� i.f:�•...:': �. i�' ill' 'fi .���F� .�.:�•:: :"!,. �:'.. �:..::. ii��, if. I:.....�.::'f•::If
Ilse drawings'"of;facility'.to: bettcr:explain situatiara'{ase aitdi'tional:pa$es as"necesaryy..•,••.;::;,;_ .::;if.;::,, ..I� l
C PU& 7-0P _"'.
f /a...'11r�ill�'c n7 r��! G�ek�
A'ev r f_
Reviewer/Inspector Name:
Reviewer/]nspector Signatui
Phone: gle ;T03--0l5-1
Date: 9_: -! . go I
21412015
Page 3 of 3

1' 7 3 °'fa
Type of Visit: 91compliance Inspection 0 Operation Review Q Structure Evaluation Technical Assistance
Reason for Visit: Q Routine Q Complaint Q Follow-uue 0 Referral D Emergency Q Other p Denied Access
Date of Visit: - _ Arrival Time: Departure Time: County: y,.L
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: _64Wp, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region: (�
Design Current
Design
CurrentMC.
Design Current
Swine Gapaclty
Pop.
Wet Poultry
Capacity
Pun.
Cattleapacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D P,oultr.
Ga aei
1?0
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Outer
TurkeyPuuets
DtherI
vt
I Other
Dlscharecs and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes M-No ❑ NA ❑ NE
❑ Yes ZfNo
[]Yes RNo
❑ Yes ❑'No
❑ Yes 0 No
❑ Yes [�'40
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I oj3 21412014 Continued

Facility Number: 3 ! - 7-ft Hate of Inspection: - y—
Waste Collection & Treatment
4. Is storhge capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
B No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 130
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Q 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
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9, Does any part of the waste management system other than the waste structures require
❑Yes
[No
❑ NA
❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
PNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
2No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
.0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�:r No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[2No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other;
21. Does record keeping need improvement? If yes, check the appropriate box below. R Yes jVo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis X 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 [Er'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 01�0
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection; --t-1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ,�fNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(g) 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
Ej No
❑ NA
❑ NE
❑ Yes
.❑ No
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes f Z No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes eNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES onswcrffi:andlor Any, additionallrecommendatlons,or,any:.other. eoinmentg:° ¢=',::a
Use drawings of'faciiity'to"be`tter'explain:situations.(use-addltio' iul p, s as ;necessaiyj, .;''`? , a; `; '•;'� kFryl js,• .' �; i; a.';�`:
ILld �01'5 s
• A4e-eo� sar
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 oj3
Phone: �! - n(-- 73l3
Date: ''q-1
2/4,,2014

i ype of v isir: V t-ompnance inspection v vperanon Keview v structure Evaivanon CJ i cenntcal Assistance
Reason for Visit: a Routine Q Complaint 0 Follow-up D Referral ❑ Emergency D Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: O County:
Farm Name: ��� 1j Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Region:
Onsite Representative: Integrator: P,
Certified Operator: Certification Number: 4& Cw
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Gapac€ty
Pop.
Eattle Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
C]
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. 1?oultr
Ca acit
Po .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
OtherI
10ther
Discharees and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes 0 No
❑ Yes No
❑ Yes FP
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Faeilit Number: - []ate of Inspection:
Waste_Coklection & Treatment
4. ks storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Struck Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[] No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify ❑WR
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
0 Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[:j No
[] NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application'! If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
NE
15. Does the receiving crop and/or land application site need improvement?
Yes
[] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[] No
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment'
❑ Yes
❑ No
❑ NA
❑ NE
Rcuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'!
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility tail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other;
21. Does record keeping need improvement? I['yes, check the appropriate box below. ❑ Yes ❑ N
❑ 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 ❑ N
23. [['selected, did the facility fail to install and maintain rainbreakers on irrigation equiptncnt? ❑ Yes ❑ No
o ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o ❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: JDate of Inspection: .i
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes �kNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
[:]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes [No ❑ NA ❑ NE
%
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes �No ❑ NA [] NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes PNo ❑ NA ❑ NE
permit? (i,e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes 5 3*No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes Z� No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes N ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. .
Use: drawings of facility to better explain situations (use additional pages as necessary).
l /V
r
�7 y V/6hy- 1 • z
3lzsl/s�,gc�
021� ///
/6I16I•y. �-
Reviewer/Inspector Name: Phone:
Reviewerflnspector Signature: Date: ICI I�
Page 3 of 3 4141206

i
type of visit: -41 Lompliance inspection V uperation Neview V btructure Evaluation U Technical Assistance
Reason for Visit: erlioutine Q Complaint Q Follow-up 0 Referral ❑ Emergency Q Other Q Denied Access
Date of Visit: / Arrival Time: © Departure Time: County:,Q'J�
Farm Name: 7 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
4
Title: '
Phone:
Region:
OnsiteRepresentative: allmi MadCAL, Integrator: �St4,n Q19
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D P,oultr.
Ca acit
li'o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gifts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Points
Other==jml
10ther
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
i
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3, Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge? ,
❑ Yes JZ No ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
ff No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 Z/412014 Continued

Facili dumber: RI - 521ci Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes J2"No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?.
Designed Freeboard (in):
Observed Freeboard 3
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes ;3 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ONo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes )2-No
❑ NA
[] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesZ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes �W(o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Ycs_E'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes .E!�`No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes Ca No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [3'No
❑ NA
❑ NE
Repulred Records & Documents
19. Did the facility fail to have the 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
❑ Yes C7N❑
❑ 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 ,Eft -No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ;2,'go
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ;J fi
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA [] NE
Page 2 of 3 21412014 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E�'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ,[EI'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 structurc(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes RNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes VNo [DNA ❑ NE
❑ Yes JE2'No ❑ NA ❑ NE
❑ Yes ;2-Ro C] NA ❑ NE
❑ YesEfNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP? ❑ Yes ,E!fNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes elNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes &No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations [use additional panes as necessarVj.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: QM 6
I I
Date: 5
2112014

r . k
Type of Visit: OrCompliance Inspection V Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: OrRoutine ❑ Complaint Q Follow-up Q Referral Q Emergency 0 Other Q Denied Access Date of Visit: Arrival Time: _t]l} Departure Time: County: �� Region: VzAo
Farm Name: �jr��'e, r,,v-\ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator: ��1 �.mXinc-kowl
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capaclty Pop.
Wean to Finish
11
Wet Poultry
JLayer
Design
Capacity
Current
Pop.
Design Eurrent
Cattle Capaclty Pop.
Dai Caw
Wean to Feeder
iNan-LaXer
Dr. 1P,oultr-
Layers
I
Design
Ca acit
Current
1?0
i Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
eNo
❑ NA
❑ NE
Page I of 3 21412011 Continued

F'acili Number: 3 - Date of ins ection: -ti
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate' ❑ Yes 21 No
a. If yes, is waste level into the structural freeboard? ❑ Yes Z5 No
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in): p� J
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes ZrNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [fNo ❑ 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 E] No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [fNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc,)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [D 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 Zj No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[;D No
C] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
7T No
❑ NA
❑ NE
Re uired 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
71 No
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes 0 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 P No
23. If selected, did the facility Fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes t No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[]NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: ILL - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes .6 No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes eNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structurc(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 tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0 No
NA
❑ NE
❑ Yes
P—No
❑ NA
❑ NE
[:]Yes ;2 No ❑ NA ❑ NE
❑ Yes [;rNo ❑ NA ❑ NE
❑Yes 7No ❑NA ❑NE
❑ Yes 7 No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes allo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.:
Use drawings of facility to better exulaln situations fuse additional Daces as necessary}.
Reviewer/Inspector Name:
Reviewer/inspector Signature
Page 3 of 3
v Phone:d~ab���
Date1<3 r
21412011

Type of Visit: Q 7Routine
pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Q ComEllaintt�0 Follow-up Q Referral Q Emergency Q Others 0 Denied Access
Date of Visit: I 3[!3 I Arrival Time: ® Departure Time: County: Wgh� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: C Dvtz►J SIALJCM&D M069k, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Capacity Pap.
Wet Poultry
Capacity
Pop.
ty Pop,
Cattle Capaciim
to Finish
La er
Dai Cow
to Feeder
Non -Layer
Dai Calf
r to Finish
Q
Dai Heifer
w to Wean
tFarrow
Design
Current
D Cow
to Feeder
Dr. Moult .
Ca acf
P,v
Non -Dairy
w to Finish
Layers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Outer
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes [:]No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes �I�10 ❑ NA ❑ NE
Page I of 3 214/Z011 Continued

Facilitt Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes N❑ ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in). -
Observed Frceboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
b. Are there structures on-sitc 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 environmen I threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
rNo8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes❑ NA ❑ NE
(not applicabie to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ENo ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffcrs, setbacks, or compliance attematives that need ❑ Yes No ❑ NA ❑ NE
'? maintenance or improvement
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes LZNo ❑ 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 ElEvidence 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
q ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ffNo ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Ye'
N " ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily avaiiable7 If yes, check ❑ Yes E(No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ZNo ❑ NA ❑ NE
Page 2 of 3 2,1412011 Continued

Facili4y Number: '�l - 2.F, Date of Inspection: � n4I
;
-24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [r N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes Ej'eo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N6
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yesrj/o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 6o ❑ 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 7[�No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [:]Yes dMo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility`? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ YesVoO
NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? CD Yes NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations -or any other comments:
Use drawings of facility to better explain situations use'additional. ages as necessary):-
Reviewer/Inspector Name:
Reviewerllnspector Signature:
Page 3 of 3
iJ L,U Phone:
Date: 3
21412011

Division of Water Quality
Facility Number - y 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: xCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: &Routine ❑ Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: ® County: U1 Region:
Farm Name acL fv,, Owner Email:
f p LA3) �1 Phone: I.t ] . �1�j L14NCF� � R t8_ Q 5_ ,t I # C )
Owner Name: r -
Mailing Address: �Q3 'S ■ x 1(C L( W(A Lc ( -c e AL A09L.p (o
Physical Address:
Facility Contact:
Title:
Onsite Representative: C" C2 fnoc>��
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone: �^
Integrator: C> �gcM,s'
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish OC7
Fat -raw to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
lTurkey Poults
Othcr
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?
Design Current
Capacity Pop.
Dairy Cow
Daily Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes *o ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes P
No
❑ Yes Q No
❑ Yes 11 No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

1~ a,cili N mber: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (. ( g l� f
Spillway?;
Designed Freeboard (in)
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 4No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 0
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? ]�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �J 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 rn❑ Application Outside of Approved Area
12. Crop Type(s):�Nt�Ct. �L�7 ►�c^��4 +1�Nk_I�L-" ��(,�•l 1 ` ,1ZLE �,�� 15GU� ���
13. Soil Type(s):�� _.._. ..
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 1� No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes va No ❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes tA No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J] No
❑ NA
❑ NE
Required Records & Documents
jT`
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
X
❑ NA
❑ NE
the appropriate box.
G WUP DChecklists ❑ Design [] Maps ❑ Lease Agreements
]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below,
❑ Yes
[� No
❑ NA
❑ NE
El Waste Application Q Weekly Freeboard El Waste Analysis ❑ Soil Anal �,
❑ Wste Transfers
❑ Weather Code
Q Rainfall ❑ Stocking ❑ Cop Yield ❑ 120 Minute Inspections Q Monthly and 1" Rainfall Inspecti s
[] Sludge Survey
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

F ilit 4N tuber: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes o
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yeso
tN
❑ 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?
[j 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
❑ Yes 1;tNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
�C
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
tpNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ItNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments:: • ,::., .;•
Use drawings of facility to better explain situations (use additional pages as necessary).
,. N� 1_� Cv OF aiC_ 1/V e�� C-� D r+n5 �71� �� ► u
��� 0
A� t1
yo-ICe- 7�u4�-t �Ax.► C
L-C�aa�D
N
SIN/n i.5
oil I
s,A1r CXXr eL3 A- p p L
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
l 1 f,Q(,v 5 3)-%p
&jgq --, 1016
cljjo -sot - u��5
o� _ Sal � saltL.i3 +E
Phone: U- 77[p;13D_4
Date:
r
21412011

kDivision of Water Quality
Facility Number j `7Z11 ivision of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit DSRoutine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: �b Departure Time: County: Region:
Farm Name: l pt-� �� Owner Email:
Owner Name: - _ t�Wi [ �� � 14�Il l i tom " s _ 112 71 S h
Rj� Phone: �+1 5r 1 Cw
Mailing Address: J /Y �' L4t'`��i �-�`-' �} C [rC.., 9&`/(D(_0
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 [= ` =1 Longitude: 0 0 =1 =
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
Nan -La ei
Dry Poultry
Layers
Non -layers
Pullets
Turkeys
Turkey_Poults
Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current.
Cattle Capacity Population
❑ Dab: Cow
❑ Dai Calf
❑ Dairy1leifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: FT
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
Cl NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ' No El NA ❑ NE
❑ Yes ' jVNo ❑ NA ❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LAGOCW
Spillway?:
Designed Freeboard (in): )9.5
Observed Freeboard (in): +
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes KNO
ElYes ❑No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes )] No ❑ NA ❑ NE
❑ Yes K 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 stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement'?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
1 t . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ 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 Ewiq (— 1 CLA e 2—ErALC. P )1 cs_E r e SCLc— -
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
XNo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
XV0 ❑ NA
❑ NE
":. �..i..3.: ...::::,.:.�:°�._.i W.G�y.Y ..fix ..� v:+.j °i:.a �•!�
Comments (reter:tii,question::a# Uxplain.gny ,YES atffwens'and/or•any recommendations.or.any::otHer. comments: ., :. ..
r 1� L3r y
l]se drawmgs:of faclliiy to better explain situations: (use,additional pages as,necessary}:�) :x-,; �, x� `a� g
Re►iewerll nspector Name Y (Qf� "' I/Y� Ste:. r Phone:
'. ma
Reviewerllnspector Signature: L Date:
Page 2 of 3 12/2VO4 Continued

i
Facility Number: j — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP 0 Checklists El Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ;nnual
NA ❑ NE
ElWaste Application ElWeekly Freeboard 0 Waste Analysis 0 Soil Analysis [I �ste Transfers Certification
0 Rainfall ❑ Stocking [] Crop Yield El 120 Minute Inspections El Monthly and I" Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
A No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
' l
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9No
❑ NA
❑ NE
.
Additional Comments and/or Drawings:A.
Co L1 q�Z i ICW S�'E l
70 H PUR-_ A CX:25/V C- b OW At C-o(� E
14►4 UL N R ❑ -1C-3
S EN / Ar
0.95
p o 1 • � w ttjiC 1►CX UA L L-Gor- CQC�S .
1� F) TO S�
Page 3 of 3 12128104

F Division of Water Quality
I M Facility Number �,1 rj Q ivision of Sol] and Water Conservation
Q Other Agency
Type of Visit VCompllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �kgoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date or Visit: %i Arrival Time: ® Departure Time: County: bcpci r✓ Region:
Farm Name: I [ {—C- ?S �Ae m Owner Email:
.110.�
Owner Name: ���tNA�Ae� Phone:
Mailing Address: �[� _ C `'1' A C-L AGe,. /X`— (gesLi�
Physical Address:
Facility Contact: � �Tiitle:
Onsite Representative: aa'�-'�--
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
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 ❑ = = ` Longitude: = o = 4 0
11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
I Mayer
ID Non -Layer
Dry Poultry
❑ Layers
Non -Layers
Ej Pullets
❑ Turke s
Other El urkey Vaults
❑ Other 10 Other
Discharges § Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
Dairy Calf
ELDaia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
$eef Feeder
❑ Beef Brood Co
Number of Structures: Z�
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 0No ❑ NA ❑ NE
[I Yes
❑No
❑NA
❑NE
[I Yes
❑No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
bLNo
❑ NA
❑ NE
❑ Yes
` No
❑ NA
❑ NE
12128104 Continued

t
Facility Number: Date of Inspeetfon d
Waste Collection & Treatment kNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes ElNA ElNE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier; LAS+bD]V
Spillway?:
.Designed Freeboard (in): 67- 1J
Observed Freeboard (in); I LP
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes qNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any ol'the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
mai n tenance/improvement?
❑ Yes NINo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes f allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen 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) (A ] 14-C S e �e CJ—,,
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[:]Yes /� No
❑ NA
❑ NE
17,
floes the facility lack adequate acreage for land application?
ClYes R71'No
❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Comments (refer to.question #}:- Explain any YES answers'andlor any recammendaltntis 0 any other comments..
Use dra►vinis of facilityto=better'ex lain. situations.: use'additivnal a es,as:nccessar ,'
cv n ►4CT)UC.. -- cs�p�c� F ��ta pu w� CGi s
(AN(Xv- PA'6
Reviewer/inspector Name )Lp T - - ;,a. ..a 'Y Phone:
Reviewer/inspector Signature: Date:
12128104 Continued

Facility Number:-? Date of Inspection ld
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box. ❑ WUP El Checklists 0 Design [] Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
XNo
❑ NA
❑ NE
0 Waste Application [`] Weekly Freeboard 0 Waste Analysis El Soil Analysis ❑�ste Transfers ❑ nual Certification
[] Rainfall El Cl Crop Yield 0 I20 Minute Inspections El Monthly and 1"
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
IfseIccted, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�kNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
N No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Q No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Additivn'ulj�C mme ts,�andlvr llrswings:
C� h
12128104

I
Type of Visit compliance Inspection Q Operation Review D Structure Evaluation n Technical Assistance
Reason for Visit 0,Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: 1571141 Arrival Time: Departure Time: County: u N Region:
Farm Name: �_r? g Owner Email:
Owner Name: LA,) C-A A[Z 1 Phone:
Mailing Address: _ 1 C L) I H� At—� SCE _ IY„ 0��`7to co
�-
Physical Address:
Facility Contact:
Title:
Onsite Representative: Qs?.EEF �0��Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = a = I 0 f` Longitude: = v = 4 Q
tl
Design Current
Design Current
Design Current
Swine Capacity
)vpulation
Wet Poultry Capacity Populitinn
Catt[e
Capacity Papulatlon
❑ Wean to Finish
La er
Dair Cow
❑ Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Lj Dairy,Heifer
❑ Farrow to Wean
pry Poultry
❑ Dry Cow
❑ Farrow to Feeder
LJ Nan-Dai
❑ Farrow to Finish
❑ La ers
ILJ Beef Stocker
Gilts
Non -La ers
❑ Beef Feeder
8Boars
❑Pullets
Beef Brood Co
Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Dischartres & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA Cl NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
XtNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
0KNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128.104
Continued

T
Facility Number: 131 — L09 bate of Inspection
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure: I Structure 2 Structure 3 Structure 4
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in);
5. Are there any immediate threats to the integrity ol'any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ANo
❑ Yes ❑ N❑
Structure 5
❑ NA ❑ NE
El NA ❑NE
Structure 6
❑ Yes �0 No ❑ NA ❑ NE
❑ Yes )kNo ❑ 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 IVINo ❑ 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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes )qNo ❑ NA ❑ NE
11. is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 1bs ❑ 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) (g 120g0
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes K No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes MNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
No
❑ NA
❑ NE
17, Does the facility lack adequate acreage for land application? ❑ Yes
[ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes 121N❑ ❑NA ❑NE
3+...�•: .. .,Fn. .e::'.�;i � ... •.: ,;:..�,.. :. :.}::�a .a?x: :�. .: .:�v:$:S°: �Sn•`.t. tli�':.!. u. ,$.P�*.=..qi,� �`���rF..
;Comments;(refer to.;questiom.#]: l�xpluin any. YiS.;answers an dloranyirecnmmenda#iunK�r tsnyfother;i ommct�ts:
[]se drawings of facility to bettenrxplain situations: (use'additiunal�pages as R(
cosaryN,
V44
SmALL &%Q AiN POP- i46gq US%7 - A PTe Z Conrs(ALr) WC W I7ht `il n1 F1 qc� �QCf1C�+titST �
VACW F t6Gts wipe ►3E. c_orvuEQTEb To BEQMµ%4 -rWiS T pgwver
IL-J- G 1 e eta Ncrr oc�'r %F--r - Gk t] B I M S CAI G '4C-rI u E
RevicwerlInspector Name 1 A �wW W ~ m M� Phone:
Reviewer/Inspector Signature: Date: 31,1109
Page 2 of 3 12128104 Continued

Facility Number: j —ypi Date of Inspection C7
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropirate box. El WUp El Checklists ' ❑ Design 13 Maps El Other
❑ Yes t�No ❑ NA ❑ NE
❑ Yes *o ❑ NA ❑ NE
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes Wo [INA ❑ NE
E] Waste Application [] Weekly Freeboard 0 Waste Analysis 0 Soi] Analysis ❑ baste Transfers ❑/nnual Certification
0 Rainfall 0 Stocking ❑ Crop Yield E] 120 Minute Inspections ❑ Monthly and V Rain Inspections ci Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Z No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
% No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
❑ No
9 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
YkNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ 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
KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/[nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
6Ko
❑ NA
❑ NE
'A�dditio all'C mmetits4andlorDrawngs:
M 91cc Sug-E -TO J)Vj r i Rc_ Mt)N7#LL� 9-41N INS ► rcarv�
Page 3 of 3 12128104

i ype or visit yy.OQmpliance Inspectlan V Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit )() Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ berried Access
'ISDate of Visit: � Arrival'Time: Departure Time: County: L Region:
Farm Name: Owner Email:
Owner Name:
,Mailing Address:
Physical Address:
Facility Contact: pTitle-
Onsite Representative:GIUS- � ` n b IfV L"Omo
Certified Operator: Eb%,S)At 6,] . % LA'MGfA 2
Back-up Operator:
Phone:
Phone No:
Integrator: nn
Operator Certification Numher:
Back-up Certification Number:
Location of Farm: Latitude: 0 U = 1 = " Longitude: 0 e = 4 =
tg
0 Ulpsil,gn
.�`
Current
Po ulatinn4"
P
";.;., a., Current
y 17tgn'.;,Current ... k::: Dow
esign rSwine., '',.:eit
:�,r3 ---PRole, _-� <, Capacity F�np lotion
;. W.,et Poult Ca acrty ati_vn Cattle. -'.�..,,y'
k❑ Layer
❑ Non -La et
_ ��.
```
Dryi'Poultry
a�:�"''"` '..�''�`'` .' . 9.
❑ Layers
❑ Non -Layers
❑ Pullets
Turke s
❑ TurkeyPoults
Other Number of Structures:
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other, .
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy l�eife�
❑ D Caw
❑ Non -Dairy
❑ Reef Stock
❑ Beef Feeder
❑ Beef Brood Co
Diseharues & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
9 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ZNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�No
❑ NA
❑ NE
other than from a discharge'?
12128104
Continued

F Acility Number: 3 f — 9,Q5 Date of inspection �- --1
Waste Collection & Treatment
�qNo
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: LAQC)d
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): p(
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
W No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
4 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat,
notify OWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
N No
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
� No
El NA
El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Apnlication
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes q
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes r7No ❑ 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
DoNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rallo
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
gNo
❑ NA
❑ N E
Comments (refer to question #): Explain. any YES answers and/or any recommendations or any other comments:.
Use drawings of facility to better explain situations. (use additional pages as -necessary):
Reviewer/inspector Name T N 1 - Phone: g a#
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

a
Facility Number: Date of Inspection L.
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes gNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below, []Yes Z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
9No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ETNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
115No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
4 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JKNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[:]Yes
❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
§4No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
gNo
❑ 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
E�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2tNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E 'No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number �,5 Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit 0 Compliance inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit VRoutine Q Complaint 0 Fallow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: eparture Time: ' D County: C% Region:
Farm Name: r/s���CfZ QIY1 Owner Email:
Owner Name:_,._.4424&JZlv - Gf�i�4 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Ph ne NO.
d0�
Onsite Representative: Integrator: --
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 ` o" Longitude: 0 ° "
Swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Puliets
❑ Turke s
❑ Turkkeey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population...-
❑
DaiEx Cow
❑
Daky Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stockei
❑
Beef Feeder
❑
Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: EZI
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NC
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes X,No El NA El NE
El Yes �No ❑ NA ❑ NE
12128104 Continued

Tacility Number:31 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No Cl NA El NE
a. If yes, is waste level into the structural freeboard? ElY ❑ No ❑ NA ❑ NE
Strupture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc,)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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 XNo El NA El NE
9. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
(Nat applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,Lr! No El NA ❑ NE
maintenance/improvement'? ///
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes), No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
_rWindow Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s) ��� r �
13. Soil type(s) d 7
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
Zj!fNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ZYes El No ❑ NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes Z!No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 1140 ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment'? ❑ Yes ](No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
r
ReviewerllnspectorName Phone: U10 �?&-737-7-
Re►view•erllnspector Signature: Date: vl
12/2N/04 Continued

3
Facility Number: Date of Inspection
Re uired Records & Document
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 I?fNo []NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ;eNo ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes XNo ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No ONA
❑ 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 XNo ❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes )ffNo ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No ONA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
�- CL �.5 JT� r!
��P2v JVZ4_vc.
12128104

1
Type of Visit )25 Compliance Inspectlon O Operation Review O Structure Evaluation O Technlcai Assistance
Reason for Visit P Routine O Complaint O Follow up O Referral O Emergency O 0ther ❑ Denied Access
Date of Visit: 0 Arrival Time: ^/�:� departure Time: / ' unty:GZ�A) Region: W)96
Farm Name: TpL F f�l1'1 _ __ _ Owner Emall:
Owner Name: �i3Gt]1 �.L'>G Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title: Phone No:
Opi2� FPS i+J
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o Longitude: ° u
n Current
Design Current
Design Gurrent
Fity Pnpu[ation
et Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish 110
Layer
❑ Dairy Cow
❑ Wean to Feeder 1
10 Non -La er I
❑ Dairy Calf
eerier to Finish
❑Dai Heifer
El Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
El Boars
Pullets
❑ Beef Brood Co
Turkeys
Other
❑ Other
❑ Turkey PuuIts
Other EEE
LIM a of Structures:
`--y`--'
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
XNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
h. Did the discharge reach waters of the State`? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
00 No
[I NA
[I NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[I Yes
XNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

'I Facility Number — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: nn
Designed Freeboard (in): ` ,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes, � No El NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes tONo ❑ 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 ElNA ElNE
maintenance or improvement?�INo
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes /71 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [I Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 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? ti
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
VNo ❑ NA
❑ NE
Comments (refer to question #):. Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages -as necessary):
20 &4)t/)0 A bl-,05
7oor�64-v
6
s
ReviewerlInspec#or Name
f Phone: aijO - '7016 ez
Reviewer/Inspector Signature:L4
4- Date: D
Page 2 of 3 `--' 1212AV04 Continued

Facility Number- 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 ❑ Yes ONo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes0
❑ NA
[:]NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 9No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ZNo
❑ 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 PNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes (�No
El
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes'0No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency? '
❑ Yes o No
❑ NA
❑ NE
Additional Comments and/or Drawings:
ti
Page 3 of 3 12128104

Type of Visit (6 CoC piiance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit V Routine Q Complaint Q Follow up 0 Referral a Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: D 00 Departure Time; County: &212LAI) — Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: COW-tO 91LA1X 1Ad7_Q
Certified Operator:
Back-up Operator:
Locution of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finisl
Gilts
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 o = . = Longitude: = ° 0 6 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
i
F ❑ Layer
❑ Non -Layer
Other
❑ Other j
Dry Poultry
Pullets
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
h. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes ErNo ❑ NA ❑ NE
12/2&04 Continued

Fac0ity Number: 31 - Date of Inspection
.y
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2JNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes []No ❑ NA LINE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i AGcvN {
Spillway?:
Designed Freeboard (in): v'� a —
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
lJ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
L`I No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
2"No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
2 1No ❑ 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. Are there any required, buffers, setbacks, or compliance alternatives that need ❑ Yes
CJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
,,��, /
Lf'1SIo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or ] a ]bs ❑ 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) S bq_dEAr-1 W laiA7 �C5 we; C �r
13. Soil type(s) G04-wea"
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2"N'o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Des
0 No
❑ NA
ElNE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
O No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;/N a
❑ NA
❑ NE
3�R
�a-1E:�:a'�%`¢�.tNA :}.��.'i��.::::A Lk.Y�i'ib��Y{'1! • ]liF[.ti a Siidlriij �'".90A .�.� ��i•yy,,����
e (xxLO c ;cioL_'
aaQeiLw OOLK lt� G6oD Sid APSE .
Reviewer/InspectorName `Ta#.!� 4 i t' '{;c :.:,r.. :. • .,: ' Phone:(q 7�� -7
Co
Reviewer/Inspector Signature: Date:
12128104 Continued

1Faciillity Number: 31 - ;>fas Date of Inspection l a a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes LJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L+1 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other ,_.�,
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes Ld'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly freeboard Cl Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[2'�4o
ElNA
❑ NE
23.
If selected, did the Facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E No
[I NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit`?
El Yes
3"NNo
❑ NA
❑ NE
26,
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Qf No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
D<A
❑ NE
Other Issues
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
ElL_f
,,----,,��
❑ NA
El28. NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Yes
ElL
,P+o
PVo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,,.�,,�
L.�'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
ElYes
Q-1 o
❑ NA
❑ NE
General Permit? tie/ discharge, freeboard problems, over application)
32,
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9-K-6
[INA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
E?I o
❑ NA
❑ NE
itionai:Cotnmen, ts,andlor.Drawin a:. +'
12128/04

:z
IType of Visit QjCompiiance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit PrRoutine O Complaint Q Follow up ❑ Emergency Notification 0 Other M Denied Access
Facility Number Date of Visit: Tuc►e:
Q Not Operational C Below Threshold
Permitted © Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ....-.».»..---
Farm Name: County: » gjr j. ............
Owner Name: » „»�. . ��......___..__....... 'Phone No:
Mailing Address:
FaHlity Contact: ------------------ _.__ Title: »y......».»»-. »._ . .. ___._. Phone No: .», » »�. , ».........
Onsite Representative: rl?,�.�!'JG! Integrator:
Certified Operator:
Location of Farm:
.,.,,.----- Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
;Desig ,,. Currear:
.";: ; zy., .� : E;u. Sign, .. • i Cartiut.: ,;:
"Cui-i it
on
f
o n
Pdl�i
❑ Layer ❑ Dairy
flS on
J
W
eanFeeder
k
❑Nop-Layer Non -Dairy
Other
'ryr�v P, Taltat' SSLW
�.,.. _. .
"
Finish
Q
Can
Feeder
Finish
Ntrnr�ber,
Dtseharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
[] Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JZ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 00
Structure I S=ture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......
Freeboard (inches): '317
_._......._............»..»...»..».»»»M».».»....»...
12/12/03 Continued

acui umber:,3I HEEI
Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
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 maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload E] Frozen Grquad ,❑ Copper and/or Zinc
12. Crop type p 7: % '
13. Do the receiving crops differ with those designated in the Certified Animal W to 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?
Odor lksues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes 0 No
❑ Yes P No
❑ Yes R No
❑ Yes id No
❑ Yes E9 No
❑ Yes 9No
❑ Yes QfNo
❑ Yes OZ No
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes A No
❑ Yes 1pdNo
❑ Yes �YNo
❑ Yes o
YesAZO
❑ Yes �Na
" '--
.i•u ..'. , ._...F.� .,.3.: ,^.n^!'_'r".'w - -T":YT;.'4! gia.:x.
i;. nx �
I
Cam (rater to esfimn #} �Ex l� �Yffi'aas�.pw�rrs'au�J�r an 'or. aia other oo�ts � �*� � � � =a, "�;��;� I14F
V S.iis;
23 Oe ev 4DN6T E 4, )? -ro 1 r a_
Jr S � r-3 ❑ �N � ER ArtO1C �G � � t-f4 Pt RC�-F � � `�" ct^ rJ F�-1•�c��J ���.
J (7KIEp �o
33 , 3 � ���
Suewey NOV
lJP�ES �6Z('�T �55NF_D
ReviewerAnspector Name �:.
�i_:T3,�..�Pk'...:'�is,..::
Reviewer/Inspector Signature: Date:
1.211"3 Confinum

F& —tc SW Number: j Date of Inspection
Required Records & Ffocuments
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes %No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WIT, checklists, design, maps, etc.) ❑ Yes 91 No
23. Does record keeping need improvement? If yes, check the appropriate box below. ?Yes ❑ No
A 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 gNo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes RrNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes [Pf No
27. Did Reviewer/Inspector fail to discuss reviewlmspection with on -site representative? ❑ Yes P No
29. Does facility require a follow-up visit by same agency? ❑ Yes JgNo
29. Were any additional problems noted which cause noncompliance of the Ccr:ified AWMP? ❑ Yes ONo
il` PDES-Eermitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) %Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes JZNo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
i© No violations or deficiencies were noted during this visit. You will receive no hwtber correspondence about this visit
I21.12A3

�i
Type of Visit SXompliance Inspection ❑ Operation Review D Lagoon Evaluation
Reason for Visit ISILRoufine ()Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number hate of Visit: /d ! b Time:
Not erationAl Q Below Threshold
®-Permitted ®-Certified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: �r� County:
Owner Name:
Mailing Address:
Phone No:
Facility Contact: 11 Title: Phone No:
Onsite Representative: �1r a A7�r 'Z Integrator: - I I S
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �9 Longitude ' 0• �"
-Design: Current
Desgn Current
Cavaeltv. Population.Cattle Ca seih ; PaCurrent
nSwine. Poultry Ca aeity Population ...
Wean to Feeder I Layer JEJ Dairy
Feeder to Finish Nvn-La er ❑ Non -Dairy$
El Farrow to Wean
❑ ❑ Farrow to Feeder Other r
❑ Farrow to Finish i
Total Design Capacity
•
❑ Gilts 1;
Boars al SSL
I Ttst W '
' Number, oiUgotms:
g ;:::';: ;:° u su ace Drains resent La aon Area Spray Field Area
i Gldiinj Ponds l Solid ;Traps �; •„ '. No Liquid Waste Management System
Discharges & Strearn ImRacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
e. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection eaten t
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier;
Freeboard (inches):
05103101 Continued

Facility Number: 5/ —
Date of Inspection JU 10�
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 maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlieation
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Croptype
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Rgquired Records --Dements
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
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 ❑ No
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 ❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Corot>ieats:{reFt'r:trs:.questlon #):`Explain any:YES r€any reeommetYdatioaS orany other cotnin answers aninvo
. u ...-.........a .......... ...�..,,...._._...
Use drawings of facility, to better explam situatlons;Juse idditioi itpages as necessary): Field Copv ❑ Final Notes
.. �
` .A...i �r { . _. .I '...'•.:. �. it �F . � .€ ii � �€j,!,�::• iH _�r ;x , 1
, ���I
J ;d " A",tf/ 19+[I'eol holy die. ee ' l[� a r ��Z �rcG 7Ad' r��/I'
%f m k� I rrr 7• L_�oo z Ze,,el f`5 /,,.9 A-
Reviewer/InspectorNome ,a P
Reviewer/Inspector Signature: Date: e
05103101 Continued

Facility Number: 3 -
Date of Inspection
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. [s there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan b[ade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ Vo
❑ Yes ❑ No
❑ Yes ❑ No
AddlOnnal Comments and/or Drawings:
JWJ
05103101

(Type of Visit 0 Compliance Inspection Q Operation Review 0 Lagoon Evaluation J
(Reason for Visit 0 Routine 0 Complaint ❑ Fallow up 0 Emergency Notification Q Other ❑ Denied Access
FDate of Visit: SISDISODZ Time: 1Z:45
Facility Number 31 425
Q Not Operational Q .13clow Threshold
® Permitted ® Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .............
Farm Name: P.Q&Chap.#l...................................................................... County: 1).y 1La.................................... Y.YJRQ......
Owner Name: ,IQltu.11'�P.eterstrn Phone No:
Mailing Address: FjQ.Uox.2,lt.?................. .:.......... ,............................................................... 3'i!Alard..N.C........................................................... Z547A ..............
FacilityContact:............................................................ Title: ............................................... Phone No: ......................................
Onsite Representative: .I�nxpetexs4p--•---•------------------------------ Integrator:l!'�utRl>,y���i),Y�Jtt�---.---._._._._---•
Certified Operator: Jam cs..U.. ............................... jFK'tRXjQ 2........................................... Operator Certification Number: lfi4fiS.............................
Location of Farm:
West of Wallace. On South side of Hwy 41 approx. 0.4 mile West of eastern intersection with SR 1156. +
® Swlne ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 44 24 « Longitude 7$ 046 F 2474
Design Current
Swine Canacit►+ Pnnulatinn
❑ Wean to Feeder
® Feeder to Finish
1800
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design. Current
Poultry Capacity.Population Cattle Capacity.Population
❑ Layer ❑ Dairy
❑ Non -Layer I 1 ❑ Non -Dairy
❑ Other
Total Design Capacity 1 1,800
Total SSLW 243,000
Number of Lagoons 19Subsurface Drains Present ❑ Lagoon Area ® Spray Field Area
Hiilding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ® Yes ❑ No
Discharge originated at: ❑ Lagoon ® Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. Ifdischarge is observed, did it reach Water of the State? (If yes, notify DWQ) ® Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure ti
Identifier1........................................ .......................... ........................... ........................... ...........................
Freeboard (inches): 24

VO/U. Nul
►.UMM"eu
171iciifity number: 31-425 Date of Inspection ZIZ012t]UZ
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. is there evidence of over application? ® Excessive Ponding ❑ PAN ® Hydraulic Overload
® Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA WMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records _&_Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
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
®No
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
❑ No
p No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit,
.,._-.i...r. rvvJie�' a i;Y m nsl tiR51a,7q�YIF.tiiH#1 j � Mk' "q �' _ 7E� "�RfM1liAJ1A13R1. -i .�.,d11 .I ..�id�]�:I��Is1eL1. I.I._�lal.l�.�. I.�ai�i4.µl .I •::�: :iahltt.x�..l#�,i.lei-�.::.,IE;s r,-:....�:ie: _•I i.:.•..-• .. '��� }ai � i � i� !• : !� �1�1 , ,.. x . .
Camtnen0 tref I'G.question #):I'Explatn any YES;answers:and/or.:any recommendations or any other comments,, t-1
stw�as s.-,, as .�,w �la� �-ri„ s a �a�4e^a,y.,.,wne ;�,� ..nls:slaa I i'
Use drawings of:foci//tyin'better,,:explalnsituations.t(useadditinnal'page;as„neeessary)!3;[„fif5'
❑ Field Copy ❑ Final Notes
� a y�qy dN.ye j�!-g� : ;; a.:g pI
�. "ICI IiPoPoft�3 ;4-`I @rt��'�""INH2'A Si 48 I'll A�.4 sx.
This inspection was conducted after 1 observed animal waste in the unnamed tributary to Rock Fish Creek at Highway 41 just
downstream of the facility.
1. Mr. Peterson was land applying animal waste earlier this morning. Waste is continuing to runoff of the field and discharge into a ditch
which discharges into an unnamed tributary to Rock Fish Creek. Water quality samples and pictures were taken.
4. It appears that the lagoon level was at 18 inches in the recent past which is a violation. Pictures were taken of the lagoon and lagoon
marker.
11. Animal waste is ponded on the field and continues to run off of the field.
,.:..,............X
.......:.:.:.:.
Reviewer/Inspector Name Stonewall Mathis ,:...... .: E .........:...::
Signature: Date: 3 J 4

pe of Visit S Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit D Routine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number 31 425 Date of Visit: Zn112gt]Z Time: t 1:Ua
ro—N—ptOperational. Q Below Threshold
® Permitted ® Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold: .............
Farm Name: P.QtJ GhuAl.................................... .................................... County: D.Uplia .................................... WIR03......
Owner Name: ,Iolun.l��._._.. P.etersvn Phone No:
MailingAddress: PQ.Rt?x.7.6.7.............................................................................................WAlard..NC........................................................... 18.47.,A..............
FacilityContact: ...........................................................Title:............................................... Phone No: ......................................
Onsite Representative: dDhq�El€r�Aq..IaultrS��#erBM_._. Integrator:
Certified Operator:J,>tmj:A.D. ............................... jrg'(RX.&QU ........................................... Operator Certification Number: l64,fi5.............................
Location of Farm:
West of Wallace. On South side of Hwy 41 approx. 0.4 mile West of eastern intersection with SR 1156. +
T
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 ' 44 f 24 K Longitude 780 1 U4 , 24
Design Current
Design Current
Design. Current
Swine Capacity. Population.
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
ICI
® Feeder to Finish
1800
❑ Non -Layer
Non -Dairy
❑ Narrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
1,800
❑ Gilts
Total SSLW
243,000
❑ Boars
Number of Lagoons ICK Subsurface Drains Present ❑ Lagoon Area IN Spray field Area
Holding Ponds 1 Solid Traps - ❑ No Liquid Waste Management System .
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon IN Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
® Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes []No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. 1............. ........................... .......................... ........................... ................. .......... ...........................
Freeboard (inches): 23
AA- MI AA

ua/ua/vl
q_unrenueu
11%zility.Number: 31-42'S Date of Inspection 2/21/2002
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
El No
(if any or questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11, is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
I e fti
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (W irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional 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
® No
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
❑ No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
95?ii�.. �.... >5+"wEIRH�l+�w9! ..II"gPKF„A�..' '"�:n%1isFE3tflY.l:l-1'd.:i.ir'�SE
Comments (refer to questl.on #): Explain=an YES°answers and/or an recommendations ora.n other.c:nmrttents'r;;i;; . •;.:I'ia :=1;.;; `?;:;
:.. ... ,,... ._ FhyA!Ipr.usltt;s�rs�?PCs,�k�asi:ss��da° ns:';# .:. :. .:. 3'..:.: :.:::...:.: :.: ..::.. .:.
.�,M;.,.....;
Ilse drawings otfacilrty��ta€bretterexplain situation{use addittnnalfages as;nrcessary):,£, ❑ pield Copy ❑Final Nates
This inspection was conducted as a followup to the 2/20/02 inspection which was performed to investigate a discharge from the facility.
�►
1, Animal waste continues to runoff of the field and discharge into the ditch. Water quality samples and pictures were taken, The
representatives are working to contain and cleanup some of the discharged animal waste. I told Mr. Peterson that DWQ estimates the
discharge to waters of the State to be 40,000 gallons of animal waste and instructed him to issue a press release and a public notice.
r
7.
iewer/Inspector Name Stonewall Mathis''
E
iewer/Inspector Signature: Date: %� 42

Type of Visit d Compliance Inspection p Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint Q Follow up Q Emergency Notification Q Other 0 Denied Access
Date of Visit; 2122l2002 Time: ID:05
Facility Number 3l 425
Q Not ❑ erational 8 Below Threshold
® Permitted ® Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:.............
Farm Name: 1Put'.k Chop.€E.1....................................................................... County: 1.u3 jU.................................... WIR111......
OwnerName: xohn YL,._._._.._.___ _f P.eteC8411---------------------.---- Phone No: 9I.Q-Z85.3M6.{U1_25,EAQ71(N'a------. --
MailingAddress: iJP.Q.A9,X.Z67............................................................................................ WillArd..t C........................................................... 2,8.478 ..............
FacilityContact:...........................................................Title:............................................... Phone No: ......................................
Onsite Representative: .1��.p�etQ�.,IQhl��etersQn.._,_._--•-----.---- Integrator:• ------
Certified Operator: ,IAmca.Rx ............................... jrAt'eUQXk........................................... Operator Certification Number: 1A465.............................
Location of Farm:
West of Wallace. On South side of Hwy 41 approx. 0.4 mile West of eastern intersection with SR 1156. �►
® Swine ❑Poultry ❑Cattle ❑ Horse Latitude 34 • 44 24 K Longitude FT4
Design Current
Swine Canaeity Ponulation
❑ Wean to Feeder
® Feeder to Finish
1800
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑..Gilts
...
❑ Boars
Design ' CurrentDesign' Current
Poultry Ca acit Pv ulation Cattle Ca acit .. Pd uNtiun,
❑ Layer O'Non-Dairyl
Dairy
❑ Non -Layer
❑ Other
Total Design Capacity F 1,800
Total SSLW 243,000
Number of Lagoons - 1 IN Subsurface Drains Present ❑ Lagoon Arco IN Spray Field
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System " ei "'
Discharacs & Stream Impacts
1. Is any discharge observed from any part of the operation? ® Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
w Identifier: ............. I............. ,:.......--......................................--........................... ........................... ........................
...
Freeboard (inches): 23

UNW/Ul GUMMICH
^Facility Number: 31-425 Date of Inspection 2/22/2002
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [:]No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes []No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes []No
Waste Amlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (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 ❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? '
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
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
® No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted4hich cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Mid''•,1Wy'...'"'MF'tlIPIV•..AWWW ►tlgr"+�4"tl �•`'.4ldjlif:iBiJi%}j3in:.'•'Hfiis1.'H!s9A 1Flfl4is{sze:yfiFal$!8�:!'N1:1if�f:�.'yl �'I:�:]:i'q'''�'
Comments (refer to questio-nl1/—#}; Explain:any YES answersandlnr:any.recpmmendat�ons or'„any: Qther commen.ts:.'
9Ni °4d' 1�[1 N.wni._ reei_ •..,;.i.re�ln.'
is �e
Usedsowings of�facility to better.:expiain situations. (use.additional.Pages as. necessary); rCj FieldCopy❑ Final Notes
�s-
• .. ,,... S�ss:8iII5 ;&� iYs�i3;•."T�,^.IN'w!;.'riT;:"':-,!1-'°i"!.'.,°:".`M?E:SB ;ii:f...., .al;
This inspection was conducted as a followup to the 2/20/02 and 2/21/02 inspections. Representatives continue to contain and cleanup
some of the discharged animal waste.
1. 1 observed animal waste discharging from the lift station and discharging into the ditch which discharges into an unnamed tributary to
Rock Fish Creek. Water quality samples and pictures were taken for this event as well as followup to the discharges of 2/20/02 and
1 /02.
�.� ..
Reviewer/Inspector Name f'
Stonewall:Mathis
Reviewer/Inspector Signature: Date: 02—

Q� W ATF9
o Y
March 11, 2002
John W. Peterson
P4 Box 267
Willard, NC 28478
Subject: Inspection Forms
Pork Chop # I
Facility Numbers: 31-425
Duplin County
Dear Mr. Peterson:
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Gregory J. Thorpc, Ph.D., Acting Director
Division of Water Quality
On February 20, 21, and 22, 2002, I performed inspections of your animal operation and the animal waste
management system serving this operation. Please find enclosed copies of the inspection reports for the
referenced inspections. If you have any questions concerning these matters, please do not hesitate to
contact me at 910-395-3900 ext. 203.
Sincerely,
Stonewall Mathis
Environmental Engineer I
enclosures
cc: DWQ Non -Discharge Comphance/Enforcement Unit
W Y Sj
n
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405-3945
Phone: [phone]
Fax: [phone]

`Ilivis[an"of•Wafer- a li��,�' - -
W:_�.., •..... _.. .... _ ;'�+e..::.�, .: _:.:., ..,�:rr.�.. 4.._—____ ._i_.ev � --__ _ _...`J �."t., ._ .�i v. ��i�tih i.�7. �...� ti :f r..� . � � ..
EType of Visit Q Compliance Inspection D Operation Review Q Lagoon Evaluation I
Reason for Visit 0 Routine to Complaint Q Follow up Q Emergency Notification D Other
❑ denied Access
Facility Number 3l 4Z5 Date of Visit: 2r21]ROt72 Time: 12:45
NNot O erational ❑ Below Threshold
® Permitted ® Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ----------
Form Name: P.RtiXhi]p .1........................... County: Alt,FIlil.......... .......................... 3'. IRQ......
Owner Name: jolm.W.__.___._•--_-_-- ............ Phone Yhone No: aQ 85:3 Zf►-(H,1-2.8{ s 4T .(�'1'J._--------
MailingAddress: P0.2.01 67......_........ :........ ......_.......... .._.... ...... ................. _....... .W.Mars..NC.......... ............................ _... ................ MAN ..............
FacilityContact: ...........................................................Title: ............................................... Phone No: ......................................
Onsite Representative: ,Ia1pg,5 p�Qp-----__--------------,_----_•-._. Integrator:lrphy�amlJ~x�ax�t_---_------•---•--•
Certified Operator.Jamles.B ............................... fttg,C ott........................................... Operator Certification Nuinher: 1iy4.taS.............................
Location of Farm:
West of Wallace. On South side of Hwy 41 approx. 0.4 mile West of eastern intersection with SR 1156. +
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 ` 44 24 u Longitude 78 • di
Desi' n ` � Curren
_ ne
a"C'aci Po' �ilati
y_a ❑ Wean to Feeder
Feeder to Finish 1800
Farrow to Wean
❑ Farrow to Feeder
;.S ❑ Farrow to Finish
❑ Gilts
:-a
❑ Boars
Number of.Lagoans - ,' 1
"' .Haldiag Ponds l SoIid,Traps =
Desig 4' ren Ilesigri Ct<rrent
F;: n.a: ur
Pnul `; Ca aci' Po illation Cattle_ Cs., ''cif"'I!IPo' fi a u1a on
'r ❑ Layer ❑ Dairy
❑ Non -Layer JEJ Non-Dairy
Other
; Total Design Capacity, j 1,800
- f,. Total SSLW 243,000
Subsurface Drains Present LJ Lagoon Area 10 Spray Field Area i
No Liquid Waste Management System
t
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ® Yes ❑ No
Discharge originated at: ❑ Lagoon ® Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ® Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _......._..1....--•--........ -- -- -- - ---- --» -- -- -- -- -- -- -- __...-•-- ----•--........... ....... r... _............. .................. .........
Freeboard (inches): 24

c�: •�; •; Eir
i.rnrrrnrreu a
Facility Number: 3174:5 Date of Inspection 2/20/2002
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? (If any or questions 4-6 was answered yes, and the situation poses an
❑ Yes
❑ No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ® Excessive Ponding ❑ PAN ® Hydraulic Overload
® Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA WMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records &_Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
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?
(iel discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/inspector fail to discuss reviewfinspection with on -site representative?
❑ Yes
®No
24. Does facility require a Follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
C! No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
x IMtt a . ism MR r re ommen a ans or any;oth r,cnmments.. � ;f.,,'
Loom ents r fer o u.es W 11
t7s�e awln s tif�fa "ill to aet a ex ns a used ton ❑Field Copy ❑ Final Notes
This inspection was conducted after I observed animal waste in the unnamed tributary to Rock Fish Creek at Highway 41 just
downstream of the facility,
1. Mr. Peterson was land applying animal waste earlier this morning. Waste is continuing to runoff of the field and discharge into a ditch
which discharges into an unnamed tributary to Rock Fish Creek. Water qualitysamples and pictures were taken.
4. It appears that the lagoon level was at 18 inches in the recent past which is a violation. Pictures were taken of the lagoon and lagoon
marker.
11. Animal waste is pended on the field and continues to run off of the field,
^r
Per/Ins .,,
Reviewector Name tnnii all
;uC W ;Mati�is;y..�.:.
Reviewer/Inspector Signature: Date: 7 11 Q'Z

Type of Visit Q Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit O Routine Q Complaint Q Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number 31 425 Bate of Visit: 21211Zt}o2 Time: 11:U0
D Not ❑ erational Q Below Threshold
® Permitted ® Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: . .. .. .- ......
Farm Name: Putk Ghpp.#.1............................................................. County: I?.uRlia...... ....... ....................... WJR0 ......
Owner Name: dolun Yl',_._.- P_ett tsD1�_----•-----------._._- Phone No:
MailingAddress: PSG. p GT_-..-._...-._. -.. .............m ............-_ ........., Wi(]lard..NC._................ ....................... ................. ..............
Facility Contact:...........................................................Title............................... Phone No:
Onsite Representative: Integrator:l�urvhx�amilY�_._.---•---------..
Certified Operator:James.B. ............................... Petstan....»..................................... Operator Certification Number: ...........................
Location of Farm:
West of Wallace. On South side of Hwy 41 approx, OA mile West of eastern intersection with SR 1156. +
T
®Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =OF-4-4761 24 .6 Longitude
- - -
- D = y F..=._'.`'.. Dest n ° r..Curren C r • Desi
y.. esign,.J=_- urren :.. :: ,.....: -r g a=,. �,;" gn urrent
Swine - Ca ''aci'
Pu ulatlioi%
❑ Wean to Feeder
=. ® Feeder to Finish
1800
] Farrow to Wean
:; ❑ Farrow to Feeder
❑ Farrow to Finish
a Gilts
1' Bars
4-: ❑ o
°Pu¢itry'= : ',. xCa aci Pawtzlatitin -Cittle - Ca2sci!X Population
Layer ❑ Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other
a;TntalmDesi n Ca a±ci $00
'� ry �v:=Total SSLW -:� 243,000
••� Tom• -
h
-
r'I
ber ® bsurface Drains Present g Spray Field A ea
"Number fliLagoons 1 s"; Su t ❑ Lagoon Area ® pro e1d r
HnIding PoA /,Salid�Traps y ,;; Na Liquid Waste Management System
Discharees & Stream 1 mi3ac
1. Is any discharge observed from any part of the operation? ® Yes ❑ No
Discharge originated at: ❑ Lagoon ® Spray Field ❑ Other
a, 1f discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b, If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes '[]No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [:]No
2, Is there evidence of past discharge from any part of the operation? ❑ Yes [:)No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............. 1............. .... _......_......_ __.. _.-- -- -- -- -- - ------•......_......_... . .........................
❑ Yes LINO
❑Yes ❑No
Structure 6
Freeboard (inches): 23
nrms,na

u�u: trr LUI7ftlIllCll
Facility Number: 31-425 Date of Inspection 2R1R002
5. Are there any immediate threats to the integrity of any of the structures observed 7 (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN El Hydraulic Overload
,,
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents .
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel %W, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes-
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional 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
®No
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
❑ No
�] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
en re a ue on x 1 n e n 1} me a n s or any o het comments,
s. 1n s: fyfac 1� a e lain a s a d a a ec sa ❑ Field Coy ❑ FinaI Notes
is inspection was conducted as a foIlowup to the 2/20102 inspection which was performed to investigate a discharge from the facility,
+
1. Animal waste continues to runoff of the field and discharge into the ditch. Water quality samples and pictures were taken, The
representatives are working to contain and cleanup some of the discharged animal waste. I told Mr. Peterson that DWQ estimates the
discharge to waters of the State to be 40,000 gallons of animal waste and instructed him to issue a press release and a public notice,
r
Reviewer/Inspector Name ;Stonewall a..this;,,r,:t �►t �GG.,....
....... _. rF.......
Reviewerfinspector Signature: Date: 3 11 4-2._

� � .:Y._., _ .. .r.r...:.�.i_'-.�i....':;Mr • ...:a�ri5.:'S'•`*.l]ivisian oi�Wafer_ uall � �;��-0- .�,�., 5 �-�-e= -�:='� �r��F.. - -Cri
' S.: � }a-S...-,w � _�.vey:�� � �*, �� .� f . _-".x��l'lYi��l!4�CRir4� s'y..: ���:.«w'I• !i.;,k �. �',��i' _
-
"�•+ •.��.�.�..,, �" .. � "�__.r ._ - n"�e ° _ _ �'..�..-�..�� ..�.i::: ���. `r�`�': �.. is �. } wp '.. '. . �a:;m . ri.�i.:i �. -
,. a �:. .. . . :..::. :.......
x
-'�-^.�z�r!ra.*�!z• ._.,^±!'"..!i+�" - _ ..5"�:'?�."Y-'-'....". .�.� ...... •. —___ ''�+•;iSr....'"L'iY""a�.:..;^�w..�f�;;'!inf�.�:......'�wiw � i..,...:.
Type of Visit O Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit a Routine Q Complaint © Follow up Q Emergency Notification 0 Other ❑ Denied Access
Facility Number 31 425 .
Date OFVisit: 2R2l2oaZ Time: lU:as
O Not O erational D BelowThreshold
®Permitted ®Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: P.arli`ChtlpAlv......... .... ............... ..-......................._....... County: DAPlia...... ...................... ........
Owner Narne: ,lobo Yl'.._._.----_--.- _ P.etersv]>-•---------»------- -•-- Phone No: g1� 2$$:3 25.Lki1 8 $QT�(�'Y�.----•--.
MailingAddress: rQB_Qj.2LV ...... _... _._».............................. .................. ..... ' ..Wi.11Ard..X•.........•.,..._..:............................I......... ZRAN ..............
Facility Contact : ............................... ».... - ....... »........... Title: ............................................... Phone No: ......................................
Onsite Representative: dS]laf,S.PIG QD,aIohA�gl�rm------..---------..--- Integrator.
Certified Operator: .1,amca.B„ ............................... Ectfrin.......... ................................. Operator Certification Number: 169C5.............................
Location of Farris:
West of Wallace. On South side of Hwy 41 approx. 0.4 mile West of eastern intersection with SR 1156.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 • =I F-2-47u Longitude 1 78 • t]4 -2-4-1-
.Le esi n -Current: -''� �Desi n' _'.Curxesit• _,.; Current
:.;..,75
- --
g
Ea act �1Po diatior: o- r'Poultry r :':::_ F' Ca foci c o tilafion :Cattle '•r.9narh-v Pnnulnfinn
1....., _.__..... ,...
El Wean to Feeder
..�
@ N
;
....."- .., _...
❑ Layer
® Feeder to Finish
1800
❑Non -Layer
❑ Farrow to Wean,,.°
"�� ;
❑ Other
2
❑Farrow to Feeder
- _ ,
= :TotaI'l Des.
'::'C'.' - :!!:'��•. '•_ f"A�" --�i �`: .d"Fi'„ }'y'l.}'LN�gC�i +!:
•';�•-...�.,:". .r' :�,.,. ..-.. '�r;::.,..,,..r .:'r��.
r Farrow to Finish
�:p Gilts
-.
Boars
❑ Dairy
❑ Non -Dairy
gu apacify 1,$00
T0taI S 81.0i 243,000
;Ntiinber.nf Lagoons 1 lay H„ ® Subsurface Drains Present ❑ Lagoon Area ® Spray Field Area
��M -���
Holding Ponds 1 SolidTrapsN ❑ No Liquid Waste Management System
Discts r es & St_ _ ream Imnagts
1. Is any discharge observed from any part of the operation? ® Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes b No
b. If discharge is observed, did it reach Water of the State?'(Ifyes, notify DWQ) ❑ Yes [:]No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier: ........ -1...... ._...... _ .... »-...... ....... __... -.-..... .... _..................... ....... _...............
...
Freeboard (inches): 23
nrjm%mt

try/tr�r[rr
�.-rr[rrrnrrru'
Facility Number: 31--425 Date of Inspection 2/22/2002
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6, Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
❑ No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
_Waste Annlication
I0. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (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
❑ No
16, Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Rcauired Records & Documents ,
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? '
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ict irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes-
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify' regional ❑WQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
®No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted -which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
r e a es o 3an an c n a i ns nr any o----
ther c mments.
;Use rawm s of m t i1e t r e a s e: o °n cessa ❑Field Copy [3Final Notes
This inspection was conducted as a followup to the 2C20/02 and 2/21/02 inspections. Representatives continue to contain and cleanup
+
some of the discharged animal waste.
1. I observed animal waste discharging from the Iift station and discharging into the ditch which discharges into an unnamed tributary to
Rock Fish Creek. Water quality samples and pictures were taken for this event as well as followup to the discharges of2/20/02 and
1/02.
tan_eWrill'Math tK� ., mx:.
Reviewer/Inspector Name is : „w-.rA.'�"''�;
Reviewer/]nspector Signature: Date: I 02-

_ , M �.......r_..... -.. S7_ _ ..•:.:{•: f.f •r.•Jr':..+.. rr.:4<.<.v.. _ _ ._. .; w....+r..5.�::'c .i,A:� .. .rr...- ... ...Y. .. .._. ... �... �.
Type of Visit oCompliance Inspection 0 Operation Review ❑ Lagoon Evaluation
Reason for Visit Cy Routine D Complaint.,g�Fonow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number a? l r7 Date of Visit: iL� Q� Time:
Q Not Operational Q Below Threshold
13 Permitted 0 Certified 13 Conditionally Certified ©Registered Date Last Operated or Above Threshold:
Farm Name: .............................�J...!.°...�........................ _. County: ...........
'r.'.!............................ ....... ............ .......
......
Owner Name: „....... ��p„� ! .... Pei - s ar?.......................................................... Phone No:...................................................................................:.
FacilityContact: ... ................. I..................., ....,.............................. Title:................................................................ Phone No:...................................................
MailingAddress:.......................................................................................................................................................................................................... .........................
Onsite Representative: c�rxeS �Q IK�SDE'] �?t" :�.?r°'Sn¢!'G ......... Integrator:... J I�Fhvl....................................................
f...
Certified Operator: , Operator Certification umber:. .............................
Location of Farm:
i�
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �� �" Longitude •
Design
Current Design . Current Design Current "
,' S►vine ` Ca" aci
Po'"elation Poultry Ca" aci Po elation Cattle Capacity `Pa ulatioti
❑ Wean to Feeder
❑ Layer ❑ Dairy
❑ Feeder to Finish
JO Non -Layer I I JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
10 Other
❑Farrow to Finish
Total Design Capacity
❑ Gilts
_
❑ Boars
Total SSLW
'Nnnobet. of lug"w766'
Subsurface Drains Present IFO Lagoon Area I0 Spray Field Area
S �-Hol ing Pond '_/ Solid Traps
❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. It' discharge is observed. what is the estimated flow in gathnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑-No
Waste Collection & Treaftnent
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3- Structure 4 Structurc 5 Structure 6
Identifier: ................ N. C.L,/..........................................,........ .............. ............. .................................... ......................... ........... ............ I.......................
Freeboard (inches);

mber: -j I -- yZ 5; I Date of Inspection 1 e Q 1
ere any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
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 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? "Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? PrYes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
M. 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?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc,)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
kf
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?
C7 .Yi arjs.o ' ¢ f cle,01 ire ka 0jug 5•Yjstf
.. • �arxesi�orit3esr:ce: a�atit: this visit......... •...........................
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes VNo
❑ Yes ❑ No
❑ Yes ❑ No
�7M,,: n: ..a.,..ir..�... ;. ..,,.� ,�; . - ...�- .-... - -- • r"�'efltn..nmr-Y� •r - -
Cotntnents (refer Go question.#):;,Explaidany_Y1:.5 amwers sndlor any, men iion's or aiiy'other'toriiiueafs ` �; GA
'".i A;H{3}.. _.�. ;•� - -.Z1—ra_:IA;VT .u� ;t+; Y:;hl.-....:� L ^:. .� �i"ter',; �' • .
Use drawin of factii to better a laui`si[vahans. tise"additianal ages as necessary}= #,? �_,: -''"x�
5 cw. r0 Gl% `I j tj ot5-� rx % `
NG>~iE : �leel�L �-Q i"� a i�ti r'"iDC�,'{i Cq-�'i Qz'} 3 '�d Y ��' � � f
sal ifAs nv'e 6Dv4c,;ncdJ, .sr�•.,� soi its a+-t� L"Ie"Ae qrr
41 e ek,d dF +1,e kzv htL sus + ?A q c tA1,e�r ll, f� QG�S�S
N Eery r� Blue r� w.i �o CA -? u re -jL► � z W as 4 e aMd r� l � �� r,' t,., e c� ; s c. u ss--4
L""; i4:.-lr� �{ 1"ald Cal ; •, p►�t ke r i fx4 koLtie �` ��Ei7irr,��j C r�G� �7,1Si h
o h ias-� �ovse . fl c,L>se 4'2 does m 0 Af pear 44 be eA P�''Vbrer-, ;}, 41iis
res,Fe e,} , bL)a shncs{A k mpvt oreA 4 r-1od 'a-, iP- Y-" ,t,d e essar�.
■� � �n �� - � ]� g ( ' �NY� .►:2•��jf:Y:� ; =:r. ;_.�.r :f"�'y.� �,d =iC^i.::''itF�'�u � '� '�'YU
Reviewerllnspertor Name d ' 1+�; ,•leaf r'+ +.,�.� <l ':l/�+_s " �.i.� w� L:; a n' ryri=:• :::} tw' 3e a r4,H =';;�
Reviewerlltrspector Signature; Date: 10 2 IfQ 5100

Date of inspection jd Zi p I
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the Iand application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
�.:. - - ,. � rvona Comments an ar ra ngs: _
Ne4c. 4o eon4so tr.< i"qs;c{P 11t)LAR qY�d 1Peeves14 Ae"
`
-�r0 n► $ r d I IP-1 s-i c1C S of 4ke rtz r M n1(!nd r c'J
Y'AA I i + c r r d s 6frzh -le
the
I� ti54 3 4 �er meefxl � eretUre rl?'Pper O fem. 4;'Of)
F-4
p•F +1,e W x, -me s . 1NJev dt 4,o �e .Sv r e-4kq � L-744 s4 e ; _� C,Ci! ` q;A
LEI;,41 ,&, qkc wr..34e. ,r►1c4ng)eVV%,o4 .S��c►� j�' t��q �rS �� v� -�d
be, �mceie do FvmO.
"Ced 4o ir1��R �! , 45 d eo ree �; �e ir,]�c�seGj;c�rf kAJk 1'e
•1-l: a eA k if A-� em A� r;19e -�i L,4 tk-fc1L'1 r9eV 10o he /ayeh r
Al sii, rleed 40 rn�A eredZ4 creel on ; vie, er &kc uvall LvMt
c1q�; 1� pears ~��+ 3 ��,;s �re�, �,�ser� e� 1" s1k1e r1y
AMC` NCO -{D
h�rv�s�ed� Fu4vre s(;0e4 -iced k7eeof e 4.- be L AuI ed 4o
4-t,% c° f el rl tt i 1) .to r d $ sfvsa I
lUo-1�� T�ve diPA has been fVenf e'4 "'4 410 ren\e>Ve Ae t/t/a-"4C
-ry,❑m 4(,,r d+k,.k, Z+i-C Lv..,s eto�,R of nit, )1,1s4rVG4
5j00 -

Type of Visit jWCompliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit O' Routine Q Complalnt.,IdFoilow up 0 Emergency Notification Q Other ❑ Denied Access
I 25 Date of Visit: Il+ Z CJJ Time:
Facility Number
tD Not O erational 0 Below Threshold
13 Permitted © Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: ........... .c.r.k.... hap. 1.......................... ................ I.......... County:. V .'.....»............................... .... ..... ............
OwnerName: ......... 470.�'+t..... PAr a ............................................................ Phone No: ......................................... ............................
�............
FacilityContact: .......... ,.................................................................... Title:................................................................ Phone No: .................. ................... ......... »..
MailingAddress:.................................................................................................................................................................................................,,.................................
Onsite Representative: r�r+.e5....Pi� �SD!7t.. �mc.Y....Pie ►^G............ Integrator:... '�.�.....................................................
Certified Operator: ❑ erator Certification iVamher:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� �" Longitude ' 6 66
Design :Current'
Swine Cauacity Poouladon
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design ' Cui'reiiif i:r':
WG I
Poultry CapacityCipacity Population . Cattle Capacity! .Po ulatiun4i .:,
❑ Layer ❑ Dai
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity ,
Total SSLW
x
Number of'Lagoons : ❑ Subsurface Drains PresentlD Lagoon Area P Spray Field Area
Holding Pon& Solid Traps,. ❑ No Liquid Waste Management System
Discharees & Stream Imnacks
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. II' discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes []-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................ V w................................................................................................
................ .................................... ....................................
Freeboard (inches):
5/00 Continued on black

Facility Number: 3 I -- YZ S Date of Inspection i o p I
5. Are there any immediate threats to the integrity of any of the structures observed? (iet trees, severe erosion, [J Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancetimprovement? 'Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? J9Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Anylication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (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?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
A As•or l clenf+bi ► rp p PM.g S•VJS t Yv ►+��� #�� i�'g o # �
•caries' • Bence: t�atut the �#s#t: • ................
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes P(No
❑ Yes ❑ No
❑ Yes ❑ No
Comments (refer to question #): Explain arty,YES answers and/or any recoini endatio"ns'oir.�ariy;other [tim>iuenti%`'! ' fi `
Use drttwinp of facility to better eaiplain sittations. (use additional pages as necess>ijji
iry): a ,:.�, } y�� 1` ! ,: , l ; , l;`ji r+ I;' uR:� i t iE� 1. s 1, l, ii l
Kle-ed +0 ke 'vvwd ; r Cg41 orl .s +6 a► btew. ruG1N 4I1 W A54k Artd `
Sa}iIGf.f Al(C zP}q.+'fEd� Saws .SdIi+_d?S A►',a VvC..SAe q.-e
5i7;11 i' ��ce4e e+d eiF +iNe t t v5 �Ivu see y fAe• ,' C u jQJ hf, )7❑c1,SeS 143.
Need V hA,v6 t Wa - � Cof4vez 416!s Wms4e Arid? solid 5-
40- we
b";14 r\j a &I op,4ke F; r-r4 LjoL.,(e **1d Lv'jen*t C44tA, brtS� h
oh 1ej4 Lr.ause . H vase � does 064 ArpeAy- 4o be A pf,Vbr P ;ti 4kIS
r espe be y i v r>a� -� mdd ��°err] ors w�� d e i� heCessa�' i
IVIL i.Reviewerllns actor Name �3 9 Reviewer/Inspector Signature: Date: i Q 2 Q 5100

Facility Number; 3 -- �{25 Date of Inspection )D �y Q j
E
7N dnr 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 ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Yes ❑ No
Additional Comments an orDrawings:
N o4 e .' Nee of 4R ttOvAjSe q r\d fr-"eh4 Ae"
�rer'4► �v i f11►+^�-�ro•�+n �l,e S i otCS of 4)-,e hoGI.MP reze mnlend od
1VP4e , IVeeof --o ressvre L„1'a&L Cif aH.naf pve- r i v1 ) 44
reg54 ' 3 4►►�,.es ream teee k -fie �lF 1 erg$vre pr'opee
0-1c +I e rv-'-I ps. r0e,04 4Q �e sure -- kR- ta40e
4.v i411 #h 4ke vva-sob wLctn5LSe,04 s%s�c~'"' 1� �•ejv� ��s ��; vc �a
be, +cede 4o FvmO
N04e-, Need 4a At 45 deol-ef �,�e irt��SeCr�+or3 wkere
41,e Cent k �1 A-1~ eto glxe I.&'pe 4k,� �1c�►, fi�e� 1��0 he
Ao, need 4.* pm4e, , ero� !9fvA orr ;,,rler d.,kc Wetq 1v,4r•
c1gy; 11 gffec1rs 4VAa3 --kis Alec, Aooserok4 �rf S►r�cQ ►��
reelsa v; $;4L or►"d jr' fe �I A s rt-01 ye4 been relpal rtrd
AJv NCCZJ 440 d"-Ct spMa 4:c4 ;n 0,1 -&I;etrj dr1rP beetvts q>re
h,,,e.sPs4e,d. Fu4tlre s f ill ed -deed P7eeefr �-P be- L tiu I ed -4,
4-t\e ! wnCt �';tj for d
ed °17
`Tl-,c d �¢c� has Of bOVn fv".-,�-� -�a re►�ove a�1� l vase
-rile r. 4L-ic d• T', s CO M y ;h54rv1-4;' + -
J
5100

IType of Visit oCompliance Inspection Q Operation Review Ci Lagoon Evaluation I
for Visit ARoutine 0 Complaint 0 Follow up Q Emergency Notification Q Other 1 ❑ Denied Access
Facility Number 31 2 Date of Visit:
© Permitted © Certified p Conditionally Certified © Registered
FarmName: ..........E r ................. `6 .4» ........................... _.................
Owner Name: .... ......�� 1'.4.�e^� e r3(ti..............................................................
Facility Contact:
Mailing Address:
Title:
1 Q + l f Time: �
r Not O erational a Below Threshold
Date Last Operated or Above 'Threshold: .....................
County: J212 f r..'.-%.......... ........................ ........ .......... -
Phone No:
Phone No:
Onsite Representative:... 1 ('. .1.... r." L.$ �': t...................................... Integrator: „r`i �',?,............................... ...... ............
CertifiedOperator: ............ : ......................... I ............. ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 ki Longitude ' 4 «
Design Current Design Current Design Current`,,
''Swine capacity Pa ulation Poultry Capacity Population Cattle Capacity Po ulation
❑ Wean to Feeder ❑ Layer I JE1 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
-=Npinsl er of Lggoons ;. �. ❑ ❑ Subsurface Drains Present %agoon Area ❑ Spray Field Area
::Holding Pods I. Solid Traps ❑ No Liquid Waste Management System
Di%charyes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes 2fNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
0 Yes ❑ No
c. II' discharge is observed. what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
0Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? 9Yes ❑-No
`Paste Collection & Treatment
4. Is storage capacity (Freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes E�No
StrucI l Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ........Q.... ............. ........... ..e..;.:................... ............ ..._....... ....................... .,.......... .... ,................. ....... _.....
.............. _._._............ .,
Freeboard (inches): 21 3Z
C/AA ... _
.I'nnFi riii��i nx IfAlI`Tf

r] Number: 3 j -- et 2�5 Date of inspection 101 l 0
Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
/,AAre
seepage, etc.)
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
14. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Croptype F—ZScUt` Svet kS W k\E-A
13. Do the receiving crops differ with those design ted in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Recnrds. & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the Facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oel discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to dtsfusS rev iewlinspec tion 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?
1'IPL 48,0 cre P ad d06 g th#s'vjsti • You Xji1 xep,�ire jjo
6 res' atideni & abbot: this visit.:
❑ Yes A No
❑ Yes ? No
Yes ❑ No
❑ Yes -dNo
❑ Yes �No
❑ Yes.,ZNo
❑ Yes Z No
❑ Yes 'PrNo
❑ Yes RNo
❑ Yes No
❑ Yes No
❑ YesXNo
❑ Yes )z No
❑ Yes PNo
❑ Yes ONo
❑ Yes ;ZNo
❑ Yes WNO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes E� No
❑ Yes ❑ No
Yes ❑ No
{ id g ): Explain any'YFS y. comm"eri r y a e 1t 1
�(„-
Comments refer _ uestfoii # answers°and/or ap ter dadous a an ocher c min atB: ,.: ,�.4v
5yr .�y�'��,:• � .:f:'� "'i7:;� .: r�''4r • "- .��,ra+F �;.,A{.i:G•r••n..ti.. 'I"''
•'• ��,.. r +nip:
Use draiwings of iaciiity tu'bette� explur sihratians. [use additional pages'as necessary): ,�.,. t,;'.:;,;;; . w ;•;;
Z. 74 pipfcprS 4kq4 We-,S4Q t)qs 61 SGhctr5ej r,,crn 4bi.- k"""Se(s) n O
�lnS I ivS L-2'i A ergs G{ %14 cr a d • ,Leh . tvae i' L,1041 �rl cT vre-r w'rE
3. PeA 41A,1 } 1Zr,s bee►-, i !�d NxXf +e> XMies-1 'Ovi It, 9.o(5�+
�h6cz�► , a��� ���
W y0k,74 L).1dcv- .Feed k. )jams -2 be Ca�[
7. T'i e P'P� -} ►� dam, � •'� f ,�� s ct�,' o=L in�a 4�e 1,tJCa► 1'1�cS G1 � ; �e� ih i Ct'ICI�
►s eV'oeler & ke LJtiIr*. Tye pl,P r9Ms -fie i'e lcx',-Ce( �.�•• ;r¢�l
Ak
..
' Reviewer/laspector Name :F:. S pgWcri "'' ,tcl r1i5: - �` _ is ,:.,:,f•.s:;n„Rn,
�- eviewer(lnspector Signature: Date: td /7 1 Y 5100

Number: ADate of Inspection 1© I (1
Odor Issues
26.. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate' cover?
32. Do the flush tanks lack a submerged fill pipe or a permanenUtemporary cover?
Additional Comments an or gs:.-, _
1z Yes ❑ No
❑ Yes Z No
❑ Yes ONo
❑ Yes �10
❑ Yes gNo
❑ Yes E!fNo
❑ Yes ❑ No
'Z T'kC �'er��1�' c Irk i 5 bei•-5 Rer �!CJ)1 , t4'r" 4e Fran scJs- i1 +•5
-a �be, i�
N•��d 1*Vv..S{e �1 � ,,.,A[�[ Fre-Z4�'(,g N.&A-/0 of �.
$�f�c fob 4a �5*�r p:.ta rF r� �ct�ar ,►� c�,�
4r1G'� ptfV r8 - t �lrpe� a�4e►'��oar 1 S

Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation I
Reason for Visit ArRoutine O Complaint O Follow up Q Emergency Notification O Other 1 ❑ Denied Access
Facility Number 31 2 hate of Visit:
© Permitted 0 Certified [3 Conditionally Certified [3 Registered
Farm Name: ..........�� ... k.....'.�.................................................. .........................
Owner Name:.......... `...�...h n, N4 e {' S G h..............................................................
Facility Contact:............................................................................... Title:
Mailing Address:
Onsite Representative:... e- Q I'SG►'Z.......I..............................
CertifiedOperator: ..........................................................................,.....................................
Location of Farm:
in !} ej Time: �(j
Not O erational 0 Below Threshold
Date Last Operated or Above Threshold: .......................
County:.. ..v..r{.'...........................................................
Phone No:
Phone No:
Integrator: ...!..:.L V rit........................................................
Operator Certification Number: ........ . ................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 " Longitude • 4 94
Design Current Design Current Design Curkmt
Swine Poultry . CaacPoulton. attC_ct
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer 1 ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder I0 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts i
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present Lagoon Area JE3 Spray Field Area
Holding Ponds 1 Solid Traps No Liquid Waste Management System "" f:. {:;•
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes , &NO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes ❑ No
c. It' discharge is observed, what is the estimated flaw in gal/min?
d. Does discharge bypass a lagoon system? {If yes, notify DWQ}
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
xrYes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? 9Yes ff Na
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes VfNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .........O A ..................... �Qt"... ................... ....... ................ .................................... ......................... .......... ,
...,,.............................,.
Freeboard (inches): 2-1 32-
5I00
Continued on back

Facility Number: Date of Inspection 1 P�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
.0Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes A!fNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
Yes
elevation markings?
❑ )dNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ZNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes 0 No
12. Crop type F s C t1 a Sr E S eA
13. Do the receiving crops differ with those design ted in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14. a) Does the facility lack adequate acreage for land application?
'PINo
❑ Yes P!10
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?
❑ YesXNa
16. Is there a lack of adequate waste application equipment?
❑ Yes '0 No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes VNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes VNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes P'No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes INO
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 'No
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?
fifes ❑ No
Yi�1�t :a ' �� e1�ji.o wiv rp � �• dirriog t� s.v�s�t; - Yvip w�ti-> e J e, do �>ftt
car'rt'spondeitce a�wtat. this �isit� .. .
Comments (refer to question #): Explain any YES answeri''and/or.any reconitmendations of ii4 otfier comment&. ..€i ''O i. r
Use drawings of facility to better explain situations. (use additional pages as necessary)::,-
2. X-{ A-ejOC ,rs kA4 w4L54e �%ris 61; sGhQr'9e4 9"-Ven 4Gte 5eCs) ct+�dl •
ji� ►n40 a D�•"-FcZ► tvcdeK 111414, sG.wyWa-s . rtc4oreo e le-
3.
4-nkar).
Fee eL -} ha 11as beQ� P led ►?exf +a d; ��ties ��•► ! ode detinks� oi•-1� �� h
63 s1c 04 U,.tdav' PcaA 4►7k ids -kP be 4 IA.'UK+I1.
I"Ile fife 41-41 drqj'-,r x*041°0, ;n4a 41ze 1-t�oor�
5 ey"o A4"X3 i-1✓lt?y' dike t,,)gIf. `r e P;pe ►gMI 41e,1"era;red '',^ ;q�1•�.
Reviewer/Inspector Name
Qeviewer/Inspector Signature:
.S
�..,
_ T,
Date: 1 d 17 4 J 5/O0

Facility Number: Date of Inspection 1 t7
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0 No
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes E!rNo
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 �Vo
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 gNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Cj Yes ❑ No
Additional omments and/or Drawings:
25 . `rke - 'es cve �J „ 4tX4e pickn s4
� .
+e be •�Qof . �Jek sle O q &I a p-,A 4"' Q [ d reA' ' r. e n &d -/a ev -lee .
-2 N1ee4 4,, ell g4fj $v 1l . a�p� -�O 5 4`t� t4r Operjor ,�q GhV,"�e
�.-e rrce;,(cA Qrld epuv re 4ti.1 f rnPe, dlperlOor ; r,
►"S4ed �"Or 't�e 'Vre,rr►,
)8. &Imd 4-o Ytaje CLq.0" 1�2,5%e� ►nfOeeV14( :v� GW�1t-!
J
5/00

J$ Division of Water Quality
Q Division of Soil and Water_ Conservation L
Q Other Agency
w
r
e of Visit 1i>3fCompliance Inspection Q operation Review ❑ Lagoon Evaluation
son for Visit A Routine 0 Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Date of Visit: r?� Mim=e: r �/❑ Pa
Facility Number inted on- i12112t71}tJ
3 17�-- - ❑ Not O erational Q Below Threshold
'Permitted ❑ Certified 13 Conditionally Certified © Registered slate bast Operated or Above Threshold : .........................
Farm Name: lid r r11d �. Dt✓ jj.-►
.....F............. pp Count►•• ...
OwnerName: .....��..�+'l�....�f:54►'1......... ......................................... I .... -Phone Nw........................................................................................
FacilityContact:.............................................................................. itle:................... ....... ........ ................. I............ Phone No:...................................................
MailingAddress: ......................... ....................................................................................................... ................. . .....
Onsite Rep resent ati:ve:t►-d ±'?...E"C�.3A1'7 } M'S t��'.r0�'t•• Integrator:.. �"?'g !"" �,'"i 5�..�'lG,
Certified Operator: ... ............ : ............ .................... ....... ................................ Operator CertiFication Nutmber:_........ 4.............. ...............
.
Location of Farm:
A.
_,. - ,.... .. 177
JTSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude I.ongittrde &C
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE3 Layer I I ❑ Dairy
Feeder to Finish 7 50 JE1 Non -Laver ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons. 12 Subsurface Drains Present I ❑ ,ag—n Area P5Spray Field Area
Holding Ponds 1 Solid Traps F JE1 No Liquid Waste Management System
Discharges & Stream Imparts
1. Is any discharge observed frorn any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was (lie con%eyance man-made'!
In. If discharge is ohserved. did it reach %Pater (if the State" (If yes, no(ify DWQ}
c. II' discharge is tbserved. what is the estimated Ilou• in galhnin?
d, Does discharge bypass a lagoon systeni'? (ll•y'cs, notil'}• ❑` Q)
2. Is (here 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
❑ Yes XNo
❑ Yes X No
❑ Yes ETNo
V1 lej-
❑ Yes gNo
;9 Yes ❑ No
❑ Yes ZNo
4• Is storage capacity (freeboard plus storm storage) less than adequate:' ❑ Spillway ❑ Yes 29 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: C-} v e f .............................I.......
.....A.e- ..........................................................»....................................................................................
Frechoard (inches): 3 {
5100 Continued on back

rriber: :?I -- q 2-61 Datc of Inspection l !pLig Printed nn: 7/21/2000
there any immediate threats to the integrity of any of the structures observed'? Oe/ trees, severe erosion, ❑ Yes )Q No
seepage, etc.)
pre there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? 'ryes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? 9Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes JKNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 8 No
Waste A21dication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 1Z No
11. Is there evidence of over application? ❑ Excessive Pond'sng ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type reSG VC fR :j i., ect+ --
-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
7CKYes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement"
❑ Yes
JKNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
%No
Rectuired Records & Docitmentti
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNo
18. Does the facility fail to have ail components of the Certified Animal Waste Management Pi an readily available'?
$Yes
❑ No
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement'? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
gNo
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes
XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑Yes
(ie/ discharge, freeboard problems, over application)
,�No
23. Did Rev icwer/Inspec:tor fail to di uss, reviewinspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency'?
XYes
❑ No
25. Were tiny additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JgNo
�Vfl'*iota(ioils of Oricje'ntR$ ►i eC }70(ed. dt4ttiog tjhjs,vjsjt' • Y,o0 WflI e&OvCy 00 fut ter,'
Corr'sp fidetlC@.7�]OU .t1T1s 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):
a. is �a- I..Iay Ee4we-eh
17i r . �c � c.,r s e � Says t -� i S -f r � w► (,,]Web i�f F r}A Jfi[ e � C � �4 r1 � �-t !r rye 1; d eAr
ppond a vescs hose. j r �t5 }�y�s ►'s���r � ro►+-� -11,e end eP Ae
ryD �tci�sE Gta-5e!0 4# ' � �'�7f�7 dv� �Q ire° �'� '�e 4k44 G�fct1 ay s
�►e�sc -�a r{����t4"!• RJnCiorJ. ���! e irhr+�le�iW-Fe� �Hl�1 buil,4 ref
-�d GO►� TOI. 1 �"1 "'l►'1G 11.�,1AS� � r � -�'� a r!D [.t,��
�. Cllc! �a'�vor, n�c�s -f° be ,v+Gd�'�ora�s� ►n-�6 rtl��� ��R�' or' cldser�
Ck le car-.,.2 4e N IU s 54,1 lid
Reviewer/InspectorName-Po;,1eWg11 MeA,'J
Reviewer/Inspector Signature: 441&> Date: 1 OQ 5/00

Date of inspection
Printed on: 712112000 '
oes the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge htlor below KYes ❑ No
liquid level of lagoon or storage pond with no agitation?
Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes )gN❑
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 0No
3 L Do the animals feed storage bins fail to have appropriate cover? Cl Yes $No
32. Do the flush tanks lack a submerged fill pipe or a permanentltemporary cover? Yes ❑ No
17. C.,�,�.,-1►�dj �•c' �}r v 4E O L'J�� 4-:'J 614+cY 1 ctc�oor� rr,, a t 1.
lq. �"�e� ];-�y nec t...re �e nzre de4er�n:�n�;o� t.�as4e Prt�►�
wQ �► btr sc� Gn >V„ cf� ��r� arc�e- ^';; ►1� jQ�, .
1$. AJccA 4o eoelromC7�f Ecep( VLXA 1,L)As��
Mq nADcry,er4 T l /jkl Audi I.-16tve AvA;1n bl£ ,
rtq. AJ4M 4o ot -ee;1 4e-0 19eeAo1-me,4. hleeA 4,0 r.� a •� ryeca'-df
Z9. Pv-1 �t-Floa-��-�i��, dev' ce o,, A6' .sy3le
Ne e=. tc- ttr ve..de A� w� �ef Grey
es44 bl;Aed 46 a 1ID lv S r�yIn9,
J

01
` ! J5 Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Vislt 'IWCompliance Inspection O Operation Review O Lagoon Evaluation
Reason far Visit A Routine O Complaint O Fallow up O Emergency notification O Other ❑ Denied Access
Facility Number 3 j Bate. or 4'itiit: Time:'l 3: � Printed con: 7/21/2000
Q Not Operational Q I3clo►v'[hreshold
J'Permittcd [3 Certified 0 Conditionally Certified 0 Registered
FarmName: ......1�0..{.. ......G.j'1................ ."..........................................................
Owner Name: y7e Ve44 ►'1
........................................................................................
Facility Contact:
Title:
Date Last Operated or Above Threshold:
County: /"^
............................................
Phone No:
Phone No:
;Flailing Address: ................................. ....................................... .................. .................. ..................................................................................... ..........................
Onsite Represcntative rr T�C rr 30 ]'� des r^SO..'!.. Integrator:.. U ... . r Si n C +........
Certified Operator:................................................................................................................ Operator Certification Number:
Location of Farm:
,�T5wine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �° �•' Longitude �" �' �4'
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 ❑ her
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 2+ Subsurface Drains Present ❑ I.srg ,n Area Mq
Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Strcvam Impacts
1. Is any discharge observed From any part of the operation?
Discharge originmed at: ❑ Lagoon ❑ Spray Field ❑ Other
it, If discharge is observed, was the conveyance stt:tit-made?
b. If discharge is observed, (lid it reach Water of the State? (it' yes, notify DWQ)
c. if diticharge is observed, what is the cstimated Iluw in galhnin?
d. Doc,; 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 cutter than from a discharge?
Waste CoIiection & 'freatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spiliway
StruCUITC I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: '�"�;'' G �] ..................Y....d........... ......................................... .................................... .............................
Frechoard (inches): 3�
5/00
❑ Yes J'No
❑ Yes ;KNo
❑ Yes EM
SI /4.
❑ Yes PrNo
Yes ❑ No
❑ Yes ANo
❑ Yes M No
Structure 6
Continued on back

Facility Nember: 31- 2 Date of-111spcction L .0 CQI ] Printer/ o1j: 7/21 /2000
5. Are there any immediate threats to the integrity of any of the structures observed'? (ic/ trees, severe erosion, ❑ Yes X No
seepage, cte.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? 100'ves ❑ No
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ff Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 0-41 No
Waste ApRlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes R1 No
11. Is there evidence of over application'! ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes X No
12. Crop type F-eSC vC 1 r t]Y" , 1,3 k C q
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage ivr land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination'! Yes ❑ No
c) This facility is pendcd for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Resluired 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'?
(ic/ WUP, checklists, design, maps, ctc.)
19. Does record keeping need improvement? (ic/ 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?
(ic/ discharge. freeboard problems, over application)
23. Did Revicwer/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?
pia-* a#iQris'or ft. ficie dLes-►here izopo-00-- ing #. s.visiti Yvjt wi�i reeiye tt�o F. t. gr. . -
carrespandeiree. about: this visit. • • • • • • . '
❑ Yes $[N❑
❑ Yes Vf No
❑ Yes XNo
jFrYes ❑ No
,WYcs ❑ No
❑ Yes XNo
❑ Yes 15No
❑ Yes ONo
❑ Yes ;KNo
J6Yes ❑ No
❑ Yes JgNo
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):
s. f,,mAc ►s puddlGd hi e wG y fie-1 wrx Ae 2 ntt� -s qr,d d►464.
rnr. �e�crsch sayf i-r# is 0►^1 1,J ch r 0 W,,
qhd !.ns¢s dSe. A rt rtS 1E /,1'►S'Gk r e �J,-o••, -19e eYid W Ae
ZI d k o it -e G r AS p S� rd ✓ 41 a(V P. 4# C f �r i Q -� G I •� i ►^t j
9 sr rf ;�� � �a�'!• ZJraCfo '�px ir+� � � b it �'►'r�►
), 4P g r i m�� Ow A W be
4o covi-�.tin TA-t L.,.1�'4c in +- a ho&S<C' ' 1 J
f'o . ff ld / vo r, m C� s —fd �] iY► C D ��o r� ►''1 �� W �T e ir�►� a /' C�a�Y
[c'n[7, fo NtG5 UfahOt"��`df.
Reviewer/inspector Name o�C►�1 tai 1' C�� ;J
Reviewer/Inspector Signature: 1 Date: oe 5loo

) acility.Number: 31 — late 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 Wor below IfYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are (here any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONo
roads, building structure, and/or public proper(y)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? XYes ❑ 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 XNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes $No
32. Do the flush tanks lack a submerged fill pipe or a permanenUtemporary cover? Yes ❑ No
I. Ce,,q 4,-al ve,� a4ot4, u C, Yo wa-� dM oO ev, reLgaon war 1.
1q. pne,) ��y >r�e.eweWgjIe mere de4errnvtn4'o1, s4e p�^n
0�1 wd l'iW c atre- �Ie�e� "'�; ►1�l'�1a�, -
i$. JVcc�a v� ir+ q� G4r+i�ortc+7t C��-� i'�;�oi �►7 j,M� ��
K AJ ecnf -fie
q 1e , l 4 e .O p a e !l "o r r+'l apt . ju ceA 40 rC CO rAr
rev►% -46e"e%' Dwnce
Z 1. P.V4 IV) iC[ke P,re
Ne e = Corn sIiem 1pl Saeln be hti• V ende,01 an4 a f„ ain4av" Graf
dSldt bl;Jbed 46 A (row 5pr/41yirk
F,
5/00

Type of Visit Q Compliance Inspection D Operation Review Q Lagoon Evaluation
Reason for Visit O Routine Q Complaint ❑ Follow up ❑ Emergency Notification *Other ❑ Denied Access
Facility Number 31 425
Date of Visit �Ova Printed on: 413/2000
1-0 Not Operational Q Below Threshold
© Permitted ® Certified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .......••.....••...••.
Farm Name: AHm.Baynar.!Marlut".F.airsa................................................................. County: Ruplia ............................................... W..IKO.........
OwnerName: AJkn........................................ Raynor ....................................................... Phone No: 2.10:18&7108 ..........................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: M.JHye Rd......................................................................................... Wallace..Nc................................................ ......... U466.............
Onsite Representative:AlI4A.lWmar.............................................................................. Integrator: ]li &uVhy..FMnft..Farms......................................
Certified Operator: ,A ll=..................................... RAYM0 J.r..................................... Operator Certlfieation Number: 222M .............................
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Hor Latitude 34 s 44 L 24 " Longitude 78 " 049 72-T-166
Dischar¢es & Stream 1mvacts
1. Is any discharge observed from any part of the operation? ❑ Yes © No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes. notify DWQ) C] Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? J] Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway © Yes ❑ No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier....................................................................................................................................................................................................................
Freeboard(inches) : ................ 13............... .................................... ................................... .................................... ,...................................,...................................

Facillty Number: 31-425 Date of Inspection 3/28/2000 printed on: 4r3R000
5. Ate the'reliny immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes [] No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ 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 maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste AlIplication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
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 Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(id WUP, checklists, design, maps, etc.) ❑ Yes [] No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
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?
(iel discharge, freeboard problems, over application) ❑ Yes ❑ No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
l�fo irioiatioos: r:defrceericies were:riute�:d�iring #3iis •visit 'V,6u wfl1:receiVe na hiritier
check. Mr. Raynor and son were present at time of site visit
yn:S;Y,.i;+:{;x{;xS. F F�;any;•+;++:i•1i•?.1+9:,+1�'.,'�.•.•dt:.!.!,�d.; I.?�:i l•:i•i:•i:•i
:, :>,•3
3:
Reviewer/Inspector Name �.r...
rye

Facility Number Date of Inspection 13113 Da
Time of Inspection Z d 24 hr. (hh:mm)
[j Permitted M Certified [3 Conditionally Certified 0 Registered 113 Not Operational I Date Last Operated:
Farm Name: A I cn 12r� Lp'rer /1 k s .. F,,i f - County:..D.'.�P�.'.'?...........................................�...........
Owner Name: ❑
I..+ . .........................................►101............. I......................... Phone No:..........,............................................................................
Facility Contact:
Mailing Address:
Title:
Phone No:
J
Onsite Representative: ..... ......1.�.' !......... Z^ Q'�.................... ...... Integrator:../ .a!'?.,
....................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
a►I
.. ....... ......--... Tj
Latitude Longitude 0 •
Design Current Design Current Design Current
.Swine Capacity Population Poultry Capacity Population Cattle Capacity Po ulation
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish 10 Non -Layer I JE3 Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ soars Total SSLW
Number of Lagoons 2 ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Arra
Holding Ponds/ Solid Traps ❑ No Liquid Waste ;Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
n. If discharge is observed, was the conveyance man-made? ❑Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. if discharge is observed, what is the estimated t1ow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No'
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ® Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 -T, "C4, ,e
Freeboard(inches): ........r.,...s............................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 -- yL S Date of lnsvection
6. Are thd-e structures on -site which are not properly addressed and/or managed through a waste management or
A.closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
I2. Crop type
3 3 00
ZI Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for= a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
19, Does record keeping need improvement? (icl 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' Q•yiblaiiQns;Ot. dePOP5 •►+`q1'e 004.00609 #;tiis'v}sit! YO W111-f Wi6 Oo futtb& .
ctir'res aridence: about this A'sit* .......::::::::::........::....:::. .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
+ ❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes In No
❑ Yes ❑ No
❑ Yes ❑ No
.., ,. -.
Comments (refer to question`#): Explain any YES answers and/or any recommendations or any other comments. � ,11
[]se. drawings°of foci ity fo be Gz; 1 tter explain situatiods. (use"additional pages as necessary}:
ins
• �v�aG•�-��� 1rtJonv� s�uw-( et! �e 17y"v��✓' f `1 C�nSeG! of rdca✓��[ �a
w�S-�� wta✓tq�crv�Gn`� ��qrt �v;d ►�'t��-�-�gir�ed-
Na -� e : �'Y) . �a y n a r s�, .'o{ -� �, a Lt e ►-►-t a d + w Ar fie a�
! I r ort f o►�
j�►�9�,cUK/,e,4t vly g4ed
Reviewer/Inspector Name TO )1 c LV G I nR 44 ,"J
Reviewer/Inspector Signature: A/4LA-6:7 Date: 16 p p

Facility Number 3! 4 2S Date of Inspection 12 zVeo
Time or Inspection ! 5!S 24 hr. (hh:mm)
❑ Permitted ❑ Certified ❑ ConditionalIy Certified ❑ Registered Nat O crational I Date Last Operated:
+ !I g ?� 11
Farm Name: r+ 1 M � q n n r r !C S Fa e ►"'t ... County: , . U . tin .........................................................
..... .... ..7................................_...... .................. .......... ....
OwnerName:.............. �'�.....�� h. D............................................................. Phone No: .............. .......................................................................
FacilityContact:.............................................................................. Title: ........... ..................................................... Phone No:...------................
MailingAddress:.........................................................................................................................................................................}.._...............................
Onsite Representative: .......................................................................................I................... Integrator:.. �. V ff ....
Certified Operator:............:..:................................................................................................ Operator Certification Number:..........................................
Location of Farm:
�.
..... .................. T ,
Latitude Longitude �• �• �'�
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ $oars
+.- --Design Current Design Current
.Poultry _ :..''i Ca act Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I I Non -Dairy
❑ Other
- Total Design Capacity
= Total SSLW
.Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
HoldIngPonds 1 SaIid Traps - ' ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
h. If discharge is observed, did it reach Water of the State? (If yeti, notify DWQ)
c. If discharge is observed. what is die estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure ? Structure 3 Structure 4 Structure 5
Identifier: Lce
Freeboard(inches): .......z....................... .........................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
El Yes ❑No
❑ Yes ❑ No
❑ Yes ❑ No
[]Yes [:]No
® Yes ❑ No
❑ Yes ❑ No
JO Yes ❑ No
Structure 5
❑ Yes ❑ No
Continued on back
3/23199

Facility Nurtaber: 3 jI}ate Of lnspection
F'
6."Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste A a2lication
la. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b] Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Doctiments.
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�'S1 yi¢l 4ignjs'oi- tit~ficiertcie iv re �pted. 44 0jig �his•vis}ts yoo will-tooiye riq hutthoo
ctr�dence.abatit tizi5 visit
.V Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ N❑
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [_-]No
[I Yes [I No
❑ Yes ❑ No
Comments {refer to'quesnon #}: -Explain any YES ah"sswers'and oir'any recommendations or any other`comments."'T Y"" `=
Use drawings of faci ity'to'>ietter explain situdtivns:={us addit{onal pages as necessary
T.1s�eG io+7 cc,'ldVC,+e-, , 4, de4erw4Aivt a G'et nee. O-F A,c;
.2. A was-4e pvAA�eWs ca6serVed r�i eL sw,1e IecLd;.tiJc 4nwgrod '4,40� 411q4
4o IN, k-Fif 4 1✓rec, —F e s -wr ) e i,)oL.t rvxo r's� iK 4ke 6a4or'
6k �Ar k,�c her ,,P �n�; �R�iAq o, recevt � [oc,� eve A4 ;4 4ile tswq re. t
A 1.rdo�t�!' hose c��s friy;� in -{lie 5wq�e �7r�� iS +lc��- currcn�L'7 Go,tir�eGTeC�
-6 AVLY rlo1W S-OL"rcc . fnJ4 f�e LLJ�i S O (:'5["-V¢Oti ;,I +kc
d(ow r�s-� rCr�.`.► D,r -kNt St,,,p a l e e—K 4.41 y t;70 Al rXt; wa.sfe w a S 00Pr e v" l a n �
u ,5+,,eet,+ o G 4ie swa l e e vL40 a / f►Z-i• . LJq+e, u-a r; 4, kcn . ;
Reviewer/Inspector Name 5 ^I Ihewafi Ct Lj, f
Reviewerllnspector Signature: Date: d J
3123/99

Facility Number: 31 -- 2, j Date of Iospect-inn
Otlor 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 an 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? Cl Yes ❑ No
30. Were any major maintenance problems with the ventilation far (s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments an
or.Drawings-
.`:: „µ ;i'-
-
'RarnQ
was eid v i-re,4 Pa4o iv1,rIAec.4 ;aV� �
AL
Y c.� o u �d � �
i n. S� e G � i � � ��
F� G �� r ► �'� .
� A-�c+.,.t,�o -rle� 7o G o +? �A G+
! e 1017o' �,.�� d level .should Ge +o covyl;ance 1cVCJ
+>1 a cc
!! n
L�. A►i ►reir-�iye ktyao, iS Dv! s4e. W 4;r-k +s ncl inGar�7o�c,-�eo� ihf�
Ole bucLs e, Y"�-1gycMeV74 Plan "rid, W�;C-L, ;J tea} ; n
C1.o�urt?, {,91Ch✓1.
J
3/23/99

Division of Soil and Water Ctinservation -Operation Review '
- ;.•, "` � - ''''i 13 Division of Soil and Watiei'Conservatian -.CompIiance,Insp ctioii s>
R ..t Pig -
x�. r - f 1�1YISSOn Of Whiter al . _.
. ® Qu ity : C_6mpllance ins eCtion'.
:;;... Other A ene = U eration Reviiew.ti.�kw r ,
-.0 g Y lt,_t �, �.{...
._kR.:..��. .,, i. .���:=}'.f �. .�'• .�.. �:. .. - .- ..a_.�a.n. -. e:�'»r.^i.h
LO Routine 0 Complaint_ ❑ Follow-up of DWQ inspection ❑ Follow-up of DSWC review 0 Other �
• Facility Number 3t Z 5 ••Date of Inspection - 21 2aab
Time of inspection IZ5 24 hr. (hh:mm)
Permitted 0 Certified [3 Conditionally Certified 0 Registered 0 Not O eratianal I)utc Last Operated: p ..........................
I
r
County- ........................
Farm Name: ........A i f e►-i �a. ..jN0r asks Fc, r n-, . .!' i "•t
............................................................................................................ �...................... .
OwnerName :......... ..I.e1 ..........................`�... ..... er........................-................ Phone No:.......................................................................................
r..
Facility Contact: ..........
Mailing Address: .........
Onsite Representative:
Certified Operator:•..,..,
Location of Farm:
Title:
Phone No:
Integrator:... +� 09',-r
... l....cl............................................
Operator Certification Number: ..........................................
Latitude ' 4 Longitude ' i 46
Design Current
Swine Canacitv Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Pv ulation Cattle Capacity Population
❑ Layer ❑Dairy
❑ Non -Layer I I Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Numlter of Lagoons ❑ Subsurface Drains Present ❑ i.agaoEr Area ❑ Spray Field Area
Holding Ponds ! Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge orioinatted at; ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made".
h. If discharge is observed, did it reach Water of the Statc? (I1*yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gallmin?
d. Docs discharge bypass a lagoon system'? (If yes, notify DWQ)
A6
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation`? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway Yes ❑ No
Strulcture i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r
Freeboard finches]: S
5. Are there any immediate threats to the integrity of any of the structures observed'? (iel trees, severe erosion, [:]Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 1 -•- 4Z5 Date lit Inspection
6.,Are tli re structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7.. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application -
10, Are there any buffers that need maintenancelimprovement? '
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
vm�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c} This Facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel 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)
21 Did Rcviewer/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 AW`MP?
vIAl'a iQns'or. . ciencic� •ware )iOf d- OtWffig ON: visit; • yoit wii1->:ook ijd fu;tho '
co Cris*p6fid6c' e' a�iou t1�Tis A it. '
[]Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Comments (refer to gtiestton #): '-ExplaIn any YES answers and/or any recommendations ar any otlter`commertts.
Use drawings rif facility to'>etterexp[air'situafioris'_"(use additionai.pages as necessary
t ,,... .
4:risPcc4jon Gd,gdvOeci ;�, resf40 4a a pkenr Gcg114k-,.-4f -,,w on 4nortr-ms
,So(1•'Ge 411"4 A d;sc�,gr��e had occ.vrred -nd 4Ae �ae+'1� T a4er,Po Cd
a GerT��G-1 iti'►rl• . t�r•fnof ~}o w,�ke h;-1 a4v��e o-f -�k�s;f����or.
Y insrec4ce( -lie 4ac.;Ji4 atnod 1e)v►ia rla ev�denGe o,4' q -ecen4
as suOr5fied ty gYtonyr+,.ot/s C-al}er.
t11-. L CLOOOr•t I level szL dwld be jow e►r eo{ :in. q resrenr;�j tj 4)',e l� wtethnc r.
Reviewer/Inspector Name fV
Reviover/Inspector Signature: Date: �dDp
3123199

Facility Number 31 425 I Date of inspection 2/17/2000
i Time of inspection 12:45 24 hr.(hh:mm)
Permitted ® Certified 13 Conditionally Certified E3 Registered 0 Not O erational Date Last Operated:
Farm Name: ABeo.Rgeoar."klAl[ka.^...k:arAr................................................................ County: D.uPila............................................... ..IRQ.........
OwnerName: Allyn ........................................ Rayne....................................................... Phone No: 9.10A115:.7.2Q8..........................................................
FacilityContact: ..............................................................................Title:................................................................ Phone No:
MalangAddress:532AAter.Rd......................................................................................... W—allacc-11C .......................................................... 211.4.66 .............
Omite Representative: ........................................................................................................... Integrator: IklaLPl1Y..FamDX.FaJ'.m.9......................................
Certified Operator: Allan ........................... t........... Ray=,.Jr ..................................... Operator Certification Number: 229.8.6 .............................
Location of Farm:
Latitude F 34 • 44 24 Longitude 78 • =i F —24-1-1
' 'y
D"llia Current
r r'
=Design -Ctirrent� " as go Currept
s r ,�,., -r-
Saciao ,yr
Ca sileit
o Ailon,
Pauh ry
Ga aeN Pop .:Cut�le
„Ca [Halt �iPO aletlon
❑ Wean to Feeder
❑ Layer 4
Dairy
®Feeder to Finish
I800
❑Non -Layer
❑Non De�-r-r,
❑ Furrow m Wean
❑ Other
:rr
r
.. .
❑ Farrow to Feeder
, ❑ Farrow to Finish
Totel Design capacity
1,800
❑tilts
❑Boas
,
.. $SLW
243,000
,,,
, ?Total „
Numher oP1,a
aom
❑ Subsurface Drains Prcaent ❑ Lagoon Area 10 Spray Field Aree ,.
---Holding Pan4a Soa t
dTrape
^1
LJ'u ,�_ ❑ No Llquid Waste Management System
Ptschames d btrvam Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. U discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. ff discharge is observed, did it reach Water of the Stare? (Ifycs, notify D WQ)
❑ Yes
© No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify D WQ)
❑ Yes
❑ No
2. Is there evidence of fa st discharge from any part of the operation?
❑ Yes
❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑.Spillway
❑ Yes
❑ No
Structure l Structure 2 Structure 3 , Structure 4 Structure 5
Structure 6
Identifier:...........................................................................
Freeboard (inches): ................ 13................ ........................... ......... ........... .,...................... ... ................................. .................................... ..........................
..........
5. Are there my immediate threats to the integrity of my of the structures observed? (ie/ trees, severe erosion,
(3 Yes
[]No
seepage, etc.)
3/23/99
Continued on back

Facility Number: 31-425 Date of Inspection
6. Are there .,-uctures 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 yea, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Amplication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
7
12. Crop type
........... .......... . ---------------
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This Facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
!m
16. Is there a lack of adequate waste application equipment?
Renuired 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/ W JP, checklists, design, maps, etc.)
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional D W Q of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
211712fl04
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
O No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0 Yes ❑ No
© Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP7 ❑ Yes ❑ No
No i�inia#fans tar:d'eCrciericies were.no}eii:during #tiii•�iiii.. V.6u vil.receivrmo fYirttier:
a'rre ox+d rice �ibd�it'11�i �ira�i>r►' . .
nM > `rr►'... iita,zzZz-
t , .►,. , ri r >>:>
�I �tOr:•.:0 .iON(Owadd' i�u;,,,,>,��ii�ecii�>_>„����:�i
Raynor did accompany me to facility. Freeboard must be lowered in a responsible and timely manner and PoA must be sent to
WQ within 24hrs. A pull can be made on fescue field, PAN being the deterniniiig factor. Field is in good condition. Front field has
o crop, corn will be planted between March 20-25 (per Mr. Raynor).
WE
.-
f
Reviewer/Inspector Name,,- >:>:..... :>:....
:»::>::>::>::::.:
Reviewer/Inspector Signature: Date:

. `4. El Division of Soil and Water Conservation - Operation; Review :.. '. w '•i: ::: a! ; r.,
s Division of Soil and Water Conservation,»;Complfanee itispectiou , ;:,
® Division of Water i�uality-.Cottpliance'Iiispe�tian �:G n, .e.;,'''
.13
Other Agency - Operati6n Aevriew
1011outine p Complaint _Q Follow-up of DW ins ection Q Follow-up of DSWC review 46Other
Facility Number 3f �S Date of Inspection J / 214p
lime of inspection 15q 24 hr. (hh:mm)
0 Permitted [3 Certified 13 Conditionally Certified 0 RegisteredJr.] Not U erational Late Last Operated: A ..........................
Farm N:ime: ........L+.. 4!C .....� � � irks.... q'� �� ............. County:.... LC .I.A.....,....................................................
..................... ...........
Owner Name:............. 4 C '1 y M r� Phone No:.......................................................................................
...........' ..............................1................................................
Facility Contact:
Mailing Address:
....................... Title:
Phone No:
Onsite Representative; ... ,A1.142
... q.... & ,y.fj.Qc ........................................................
...........................
CertifiedOperator:................................................................................................................ Operator Certification Number:.........................................
Location of Farm:
Latitude Longitude ■
Design Current
Swine C".anaeity Pnnrslation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Design F. Current Design Current
.Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other
Total -Design Capacity
H Total SSLW
Number of Lagoons 0 ❑ Subsurface Drains Present 11[] Lagoon Area I0 Spray Tield Area
Holding Ponds/ Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
I. 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 ratan -made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Dins discharge bypass a lagoon system? (If'yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I
Freeboard(•snc}tes). ........... r ............................................ ......... ........... ......................... ... ... ............ I .............. I. ............................
5. Are there any immediate threats to the integrity of any of the structures observed'? (iel trees, severe erosion,
seepage, etc.)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [)No
❑ Yes ❑ No
® Yes ❑ No
Structure 6
❑ Yes ❑ No
Continued on back
3/23199

Facility Number: 71 -i�25 DaIC of Inspection
6. -Are therestructures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
� PdGl�
Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ikpplication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended Far a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
24. Is facility not in compliance with any applicable setback criteria in effecrat the time of design?
21, Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24• Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Ia yial'a idns;or• . .ficiendes •mere doted- ¢tr irig 4bis:visit: • Y:oi> W.idl•reeeive titi further
corres�arideh ' e: abhtit: this isit� .... ... .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Comments (refer to question #): ExpIain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary):
/Ve7r< eru PA57 �)::rSCwe6'E: WO5TC1VCFaS 70 Sry POK196D F►4ZeM d4cL�
Reviewerflnspector Name
15—t6;n4h/y)I 41n ke ..l
Re►•iewerfInspector Signature:
Dare: 11131 z
3/2=i)Q

Facility Pumber:31 —ills Date oflitspectinn i iz �dC+a
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon!
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, ctc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a perntanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Ad d i tione ' Comments an ar D rawrngs: S .
N f
�Zrcr2Id be sr o4-4-;, 1401 d:eec4l k 1Pr t ar -AQ 6 rea k i�,c 44* d4c1i block,
ot44 40 e-C!"Oye ► Xis4el-re;d .pl"'k4ure,
I'Ir, Ira �1taY .rq I'd .1r.012 tn1a5 ih 6e1f0rg4Cd r" 46 -l"eld OnOf q
e >•� h ¢� o r 4 o n same , d v se d -��, a o c c ��, e of ►'-� GG s rn�e
4 Gf t h t A vlf L wit s "rZ t'�cv O� Sll a ul i Gt r!'e Yhp t/ �'
y� L_,19aah i.S c4I Gcba1'''21-(es6ue ka�c 2"e,
ba.en Pum1yed Oki i�, r�braurl a �ea'' a�ci 1 a��'. A)o tv;*14e,r ceop
is Gt�r'e�en��� lcrn�ed iW 1ar�e .s1v>^�yF�`et�. W►;y0*,, e,rvp :Oxv, 4 be
olddeo� �Q w�tsG �ic►n. y!'!r• T�ay►•tor �ho�tld ��+kp �11 res�on�;b1,0
Yrt¢anS 4e lewer 1 Q0vl ]rt q �i+nne� �'►a+lt1�I'.
NOTE: I+Je Lugs eAee e vvore►2I 17 Or�1-I�[ . MO- jea-rw e x pee�< 4cel
J1]Q7�= =�l S � ia[-�-;o►� i.5 .rGa �e''�� o!,►ok npr* -f'cc r►►� . �1t+S S�a� r�� �+e J yr���,�
s�ocsc[ e r .19 ;4 Ltcts 41kg pe4e, ; n ? 4a �? e c k. r,does a �ld
+�� %'✓%r. �1y�!o,r 5e%ys 417,z4 eldt kG'jDnh '4gf beet, C11tSed . 17 Vy1Q�
Me. Xek7VAe,- 40 O-4. q'60r� a� Ae 14Yo011 c 16'swe flarl and
J
3123/99

to rcouune 0 IL�otnpiaint 0 ronow-up of i)vvy inspection 0 ronow-up of ilawt: review 0 Utner
Facility Number Date of Inspectimi 12/15/99
Time of Inspection 24 hr. (hh:mm)
p Permitted M Certified p Conditionally Certified p Registered 113 Not perationa Date Last Operated:
Farm Name: Allen.Raymar.."Marks".F.arm................................................................ County: Duplin WIRO
OwnerName: AI1,en........................................ I.iayavir........................................................ Phone No: 9.10-2&5-.72OR ..........................................................
FacilityContact:...............................................................................Title:............................................................... Phone No:....................................................
MailingAddress: 539ANtr.Rd............................................ •............................................ .W.a,Ilasp..NC................................................ •.......... Z8466 ..............
Onsite Representative: Alle&Raynor............................................................................. Integrator: Murphy..Family..Farms......................................
Certified Operator: .................................................. ................................ . ............................ Operator Certification Number: ... •.....................................
Location of Farm:
Latitude ®0®6 ®« Longitude 64
a�
estgnCurrent:...:: ..: :.....::.... -,Design .::;;.Current . ,: ,.:.. Design urrent i
Swine Capacity Population:: 1'ou[trY' . Capacity :. Population . , Cattle Capacity. Population
0 Wean to Feeder
® Feeder to Finish
0 Farrow to Wean
0 Farrow to Feeder
13arrow to rinisF
DGits
0 Boars
IY''&`? n ea 0 pray ,pgooumbetofLgoohs:=:';_"
....
......... .
in Ponds,5olid. ra ©tqu age YsHoldi. '1.i
tb:r
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? 0 Yes 0 No
Discharge originated at: 0 Lagoon 0 Spray Field 0 Other
a. If discharge is observed, was the conveyance man-made? 0 Yes 0 No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) 0 Yes p No
c, If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) p Yes 0 No
2. is there evidence of past discharge from any part of the operation? p Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? 0 Yes 0 No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? 0 Spillway p Yes p No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure ti
Identifier: ..................
Freeboard(inches): ...................................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, C) Yes 0 No
seepage, etc.)
3/23/99 Continued on back

Feeiiiiy Number: 31..425 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
rl Yes
p No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
p Yes
p No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
p No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
p Yes
p No
Waste Annlication
10, Are there any buffers that need maintenance/improvement?
p Yes
p No
It. Is there evidence of over application? p Excessive Ponding p PAN
p Yes
p No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA WMP)?
p Yes
p No
14. a) Does the facility lack adequate acreage for land application?
p Yes
p No
b) Does the facility need a wettable acre determination?
p Yes
p No
c) This facility is pended for a wettable acre determination?
p Yes
p No
15. Does the receiving crop need improvement?
p Yes
p No
16. Is there a lack of adequate waste application equipment?
p Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
p Yes
p No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
p Yes
p No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
p Yes
p No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
p No
2I.
Did the facility fail to have a actively certified operator in charge?
p Yes
p No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, ever application)
p Yes
p No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
p Yes
® No
24.
Does facility require a follow-up visit by same agency?
p Yes
p No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
p Yes
p No
SO '061hitions'or ivited -du'ririg. this 'Alsit. - You' - will -rertrive nu furthei
porr6pondenec airt this.visit.......... .......... .. .

e 0 t.ompiainr 0 ronow-up of uwV rnspecuun 0
I Facility Number I
p Permitted 0 Certified p Conditionally Certified p Registered
-up of uawt: review 0 vtner
Date of Inspection 12/14/99
Tirr►c of Inspection 24 hr. (hh:mm)
In Not Operari-o—gu7nDate Last Operated:
Farm Name: Allea.Raynar.tMarks'..'.F.axtn................................................................. County: Duplin W1RO
OwnerName: A[tens....................................... Raymar ....................................................... Phone No: 9,111-2U-50AR ..........................................................
FacilityContact........................ s............ Title: ................................... ............................ Phone No:....................................................
Mailing Address: 539.Rixcr..Rd.............................................................•_....__....__.............. W.Allact..1XC........................................ •.................. 2846fi.............
Onsite Representative: AIIc&Rayaux................................................................•............ ln(egritur:MLLrphy..Family.Farm& .....................................
Certified Operator: .................................................. ................. ........................ Operator Certification Number:.........................................
Location of Farm:
Latitude ®.®6 ®« Longitude
,.. Design :.Current:,, Design current.... ...
swine. Capacity .:Population Poultry. Capacity.,Populatiun Cattle
p Wean to Feeder
® Feeder to Finish
p Farrow to can
p Farrow to ee er
p Farrow to Finish
p Gilts
p Hoars
es gn f urren _
Capacity. Popnlatlon
1,800
243,000
..:..:...:..........
........ ...:.:.
:.;` tea O spray Field r ea .;.:m0u sur ttce tarns Present
I] a oon ;£
... .....................
.:�T�I
. ' -ManagementWaste Ys emo i Liquid ldin P nd So d Treps
11ierhHrveg &. g1ream Immek
1. Is any discharge observed from any part of the operation? p Yes ® No
Discharge originated at: p Lagoon ❑ Spray Field p Other
a. If discharge is observed, was the conveyance man-made? p Yes p No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes p No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) p Yes p No
2. Is there evidence of past discharge from any part of the operation? ® Yes p No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? 0 Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? p Spillway ® Yes p No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ............... 1.t............... ................................... .................................... ................................... ..,•..,._....._..._................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, p Yes ® No
seepage, etc.)
3/23/99 Continued on buck

Faeility Number: 37_425 Date of Inspection 12/14/99
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? IN Yes p No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
p Yes
N No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
p Yes
® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
p Yes
® No
Waste Ap)plication
10, Are there any buffers that need maintenance/improvement?
p Yes
®No
11. Is there evidence of over application? p Excessive Ponding p PAN
p Yes
N N❑
12, Crop type Fescue (Hay) Corn, Soybeans
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA WMP)?
p Yes
® No
14• a) Does the facility lack adequate acreage for land application?
p Yes
® No
b) Does the facility need a wettable acre determination?
p Yes
® No
c) This facility is pended for a wettable acre determination?
p Yes
®No
15. Does the receiving crop need improvement?
p Yes
®No
16. Is there a lack of adequate waste application equipment?
p Yes
® No
Required Records & Documents
I7. Fail to have Certificate of Coverage & General Permit readily available?
p Yes
®No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
p Yes
® No
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
N Yes
p No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
N No
21.
Did the facility fail to have a actively certified operator in charge?
p Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, Freeboard problems, over application)
p Yes
® No
23.
Did ReviewerlInspector fail to discuss review/inspection with on -site representative?
p Yes
®No
24•
Does facility require a follow-up visit by same agency?
® Yes
p No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
® Yes
® No
Cr �Ia:vitilntivils vr. tilYfiienc'res:weirs pntet.during: this visit. ' tau witl receive na fuirther. ;
.. correspodden a aboW thiS.V S t; ...............::::::::::.:.... • ... .
ReviewerlInspector Name
ReviewerlInspector Signatu

ti MINIM on TOM
aci i y Number: — Dale of Inshertion
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below p Yes p No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
p Yes
® No
28,
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
p Yes
N No
roads, building structure, and/or public property)
29.
1s the land application spray system intake not located near the liquid surface of the lagoon?
p Yes
® No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (Le, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
p Yes
® No
31,
Do the animals feed storage bins fail to have appropriate cover?
p Yes
N No
32,
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
p Yes
p No
.. _-..... _._ F
. cont-5
incorporate it. 'I also advised the farmer to pump the waste out of the ditch back onto the field, He said•that he would do these
things. 4ater Quality samples and pictures were taken.
1.
The freeboard'ievel is at 16 inches. Grower should lower -lagoon liquid level in a responsible timely manner. Grower indicated
at he intends to plant either wheat or rye on+the large sprayfield. The plan mentions thav rye can be planted. in the large field but
no PAN -loading rates are given. Grower should have plan amended to include small -grain on. the large field and.PAN loading rates
should be shown. for ail -crops irtfthe waste plan. Grower should then.plant small grain in order to,have a crop in this fiel&so.that it
can,recelve responsible waste applications. This will assist in lowering the lagoon level. '
' iM1
6. There is an old4agoon on site. 'Mr. Raynor -says that the lagoon has been closed; for some time. There is a sheet of paper in the
ecordsf'that•mentions a•lagoon,closure plan willlbe forthcoming, but-norlagoon closure plan is in the records, Also, the DWQ
inspection from -last year 1998 requested that the lagoon be closed and the appropriate paperwork be put in the records. Grower+
'Should, obtain a copy of the lagoon closure plan and'put it in the records, 1%
c,
19. Fanner shoulfteep a,copy of the soil test report in -the records, Also, the acreages used on the 1RR-2's shouldlagree with the
acreages shown in the irrigation, design. "
4
4. A follow-up visit may be performe&to examine the clean up of the discharge.
S:. A technical -specialist needs.to:sign and date appropriate documentation concurring with the wetted'. acres map that Mr..Rayiior.
has in, his records; Mr. Raynor needs to keep this documentation in liis records. Also, the last waste plan dated 12/16/97 by -Kraig
Westergeek gives credit for 19 acres in field 3 (large sprayfield): The irrigation design which Mr. Raynor says was done'rby Kraig
Westerbeek show approximately 15.2 acres being wetted in this field. The grower needs to have the waste plan- amended. such that
e acreage in the waste plan matches the acreages in the irrigation design.
�l
n
{l
ri !i
II I.i� I

.� •-4
Di71kf
ail and Water Consery DivWater uatit.-.:."'^.!°..vadn.'eeee4',w."^''p'.w•°' ... .. '."T,.�..'r" .. ..... ..'....'ew..+.^.m°t?:'.'—:""^':�4'_: ; i<:'s'�::: ii»...•'.: �': .. i�.«r..'� i;:'..;:
Routine Q Complaint Q Follow-u of DW9 inspection Q Follow-up of DSWC review Q Other
Date of It�spc�etiou L I 4
FFacility Number t
Time of Inspection 24 hr. (hh:mm)
13 Re0stered 0 Certified ❑ Applied for Permit Q Permitted (3 Not Operation Date Last Operated: ..................
1 k�
FarmName: !.L�,.........YMf..-......�.......... .............................. County:...... . ..................................... .......................
OwnerName: ......................Aw.4 . ......... ....... 1*1 xxo( ............................................ Phone No:..,.���Q.�.. 5.�.'.�G.!4 $,............................ .........
FacilityContact : ......................' ►> .... e{n�.� ............... Title: ........ -....................................................... Phone No:...................................................
...........
Mailing Address:.......�i!%ny......Q.r........................ ............ I..................... ............ a.11�� ......Nx................................. .... V.gLa.....
....
Onsite Representative:......... i ..-..[av .Y1p r....................................................... Integrator:...........�
Certified Operator:...................................•-•---•-.................................................................... Operator Certification Number..-.......................................
Location of Farm-
..... Or . ...... sk, .........,.c*a Q......Q......... 1........ .t..IQ.: �,.....IF7 i �.....
Latitude ®0 ®� L�j ��� Longitude
Design. Current Design Current .Resign __: Current
Swine: Capacity "Population Poultry e. Capacity=;Population,, Cattle.,:: Capacity' pppulaton;,
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish 6 Ile) 10 Non -Layer I I JEI Non-Dairy
EEI
❑ Farrow to Wean
Farrow to Feeder ID
Other
❑ Farrow to Finish „,, " Total Design CalpaCity';' �o
❑ Gists
❑ Boars T(ta1: SS 3 t7Dr�
.. .. .. .. .... .. 4
Member of.Lagaons I ffolding.Pan. s .© ❑Subsurface Drains Present ❑Lagoon Area p Spray Field Area
' ❑ No Liquid Waste Management System
General
1,
Are there any buffers that need maintenancelimprovement?
❑ 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
P%No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
Pj No
e. If discharge is observers, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system'! (If yes, notify DWQ)
❑ Yes
® No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
[1 No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
P No
S.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
1A No
m ai n to n an celi m proveme art?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
g] No
7,
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7125/97

it
Facility Number: 3l —
8.
Are there lagoons or storage ponds on site which need to be properly closed?
Yes
❑ No
Structures
(LaQoons,lloldipg YQud.5, Flush Pits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
�91 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: NCB,, 0.
... ............................................ .'............................... ...................................
,r
Freeboard(tt): ................................................ zr.`5............. ...,,.............................. .................................... ....................................
................... I...............
....................................
10.
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?
❑ Yes
P1 No
12.
Do any of the structures need maintenancelimprovement?
❑ Yes
No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
M No
Wy_g.5(e
Application
14.
Is there physical evidence of over application?
❑ Yes
i" No
(If in excess of W(1ug�MP, or runoff entering waters of the State, notify DWQ)
15.
Crop type k .S .............. a.?Y) ..........' ..........�........
................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWM:P)?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
❑ Yes
M No
19.
Is there a lack of available waste application equipment?
❑ Yes
CZ No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
[� No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
09 No
22.
Does record keeping need improvement?
Yes
❑ No
For
Certified QrLPpMit1gd Faciliti ' Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
[P 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
No
13-No.vialations:6c d'iciencies.rver'enated.during this:visit., You:►gill i ikeivena.furtlfer.::
correspotidenbe about ails: visit:• : :::.. • • .
.... ... ..: .... ... .... .....:.. .... .. ...... °.. r .. .. s••�!`.`. �:: sii3'iisisg3s` .l�ii•::::!
(referto question #)•.:Exp.Wn"any Y.:S answers An.. or anyr �commenslations'or ony -olli'eir'coa ents,.
Ufit« tiruwiiu s ot:�iei t ;tn better ex lafn sftuat�
,..,......... g. y p ons: fuse ad(fittana! `Pagesas nccssu )`
i
t'y 3' �E
8- d{� a�oarti 51•,oc�j �+� c�,s�r� oJ� Wf,� Pa YQOVV_ S'Ayn rj 40 Ink
�Q0-
Z z. �'�t S6j; 16V & �tj
o o�aw�sti.:� �arw_ 5�keukr} � a-
�Q g� eiAOicoi-- l i K
�1Tj ClAune
.� Vt C;-) lLW I Over. -
P1
7/25/97
.y.,..-�4,sm a �^^.,.,^u^^M^..•„ `Fn..1.....•�. W,yya^.•,•.-•.ps.�.........e$ii iyy
Reviewer/ins ector Name w! i'; 7
p � 1 .:�' r� ��3i::: � �7'� :��4���:7e:i' � �i, •S
Reviewer/Inspector Signature: �. Date: k [

...--....... .
F €s
DSWC
An1ma1 F
F. .
eedlvt;;flperativn"'Rev>tew�-
� � €�
;: nl eedlot° lratan�=" a Inset, n IR D W A mA F e S t r c >io
.. s� :..;,:» .... ',}✓.. k- Fe F.f. EsE€F•:5:.. ': :: eTg '..•'S. .'.; F ;(14'f F13`.'..ii}'•:,
s .. '. •F 1 S
..c'", -:.. .. $, .F:..�f�::;.;,•.:.:..Y :S'', a .; ;.'.}.: ;F:'-,f�xiiiiii�3ii� . :'e �if}E: NFEe}f5h.•�,}.�
19 Routine Q Complaint Q Follow-up of DW2 inspection Q Follow-up of DSWC review D Other
Date of Inspection Y 3 a
Facility Number
Time of Inspection 1L: +.�24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: 0,111egistered ❑ Applied for Permit (ex:.1.25 for 1 hr .l5 train)j Spent on Review
❑ Certified ❑ Permitted or Inspection includes travel and rocessin
❑ Not Operational Date Last Operated ..... .._... .._....... ........... _...... ....... .-................. .... _............ _-............... ........ ........ ........ _.................
Farm Name.- .»...s� u...... a x k L ..... o-f ^^ .... ......... _..... ......... .... Cnu nty: _.. 1,x ..x......._......»........_....
Land Owner Name:........ ] st r. _.......... . usa,s.!^� r................................... Phone No: ... ...... ................... ............... .................... ........ .......
_...
Facility Conetact ...............................»............... ............... .............. Title:............................................... Phone No:.. g.�.�.�. ... ».ram 2.4z
Mailing Address%._53.1........ L..i.x:err...... N.k-....... _..... ........ _........................... ... ... ...... _............... ...2%y.�7 .=.
Onsite Representative: .All ct .-m.... n a.Y ��xi�. � ��k� Integrator: ... . ..... . ............. . . ..... . ..... ......... . ......... . ..................
To-J'j
Certified Operator: .... . .............. . .................. ....... .......... . . ............... . ..... . .... . .. ...... __ Operator Certification Number: .............................. ....... ...
Location of Farm:
f].rs._.� ., �.._.......a i�. p.f7J.7i..►..tlt` Sx . »..Q... 15 4 ....... n... G ... .....kS,t.7.. ». ..............
SI.l.....�.......... .... .....i............. .... _................. ........... �}
Latitude 0 ®` ®« Longitude F 57-1` 64
Type of Operation and Design Capacity
•'a ..:� ;: � .3.. n:.}. .. .S - • n : )� 53 }' � ; t;siF.«. _, - �: •`,�E.. s, � . ....m,.«„ F,,... s.FikFFS' ,;€?«<<. ` :: '_:°� az;??:Fau:sF},.:FsE . '%.
�.:F;'f• .i. F .e .:.=}i� .:e::}: e' ,..}.. - .?�?;':F:s .. _ �F, De i n C(1 .. € ;� °:::::;:::..;:,?.:-;:`,,;;n; esi n :' K; :::.■"y ry:_ ».:nt: ��
esign.::.:.,Curren#.. ,...F..... s g Curt f.Y ❑ _ g ..;:f.,f??3,Curre...
,3 n %: F.. .:_. ["attle'j f' Hs:=;iu: 3r
........... Y,..»3.,.,.. f»>Ca ariPa ulEgtian'.. ;1.' a aci Po ulatian= ..•..i � E..Ca aCi »��,Po uI tion'
❑ Wean to Feeder Lay� ❑ Dai
Feeder to Finish Non -I a er .`;r; Non -Dairy
Farrow to Wean
.t ••.{; :;�. x. �3zi � •��.i } },E , } �� F'gi, � � �'.'•,. S.E s.F 'E i t'".: � i :�iFE��s.
Farrow to Feeder Total':Msi n .Ca aci
El _Farrow to Finish ;,titi4;
....,.».......,,... i.w.w..M............€:'` 'bx .:,Fs�;
SSLVY
�;s�4:'F.'S�'� i:P: 5 .: I1.: ' �FF•� FE'F::` ;:rSd;;; in�'A �(�
F ❑ t7ther ;:.F;.: �..:.: , 3"' ��ig ::i" - , � i� ' it� =.s» }; '�4;3.'� iii'%}Si�i•33:::,.
iF
e'l::.�, ;• '; :r
i'
.�.`.'°re'•:F's^-FRE"lFFEE°'°✓ei°Fm�'.CN!S£3'.. .«....... .«.. _ «.v«�e:•:............:.,.....«..«..e:.'.?asl°i'.�=: .ii:'� .. ��'i s t'...✓i...i.n..ii..33.€�F:i'i..,3ti,3i,r
.. «
'Wimber�of'Lagoons'.13�HnldirigYl'ot3ii§.. jf `;€ 9 ❑Subsurface Drains Present
.x..{rt .i;�, r.p.........
"iFF�FF«<:..:. '.:3• Y€
,.f,;n {'.
�'_.._ ❑Lagoon Area ❑ Spray Field Area i
.... :e+3e.:e.}. . " ;,.. • Fl.. . -,... �' .....:. i .. SF-i:sF� .. "JI. :.. �.? .. .. ,... . � s'r «.Y '. `IL. S��:s��. .i�€�.�}�':� 3� ::s.!�3
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance mart -made?
b. if discharge is observed, did it reach Surface Water'? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/34197 maintenance/improvement?
❑ Yes C, No
❑ Yes ® No
❑ Yes ® No
❑ Yes R No
❑ Yes
® No
❑ Yes
® No
❑ Yes
CR No
❑ Yes
® No
Continued
on bark

Facility Number:. i........
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 JZ No
8. Are there lagoons or storage ponds on site which need to be properly closed? Yes ❑ No
SlruclureL(Lagoons andjor Holdl}g Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes (ZNo
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
.... ,.4 a....»».. ..._..... .......... _..... .................... .... _......... »........... ........... ....... _..... ......... ....... „........ ..
10. Is seepage observed from any of the structures?
i I. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
YUste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ........... ... ]n...txa..... ............ »........ ...... .................. .... .......... ........ ........... _.....
I6. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Eor Certified Facilities Onto
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 U No
❑ Yes CK No
KYes ❑ No
❑ Yes C9 No
❑ Yes qNo
❑ Yes 19 No
❑ Yes O No
® Yes ❑ No
❑ Yes KNo
❑ Yes 19 No
❑ Yes E,No
❑ Yes BNo
❑ Yes ® No
❑ Yes St No
Coniments.(refer. co gtiestion'#j: Explain any, YES answers'andlor ariy recommendafioris ar:any:ather cott►merits
.:.. ....::.. .. ... . F. f
Use drawing 'of facility to tretter:ex' Iaix� situations.'( use additional a` es as necessary): '
s p:p. g �'_..
$.. -t4t . i.., ..0o.'.. c f-ed. W1.F � f S w 11V UL,if- old l 03 oa,.� �^'�-��c e� Q
t L. lZ u c � waif . ► b w o v t-d � c4 q v t ci ► +� s +� fv �a .. E
..... ., .1s.,r V
D r + L s tW`t e
f` _G- 0r D�' LAJ 0. I { f � r u lT' x+ Ca r. L �/ L' �+t C t
u .`j % D '�► G.+tio� j'�-fY .i t—j { p 'T t_� AL
I tN u t X- 0 ti. CA rr� L r In1- �.lL ��S 1►1 5 17 e*' -t
. .... ......... ...--^�-ra??o.�E�r p"" , ,;as;. � :?' .. .. ;i�� � �
Reviewer/Inspector Name
Reviewerlinspector Signature: ' Date:
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

OR
Site Requires Immediate Attention: _h o
' Facility No. —31 U
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
49 DATE: 151 , 1995
Time: -- 103_
Farm Name/Owner: S a-fi�+ rn `1_ M &ft_ k-S _
Mailing Address: fZ o y8 `[ B �Wa�r a �Y� �►
County:
Integrator:Phone:
On Site Representative: Phone: 31Q) 9 t S' r -7 0 ❑'b
Physical Address/Location: n(- ti I S 0.15 'Meics 5/ l 1 :7 d C:� rA.o&4,)'4d
Type of Operation: Swine Poultry Cattle
Design Capacity: i 0b Number of Animals on Site: `' I So �D
DEM Certification Number: A DEM Certification Number: ACNEW
Latitude: of
Longitude: Elevation: Feet
h []A ci•V Q.
t I J0 l t Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Bor No Actual Freeboard`.,Ft. . Inches
Was any seepage observed from the la oon(s)? Yes of Was any erosion observed? Gor No 41, vl�
Is adequate land available for spray? Ye or No Is the cover crop adequate? es or No
Crop(s) being utilized: _
-- l q
Does the facility meet SCiS 'nimum setback criteria? 200 Feet from Dwellings. Ye or No
by ••ti 100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state•by man-made ditch, flushing system, or other
similar man-made devices? Yes or NN If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o> N Fr, i rno--r-
Additional Comments:
Inspector N4me
2
Signa ure
cc: Facility Assessment Unit Use Attachments if Needed.

•
Ll

NQRTH CAHUUNA
Department at EM I Qui

Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
,� i►�.-�.
Onsite Representative: P-,,1/�-
Certified Operator -
Back -up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: f t ?�q f�
Certification Number:
Longitude:
Design Current
jjjDesign
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
We to Feeder
Non -La er
DairyCalf
ceder to Finish
'x 9 -P
'ZP100
Dai Heifer
Farrow to Wean
Uesign
Current
Caw
Farrow to Feeder
Dry I'oultr.
Ca acl
Eo
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
UurkeX
Poults
OtherI
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other: .-
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No NA ❑ NE
[:]Yes �NoA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 121412015 Continued

Facility dumber: 1 - ;-[ S"Z- Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
05No ❑ NA
❑ NE
a. Ifyes, is waste level into the structural freeboard?
❑ Yes
[] No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7'
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
No D 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
E2'90 ❑ 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 environm;�N[:j
al eat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ffNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No [0:] 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
Fj`N o ❑ NA
[] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
dNo ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo ❑ NA
❑ NE
Re wired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [] NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check ❑ Yes WNo NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking []Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

F cillt Number: - Date of Inspection: 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [T No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E rNo❑ 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 Flo ❑ NA ❑ Nu
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility'? If yes, check the appropriate box below,
❑ Application Field ❑ Lagoon/storage fond ❑ 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?
1X_
Reviewer/Inspector Name: !/ CA ,, 1A `-'< <l
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes N❑ ❑ NA ❑ NE
❑ Yes �NA ❑ NE
❑Yes 9<0 ❑NA ❑NE
❑ Yes No ❑ NA ❑ N F
❑ Yes No ❑ NA ❑ NE
❑ Yes Et5 NA ❑ NE
❑Yes No ❑NA ❑NE
Phone:
f � 7
21412015

V Division of Water Resources
Facility Number � - ® ❑ Division of Soil and Water Conservation
t
p Other Agency
f'ypc of Visit: C] Co pliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine ❑ Complaint ❑ Follow-up Q Referral ❑ Emergency ❑ Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: as County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: (VILI.U_Fl -
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:
Integrator: p
Certification Number: 9 cj D oqq
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
I ELa er
Non -Layer
Design Current
Dram Poultry CanaCitr• Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Pouits
Other
Discharges and Stream_ Imparts
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 ofthe State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dai ry Cow
Dairy Calf
Dairy Ilcifer
Dry Cow
,Non -Dairy
Beel'Stocker
Beef Feeder
Beef Brood Cow
[:]Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑
❑ Yes
[—]Yes [, No
❑ NA ❑ NE
[]NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

J
Facility Number: - Date of Ins ection: I
3 7 aste Collection & Treatment
4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: CACIp
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments 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 a"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 buffers, setbacks, or compliance alternatives that need ❑ Yes 0No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? I f yes, check the appropriate box below, ❑ Yes [3/No ❑ NA ❑ N E
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
.W�N
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement'?
❑ Yes
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
❑ NA
❑ NE
acres determination'?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
13<,c
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment`?
❑ Yes
Q o
❑ NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
YNo
❑ 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 No [] NA ❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment`/ ❑ Yes54�/o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

y
Facility Number: - Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes WNo ❑ 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 FJINo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ Yes 61NO
❑ Yes �o
[] Yes �No
❑ Yes 2 No
❑ Yes [ No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
IComments.(refer to question #],. Explain any YES answers and/or any additional recommendations.or any other comments, J
Use drawings of facility to better explain situations (use additional pages as necessary). I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phok lib L 6 ` 13 V
Date: I
214 01S

Type of Visit: Q 7Routine
Oliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q 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: �[] r, �raT ]•} l Y 1 �3.� Integrator:
Certified Operator: Certification Number:
Sack -up Operator: Certification Number:
Location of Farm: Latitude: Longitude;
Design
Swine Capacity
Wean to Finish
Current Design Current
Pap. Wet Poultry Capacity Pop.
I ILayer
Design Current
Cattle Capacity Pap.
Dairy Cow
Wean to Feeder
]Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Itry Ca aci PLOP.
Layers
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turkey Puults
I 10ther
Beef Brood Cow
Other
Other I
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [] No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3
21412014 Continued

Faclli Number: - DInspection: D J
Waste Collection & Treatment
4. Is ytorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: N 1 AL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): - a2,_ L J
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EeNo [] 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 2"No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-5 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 26o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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 ❑ AppIication Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes UZo
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes WNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes [
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes L'J No
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[] Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�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 21412014 Continued

Facili Number: - Date of Inspection: O
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �/No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes itiio ❑ NA ❑ NE
Other Issues
No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
O
❑ 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
El"No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�2No
❑ 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
2j"No
[] NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EfNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
C o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ Zo
❑ NA
❑ NE
Comments;(refertii`ijiiestibit'#}: Fxplainany.YES ails►yers�ttndlor any,hiiditianal=recoiiinnendatinns'vrRany atl�er. comments.`:¢':' .;.<. i
:.:H' erAd .u6 S.6-W.g 9 pMhVinyX§k9€e. �.¢.i3 «: xt:Pd.r nyox er,ct..", .. a
Use;drawingsnf:farilitytv?betten,ex lain`situativns;(use addi#innal; a es as�necessar j'1 :x_.:.;;a=.._.g.
Reviewer/inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
000
Phone I9i
Date: D
2/4 01

S V Division of Water Quality
Facility Number - D Division of Soil and Water Conservation
s Q Other Agency
Type of Visit: 0 7Routine
liance Inspectiou Operation Review Q Structure Evaluation ❑ Technical Assistance
Reason for Visit: ❑ Complaint Q Follow-up ❑ Referral Q Emergency Q Other O Denied Access
Date of Visit: Z Arrival Time: 11JS Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Dnslte Representative: )mtibj -0;g- U� Integrator:
Certified Operator: Certification Number: �'j b Q] q
Back-up Operator:
Location of Farm:
Swine
to Finish
to Feeder
rto Finish
v to Wean
v to Feeder
v to Finish
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er I I El
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dai Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[] Yes [Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes Y o ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

IFacdity Number: _ Date of Inspection:
Waste Collection & Treatment
4. Is.storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I of� Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 11Z No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit`? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CZ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EZ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window, ❑ Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes❑
NA
VINN9
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes❑
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
o ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design []Maps ❑ Lease Agreements
[3 Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ZNu
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspectet�o'
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
If did facility install irrigation
❑ Yes
�rNo
❑ NA ❑ NE
23. selected, the fail to and maintain rainbreakers on equipment?
❑ Yes
❑ NA ❑ NE
Page 2 of 3
21412014 Continued

Faciliky Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Isithe facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes l �No
❑ NA
❑ NE
Other Issues
ZNo
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes Cj"/No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes EJ/No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Application Field ❑ LagoonlStorage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes C.
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes Zo,
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �Wo
❑ NA
❑ NE
Cornmepts (referto: question #):;Explain anyaVES answers;andJor any. addltlonal'recommendations;or,.anyeother.;cwmnient&.K�
Use druwin'as of facilitv1o.lieitterm lain situations (use addltlonal
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
D
Phone: L(qld)jq�_j� D
Date: 100VAJ
2/4 14

C} Division of Water Quality
Facility Number ©- 0 Division of Soil and Water Conservation
❑ Other Agency Izj
Type of Visit: 0
C pliance Inspection Operation Review Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint ❑ Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: tti t ^a Arrival Time: q4 Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: , )a NA-M pN t Y t.I.t.LA� Integrator:
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
Latitude:
Phone:
Certification Number: (7) M q
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -Layer
Pullets
Other
Poults
Design Current
Discharees and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Caw
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes Wo ❑ NA ❑ NE
❑Yes ❑ ❑NA ❑NE
❑ Yes No
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: q3 Bate of Inspection: [t
13
`
Waste Collection & Treatment
ZNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 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
FONo
❑ 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
E] 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 environmentpJ threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes j 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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 21 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 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 E6 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes FNo
❑ NA
❑ NE
Re ulred Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes � o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes [ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [:]Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall InspectiFo
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge`? ❑ Yes❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes❑ NA ❑ NE
Page 2 of 3 21412011 Continued

I±aci i Number: JDate of Inspection:
` 24. Did the facility fail to calibrate waste application equipment as required by the permit? []YesVNo
[] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
gNo ❑ NA ❑ NE
Other Issues
29, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[Dyes
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
❑lIa ❑ 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
3io ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Yes
CrNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
10 ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[]-Vo [] NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
F2 No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. .
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
L ihPhone:����
Date: t
214 011

Type of Visit: @ C mpliance Inspection Q Operation Review Q Structure Evaluation Q Technicaf Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral a Emergency Q Other Q Denied Access
Date of Visit: it Arrival Time: Departure Time: I J County: CXP(ZdV Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: ,� Title:
Onsite Representative: y JZ N t "�� Rh1 A a r a Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I —MY 2
Certification Number:
Longitude:
Qesign Current
Swine Capacity Pop.
Wean to Finish
❑esigMe urrent
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
airy Cow
Wean to Feeder
Mon -Layer
airy Calf
}{ Feeder to Finish
to Wean
row to Feeder
airy Heifer
D Cow
Non -Dairy
Design Current
D . P,oultr Ca acit P,o .
row to Finish
Layers
Beef Stocker
s
Non -Layers
Beef Feeder
!IFarrow
rs
Pullets
Beef Brood Cow
er
er
Turke s
TurkeyPoults
Other
Dischar es and Stream Impact
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 past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Yes � ❑ NA ❑ NE
[] Yes [] No [] NA [3 NE
[] Yes No NA NE
Yes No [] NA ] NE
Yes Er o [] NA ❑ NE
Yes WNo ❑ NA NE
Page I of 3 21412011 Continued

)~ ac'li Number: Ds ection: v
Waste Collection & Treatment
4. I , storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Io ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA trzt�.4J j L&V-0f,_�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �� 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑*No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 2/No ❑ NA 0 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 E2<o ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �io ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ti1a ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes EErIZ ❑ NA ❑ NE
maintenance or improvement?
1 l . 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 Types):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E3<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ZkKo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
6No
❑ NA
❑ NE
Reauired Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ej No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
C140w
❑ 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 ❑ Sail 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 [Ef o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers an irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 2141201I Continued

Fneilit Number: Date of Inspection: 1 'tom
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rNo
N ❑ NA ❑ NE
25. fs the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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 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 ❑ Yes , No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes E?1 ❑ 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 '�o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [a4<- ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ ft ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 43-11ro ❑ NA ❑ NE
Comments (refer to.question #): Explain any:YES answers and/or,any_additional recommendations o.r,.any�other eomments x ;
Use drawings of facility to better. expla1w Ituati6ns (useaadditional pages: as,necessnry].M :' . I k` , ' = { ; s g �w� e , ° ;91
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: I
Date: Z.
2,1412 11
Yd

Type of Visit: (7 Cogipliance inspection V Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: It7_ D 1 Departure Time: r' County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 0b46-7kizA jL4& Integrator:
Phone:
Certified Operator: Certification Number: 1 ? Z_gj _
Sack -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
EMMA
Design Current besign CurrentOF Design
momS►vine @opacity Pop. Wet Poultry Capacity Pvp. Cattle Capacity
Wean to Finish La er Dai Cow
Current
Pop.
Wean to Feeder
Non -La er
Dai Cali'
Dairy Heifer
Dry Cow
Y
Feeder to Finish
Farrow to Wean
Design
Dr P,vuRE Ca acit
Current
Pop.
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
ether
keys
3'urkey Poults
Other
DischarMs and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes CZ No ❑ NA ❑ NE
[:]Yes [—]No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑No ❑ NA ❑ NE
❑ Yes al�t_❑NA ❑ NE
❑ Yes �rNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - ❑ate of inspection: t 41
Waste Collection & Treatment
4.,Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ZNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes[
�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify 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
VNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
C;3/No
❑ NA
❑ NE
maintenance or improvement?
Waste Atrnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
[] NA
❑ NE
t t�
mam enance or tmpr❑vemen .
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes e/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorp❑rate 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?
6/Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or op crate per the irrigation design or wettable
❑ Yes
0No
❑ 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
[�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
J�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ca/No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo
❑ 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 gaugc? ❑ Yes
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ ❑ NA ❑ NE
❑ ❑ NA ❑ NE
Page 2 oj3 21412011 Continued

Facility Number: 2 j - inspection: t t 3
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C3"N'o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 310 ❑ NA ❑ NE
the appropriate box(es) below.
D 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 13 0 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
ti10 []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
P40 ❑ 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
Io ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
<No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E3 o ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
;Kc ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
o ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other, comments:
Ilij
se"drawings of facility to better explain situations [use additional pages as necessary). .:` _ `' .;: =``;% _ :: .s 0� 3+�: g .
�,
ILIE4 j9 U06 k�6 Co Y of
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone
Date: rr
Il

® Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
❑ Other Agency
Type of Visit ,C. oompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
a Reason for Visit Routine Q Complaint Q Follow up Q Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: tl !D Arrival'i'ime:dO Departure Time: County: 1UP[.= Region:
Farm Name: I Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: V °N R� M►a-1 L[—IrL-
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Feeder
U Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 1= o = f 016 Longitude: [� o = ` = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
�_ ❑ Non -Layer
Other
❑ Other - - - _
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Pouits
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Keifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
b. Did the discharge reach waters of the Stale? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: El
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/No ❑ NA ❑ NE
El Yes
❑No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
❑ NA
ElNE
ElYes
LJ NU
❑ NA
❑ NE
Puge 1 oj'3 12128104 Continued

Facility Number: Date of Inspection if q
'r
Waste Collection & Treatment
4- Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure i Structure 2 Structure 3 Structure 4
Identifier: LAC,a'b^)_L_ Z,-'
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C12 a_c
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
[]Yes E No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes I,Q No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalth at, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes No ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes EI'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 LJ No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10, Are there any required buffers, setbacks, or compIiancc alternatives that need ❑ Yes L' I No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 6No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
VN
❑NA El NE
El NA El NE
❑ NA ❑ NE
ld No ❑ NA ❑ NE
Ld No ❑ NA ❑ NE
. .. ..�.::..:�.: . •�. .� � ... ...:: .� �.`.::-::.....•:"::�..4.;::�.�:'S .}..t�V �.E•si�...
Comments (refer tci question #): Explain any YES,answers and/or: any recommendativns:or an_ y othencomments.=
Ilse dra►vings.of facility.to better.explain: situ ations:'(use;additional pages as necessary):...
Ak
i
v
7
Reviewer/Inspector NameUsNY Phone b 73 g
p u. !
Reviewer/Inspector Signature: Date: °iIff
P c , 2 of 3 12128101 Continued
ug

Facility Number: 5 ] — qS I Date of Inspection L
k-eauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2No ❑ NA ❑ NE
the appropriate box.
❑ WI]P ❑ Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes ENo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil.Analysis [:]Waste Transfers [:]Annual Certification
❑ rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 10 10 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ o ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes E No ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[:VNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E(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
ENo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
��
31.
Did the facility fail to notify the regional office of emergency situations as required by
El[ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
La N
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
L 70
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 (if 3 12128104

Type of Visit Co pliance Inspection Q Operation Review Q Structure Evaluation n Technical Assistance
Reason for Visit Routine O Complaint Q Follow up ❑ Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: g 6 Arrival Time: (® Departure Time: County: 0 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
1-10
Onsite Representative: s..)-wfrTHArJ
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = f = Longitude: = ° = 1 = «
Design Current
Designlr-r0eunt
Design Gurrent
Swine Gapacity
Popultition
Wet Poultry Cuparcitpult►tion
Cattle Capacity Population
❑
Wean to Finish
❑ La er I
I
El Dairy Cow
❑
Wean to Feeder
❑Non -La er I
❑ Dai Calf
Feeder to Finish
Dai Heifer
❑
Farrow to Wean
Dry Poultry
El D Cow
❑
Farrow to Feeder
❑ Non -Dairy
❑
Farrow to Finish
❑ La ers
0 Beef Stocker
❑
Gilts
❑Non -La ers
❑ Beef Feeder
❑
Boars
❑Pullets
Beet' Brood Caw
❑ Turke s
Other
❑ Other
❑ Turke Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2 No
❑ NA
[INC
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
,❑
LdNo
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

1
Facility Number: Date of Inspection $ v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural t'reeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: lei Gom-►.1 t LA C--MW 11
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ."L 9 4'3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes L2'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes a No ❑ NA ❑ NE
❑ Yes 0 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 V"No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [:]Yes [:�<o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,..�
9. Does any part of the waste management system other than the waste structures require El Yes En'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
(dNo
❑ NA ❑ NE
maintenance/improvement?
1 l .
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
�,
R<o
❑ 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? El�� Yes
�
0J No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement7 ❑ Yes
�o
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
(Ko
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
2No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
No
❑ NA ❑ NE
Comments [refer to question #}:
Exany YES answers and/or any]recorrtmendatlons or any other comments.
Ismplain
Ilse drawings of fac€llty tv better explain s€tuations. {use additional pages at; necessaryJ:
A's ST'►T(- PE&I
PO►.)
Reviewerllns ector Name -
p
- — - : f '` F.. er-r..;,..:..:
�i};:>• j4 s' fi:.; Phone:
Reviewer/Inspector Signature:
Date: p
Page 2 of 3 12128104 Continued

i
Facility Number: — Date of Inspection o
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑Yes dNo ❑NA ONE
❑ Yes EjlNo ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [34o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [J"No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ell�o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
El NE
26, Did the facility fail to have an actively certified operator in charge?
❑ Yes
,[:Ko
NNoo
El NA
El NE
27, Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,CAI
CKo
❑ NA
❑ NE
Otherissues !!
28. Were any additional nroblems noted which cause non-compliance of the nermit or CAWMP? ❑ Yes 2 o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C 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
�,�
O 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
dNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,,__,,//
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
C] NN
[I NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
LJ No
❑ NA
❑ NE
Add itlon ali.Co m me nts�a n dlo r,�D ra wl n gs:
12129104
12129104

Sti
Type of Visit 3 Co (lance Inspection 0 Operation Review n Structure Evaluation Q Technical Assistance
Reason for Visit Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date or visit: g 9-1 p Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: sJ ows-rhyeD EA-TA_UkrL
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Region:
Back-up Certification Number:
Latitude: ❑ = ` 0 " Longitude: ❑ o r7' =
Design
Swine Capacity
Current
P�vpulation
Design
Wet Poultry Capacity
Current
Yaplation
Design Current
Cattle @opacity Population
iLy Cow
❑ Wean to Finish ❑ La er
❑ Wean to Feeder
Non -La er
iry Calf
Feeder to Finish i a 1,4bo
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Coy"
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
Layers ers
❑Beef Stocker
El Gilts
Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
El Turkeys
Other
❑ other
❑ Turke Poults
Q Other
Humber of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
2/No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E?Ko
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[�I<o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Futility Number:
Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure i Structure 2 Structure 3 Structure 4
Identifier. LAcxymr--� I L6 &-a-N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ENo [I NA ❑ NE
El Yes LJ No ❑ NA ❑ NF
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t7hh eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No
N ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes jRrNo ❑ NA ❑ NE
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes Cj<o ❑ 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
15. Does the receiving crop and/or land application site need improvement? (!J Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
ErNo
❑ NA
❑ NE
❑..,,//No
El NA
❑ NE
L�No
❑NA
❑NE
❑ Yes C2"&❑ ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
tS,] CoaA/ r1ab o Goo #.J Z Lhe6, 40us4,S UOIC.S tb 6�, MJ M E LLE` , Z-
64 NVT VS=nljb OZ5 A-f—&A".
[9) FAP_n-. uA Q lu P aES P(rrt-A'O�L7 oN 5�z* DE�rEa-r�•sF►� , JPO f(L- St A—' E
QEtz_mxT ?_,Acc c r`f WrT4 i�EGo�C.D3, NOtFxW 7A6 "7
Reviewer/Inspector Name Phone: t4re�7�e-
Reviewer/Inspector Signature: Date: o Q
Page 2 of 3 12128.104 Continued

acility Number: *j( —y Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropirate box. ❑ WUp El Checklists ❑ Design El Mans El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
iYes ❑ No ❑ NA ❑ NE
❑ Yes UNo ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E(No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9�<o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ff No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes Er<o ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Uo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�_,
❑ 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
rr
0 o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
��,,//
31. Did the facility tail to notify the regional office of emergency situations as required by
El Yes
}KNo
Cl NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[IYes
CI No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
2rNo
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Faeility xumber Q Division of Soil and Water Conservation
0 Other Agency A
F
f Visit ,C.,oLmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit (�outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I q L4 S Departure Time: L— -"� County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: . oti>A?N C4 0 M.0 "t IL
Certified Operator -
Back -up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e 0 1 ❑ 04 Longitude: = o ❑ 6 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
❑ Wean to Finish
❑ Wean to Feeder
© Feeder to Finish
t5
12-4 ao
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design . Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Daiix Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
.11
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes LZ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
El NE
❑Yes
No
❑Yes
ZN o
❑NA
El NE
❑ Yes
2 No
❑ NA
❑ NE
12128104 Continued

FaciliV Number: 31 hate of Inspection
aste Collection & Treatment , _,�
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l "Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �(SL [�{rp��/ Y13
Spillway?. -
Designed Freeboard (in):
Observed Freeboard (in): 3'7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Le No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ��/
6. Are there structures on -site which are not properly addressed and/or managed El Yes I� No ❑ NA ❑ NE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify OWQ
7. Do any of the structures need maintenance or improvement'? ElYJ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes IQ No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Cl No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soli 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
lJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
Mfo
ElNA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
NNo
❑ NA
❑ NE
19. Is there a lack of properly operating waste application equipment?
El yes
,B
L7 No
❑ NA
❑ NE
Comments (refer to question 4): 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):
15 j iq,p cael( of IKuf r Kf c6,jr Ca C AN! �'�r�w►�i t.i� Kc- c *K L7l. A.
LA COD a P(STC Al D,Aj(
Reviewer/Inspector Name J,014L) kA/6U Phone: a
Reviewer/inspector Signature: Date:
r1&060/Q* isienueu

Facility Number: 31 Date of Inspection
Reouired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9<0 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZrNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ld No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
QNo
El NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
ElNo
3 NDA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E, No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately ,
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ffNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
D o
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 I2128104

Yolvision or ateC ualiI T
�Faeilty ulmlaer �j [� Z Q Di sfon of Soil and Water'Cunservation
Q Other Agency
Type of Visit ,C.,o/mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routlne O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Daw orvisit: 15 L6,Yj Arri►•al Time: Departure Time: County: _nt1P.M1L— Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 6't'kw- t-* &I
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
❑o =0„ g =0=1 �
Latitude: Longitude-
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
❑
Wean to Finish
❑
Wean to Feeder
Feeder to Finish
Igio
IO 00
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
El Layers
❑ Non -Layers
❑ Pullets
❑ Turkey.-,
❑ Turkev Poults
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heitei
❑ D Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters ofthc Slate? (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?
El Yes /N, ' ❑NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
�o
El NA
❑NE
❑ Yes
WNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 31-L4Z date of Inspection LV1S
"Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. I l' yes, is waste level into the structural freeboard'?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA GOOD J I
Spillway?:
Designed Freeboard (in): f
Observed Freeboard (in): �(D
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ❑ NE
❑ Yes WNu ❑ 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 stuctures lack adequate markers as required by the permit? ❑ Yes 2 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 El Yes 2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes Ea No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Cs r6SU6 AtAM PD A C6. 5 .
13. 5oi1 type(s) Fp _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZN❑ ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑ Yes E!(b o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ElYes LI No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes YNo ❑ NA ❑ NE
�' i �i ��7i�'�!ic';fi.�`.:m,�i.::1.•�::�4�:.tib�:��. w�:.s..-::S �as..vK'd.: '. �tl:YSJ:ii�i'Tti.:�e':y.d��.�aeiY�Wrv.�,i�i!'dA'.
1 AA-M3 31 ~ qg3 A+-'c 31 `ITS. qAv( BCE+/ f'rll11AW(D, za/LZC7AT201J See-rcAj
-rTcr) fjct,. WV P Nr.% 13ao Wa&-T'TC-'tj' t;"-m FAt2Ms
leC Cv,V" C,; C AND �ira.rv�Tf . Crt.Aaz-if krl#k kALC&6'-H
Reviewerllnspector Name �. >' :,' , , ;; Phone _ �1(��3�5 - 3900 A ZQ
Reviewer/Inspector Signature: Date: 3; p f'L
12/28/Iid rnirtiaupd

i Fa tility Number: ?J — 4rj Date of inspection
.Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 4o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design []Maps El Other
21.
Does record keeping need improvement'? If yes, check the appropriate box below.
El Yes
LNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
EiNo
❑ NA
❑ NE
23,
1f selected, did the facility /ail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
ff NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
VNA
❑ NE
26.
Did the facility fail to have a» actively certified operator in charge?
❑ Yes
0110
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
E30KA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
ElNA
ElNE
29,
Did the facility flail to properly dispose of'dead animals within 24 hours and/or document
ElYes
�`No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30,
At the time of the inspection did the tacility pose an odor or air quality concern?
El Yes
�,j
I'� No
❑ NA
❑ NE
if yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector frail to discuss reviewlinspection with an on -site representative?
❑ Yes
C No
❑ NA
❑ NE
33.
Does facility require a [follow-up visit by same agency'?
❑ Yes
2 No
❑ NA
❑ NE;
Additional Comments and/or Drawings:
12128104

r 10 Facility Number 'late of Visit: - Time: ' �
Not Operational 0 Below Threshold
® Permitted M Certified ❑ C
onditionally Certified Cj Registered Date Last Operated or Above Threshold: ...... ..................
FarmName: ..».. ' .. ...F. `................ ....... ................. ............................... . County:.....r....r.. '.fy��......r.......................................
Owner Name: ......................................... ........ .... . ........ .... . ...... ... .................... ' Phone No:....................
MailingAddress: .r..................»..........................................».......................................... .............. ...... ».................................r............................................ _.....
FacilityContact:.............................................................................. Title:........................... .. .. ........................ ..
Phone No:........................ .. ............. ..........
Onsite Representative:.......44a ........ 0<, ewx..........................................Integrator•- ........ �.3,.Y...... ............................ ........
Certified Operator:...r...»....................................................................................................... Operator Certification Number: ..... ............................ _.......
Location of Farm. -
El Swine ❑ Poultry ❑ Cattle p Norse Latitude Longitude 0• �� ����
.,y[, 7 'l�:`..IJC.'ilp�{ 's�}'trvl rent :I f1f i psi ^ Isj4. ('off �. q. .w. ; N .( { I'19i Y rliryrrj.' e..,,:. w
j. .. i , 1 -� l3es� Curl en Y?' �(;C' 11 �t"1 f emu- �y Si Cu. 4 iMit4}'
f ]u:: gFF':. C��j .{' ,Des pn';;,::p
. •'<.ii .': .i, �': i � "� sl .�. j.. 31 . {. ...3 r•'i::.'� I! �Jr'jy!•.{�. �1 .�'� .P.a r.4�r i ..y r. �.,.,.."I...I�
Swine Ca aci Po ulation :T . Poultri ,_ t . `Ca ci °Po tsIation !' ;I Cattle j ;,, li. r',H ;I..Ca '�aci .. itj Pa ' nlatian":;:
❑ Wean to Feeder ❑ Layer . [I Dairy
®Feeder to Finish Q}" ❑ Non -Layer 111❑Non-Dairy
Farrow to Wean
.Y s;�..s;sjj� . , I;k ii; ;'rlril`k ;ii�'i;��;,.k::�:irs j�::l.s�.•.� ��;s,•i
❑ Other.:
,:
y ...:
Farrow to Feeder ,., ;. " � 1,�3 "�.;� 3,,, n,
Farrow to Finish ;: ::� :�:s« �,._' i �.isl'If�J iti :jf li r
E' 'Totsl. Design; Capacity; I'
Gilts s'i 'a' 7y4w,,,._.y �ye P'k.E.:
. x..S4 ..�'(�` ySI:rF�hgi, 'SYfi 1.. !: ' J�' :� C F�. „�r it •1 �' k��' 'P!.�}�:ix Y:II,i ;j'?
Boars
•I.
Numl;er' .. ;;
'of LagDUI1S .s. '
A uu.. 3•f�k�n�h.,'
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? Q Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...».........r... ......r........................................................................................................................ .................. ....... r....................................
Freeboard (inches):
12112103 Continued

Facility Number: 31 — 5--Z_ Date of Inspection 3 d
i
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
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 maintenance/improvement?
11. is there evidence of over application? If yes, check the appropriate box below,
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
® Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor homes
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20, At the time of the inspection did the facility pose an odor or air quality concern? if yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
•:.;.-.. .,yi.yrJ!:::i'i...._.....Relf'H:(!.'Ii�....r�......r.xF:id's£�ibdfn�!�.�,.....:s�":;S:i: V'd ��3titifh+[�ffi "Yi�!.g.§'yiS { � .7,111�`...iri •,'� i �M
Comments,(refer.�to question #): Explain any YES'answers and/or axty'recvmtnendations ar;any;other eomrnents f I,' Y R,};,'
M J!i' x, ' L kr .H' n:'1:} a. ''3 O '�A rau,� kz`n° RY.rs�rr �.¢,
Use drawiup o!' fsrcility�to lietterW@ikin sit tions. (we atlditianal pages as necessary):'. Field Co Final Notes
T��"Z ' , ''.'k 10 • „ sj4 t ri;x i s ❑ Copy ❑ 1F.
. .,!:�. �. 1 ..� i� :li. :.•� 5M r,:i::: ..dk s•.::i;.F�
SUP eI Volf'� r� 4•r !� w �Q n ��GC c��t�e S .`r[ , %� ,-�
[ t'V411 It*Q fG��i� /v l�f/[E✓ r
lef � ,,",/, f d ��"'t/ HV
Reviewer/Inspector Name
Reviewer/Inspector Signature: z Date:
LE/!l/U.] t onunuea

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

Facility Number hate of Visit: Jr' x Time: =
10 Not ati n 1 0 Belowr h ld
Permitted ® Certified © Conditionally Certified E] Registered Date Last Operated or Above Threshold:
Farm Name: County: Nfs�f►t
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: ��►���nD_I[�Is�flL __ _
Certified Operator:
Location of Farm;
Phone No:
�Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 C `" Longitude 0' ` 0«
Design Current Design Current Design. Curreni ..; .
Swine Capacity Pn uiation PoultryCapacity Population Cattle Ca aci Po ulation
El Wean to Feeder ❑ Layer ❑Dai
® Feeder to Finish ❑ Non -La er ❑Non-Dai
❑ Farrow to Wean
El Farrow to Feeder - ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
Boars Tota1.SSLW ::: i
Limber of ❑ Subsurface Drair
;Ptiads 1 Solid'I'raps '";. ❑ No Liquid Waste
Discharge & StreamImpacts
i, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b, lfdischarge is observed, did it reach Water of the State? (Byes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if ycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection &'Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier. of
Freeboard (inches):
—[Spray Field Area
❑ Yes
EQ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
JR No
❑ Yes
&No
❑ Yes
®,No
Structure 6
0510310I Continued

Facility Number: 21 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, e(c.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes XNo
❑ Yes �5No
❑ Yes P!�No
❑ Yes 5� No
❑ Yes KNo
►WasteApplication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 2Vo
11, Is there evidence of over application? ❑ Excessive
Pond-ingg ❑ PAN El Hydraulic Overload ❑ Yes 9INo
12. Crop type �r4. Vilz[� 74v lr�+'M V6 _
r�
13. Do the receiving craps differ with those designated in the Certified Animal Waste Management Plan (CAWMP)7 ❑ Yes 29 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes BNo
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes
® No
16. Is there a lack of adequate waste application equipment?
❑ Yes
EZJNo
Rmuired Records & Pecuments
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
® No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily avaiIab€e?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
;31 No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
X No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
91 No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
PI No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
9[No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
P5 No
24, Does facility require a follow-up visit by same agency?
❑ Yes
Qj No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O No
No violations or deficlencics were noted during this visit. You will recelve no further correspondence ahout this visit.
Gtinimcnts (refer:to question #]: Explain any YES answers and/or. any recomiricndatinti�'vir stay; other comment%.
Use drawings of. facility to better explain situations.;{use,addiftanal pacy)❑Field Copy ❑Final Nvtes �•
v►� 044- PlA Ahd AAVIU i A j. I . �i'� Itrr �t r `�T 7'—
714G L )e&4 Wo ook - f a X 0 / i74-
EG�rSr�t Lvo•�J�
Reviewer/Inspector Name
Reviewer/inspector Signature: Date: T Z
05103101 u Continued

. .
Facility Number: 3 — Date of Inspection
Odor LMM
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes E.No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of pfoperly within 24 hours? ❑ Yes 9SNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Q 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 01 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 19 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes MNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover.? Yes �Ia
Additional Comments and/or Drawin s::........;
05103/01

Y' �iL' .....
_
IOn �W '�..i
,���� 5
Vl8 t� $t!!
P ::.... ..s...
rowistok ui'f8ai1 ad�:Wateir'C
;i.
's
Type of Visit G(Compliance Inspection O Operation Review Q Lagoon Evaluation I
for Visit I3 Routine ❑ Complaint ❑ Follow up Q Emergency Notification Q Other 1 ❑ Denied Access
Date of Visit: Time:
Facility Number �
Q Not Operational Q Below Threshold
�ermltted
13 Certified �13 Conddiitiioonally Certified 13 Registered Date Last Operated or `Above Threshold:
Farm Name: ......Pa'. . �.....1:. :.`.:_...11 k .�. County:.......?1,I'7............................................. ...
Owner Name:.............................,.,.......................,................................................................... Phone No: .......................... »..................... ........... .......... ......
...,:.
FacilityContact:............................................................................... Title:................................................................ Phone No:..................................................
Mailing Address :........................................]]
Onsite Representative: .�L.... Q. .......... .........I.........
..............
Integratar:..,....1.' ..�z..............................................
Certified Operator:................................................................................................................
Operator Certification Number:.,,......................................
Location of Farm:
© Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 « Longitude u •
Design Current Design Current Design Ciirrdnt.;
Swine capacity Population Poultry. Cattle
aci Pe ulation Capacity Po uletinr
❑ Wean to Feeder ❑ Layer ❑ Dairy ,
Feeder to Finish L ❑ Non -Layer ❑ Non -Dairy I I
' ❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars TOW SSLW
Number of Lagoons JEI Subsurface Drains Present 0 Lagoon Area 10 Spray Field Area t
Huldin Ponds 15olid Tr -a No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gathnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3- Structure 4 Structure 5
❑ Yes A No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes t No
❑ Yes ' "No
❑ Yes �TNo
Structure b
Identifier: .......................
Freeboard (inches): 211
5100
Continued on back

Facility Number: — a
Date of Inspection 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
ONo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
tNo '
closure plan?
❑ Yes
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
PNo
I
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
f No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
lg No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
tNo
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
&No
12. Crop type <- W L v
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWINP)?
❑ Yes
,WNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
ffNo
b) Does the facility need a wettable acre determination?
❑ Yes
�0 No
c) This facility is pended for a wettable acre determination?
❑ Yes
tNo
15. Does the receiving crop need improvement?
❑ Yes
JtNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
&No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
krNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
W No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
too
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
allo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie/ discharge, freeboard problems, over application)
❑
E�rk0
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�ffNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
C'No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
.9No
�i f� t :�i� �igiFicienc� Vv re jn fe$ liN'4 g ��i5'�a5�t� Yn>� w�i� ee�iYc *Oo 66�0� • . .
6iresp6ridence: about this visit:
Cotnmats (refer to,quesdon #): Explain any YES, answers`and/or any recommendations or, any other co z"? - �,Y
Use drawings of facility to better explain situations. (use additional pstges as necessary)i ?;' .� i, i i' '!; :i: " `' ;:'P' ' .13
'1 q 93
i�{} �G clr-v��---� �v�,��-2�: �� r:,�-�•--��e� c �v� t ���1 car �-- ���c�c�'
Reviewer/Inspector Name f r' . .+
Reviewer/Inspector Signature: Date: FL3-01 5100

Facility Number: —! Date of iuspection
Odor Issucs
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours? ❑ Yes )'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ;R�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 kNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �'No
32. Do the flush tanks lack a submerged Fill pipe or a permanent/temporary cover? ❑ Yes )!�No
AdditionalCommentsand/or Drawings:.
1' Y �i �•=�.: Fi. 1: 'k:....,.i. .0
J
5100

.fr7ivision of Water Quality
Q Division of Soil and Water Conservation
a Other Agency / . I
[Type of Visit \0 Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit 30 Routine 0 Complaint O Follow up 0 Emergency Notification Q Other ❑ denied Access
Facility Number Date Of Visit: Time: .�-d. Printed min: 7/21/2000
� Nnt Operational Q Below Threshold
0 Permitted [3 Certified 13 Conditionally Certified 0 Registered Dateqast Opera or Above •Threshold:
Farm Nance: ... ..................'h....... ................... /1 V� ounty:...�Pjl/./1.S ....................... .:............
Owner Name: ..., aP1 iG! 1�I.............I...I.i .�..�S..Q..Y..... Phone Ncr:.......................................................................................
FacilityContact: ..............................................................................'I'itle:................................................................ Phone No:
MailingAddress: ................... ...................... .................... ......� ..........ram ..................I................................................................. ..........................
�A`/+-A+�`-`�-`/--
.. I r��Onsite Repress rttative:.I . � ....... !Integrator?G..........................................
CertifiedOperator: ................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
Al
............
',
bf5wine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude 0
Swine
Design Current Design Current
Capacity Population Poultry Capacity Population
❑ Layer
[� ❑ Non -Layer
❑ Wean to Feeder
Weeder tcFinish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Soars
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -[Dairy
Total Design Capacity
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present ❑ t.ag-ln Arent ❑ spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharge & Stream lrnu:tcts
I. Is any discharge observed from any part of the operation?
Dischargc originates! at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the con veyance trtan-made"
h, if discharge is observed. dint it reach Water of the Stale? Of yes, nenify DWQ)
c. If discharge is observed. what is the estimated Ilow in gal/rain?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes LKNo
❑ Yes ❑ No
❑ Yes ❑ No
;Oyl# —
El Yes [:]No
2. Is there evidence of past discharge from any part of the operation'! ❑ Yes ta'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes P3:1Ho
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier:.........-32................ .................................... ................................... ... -.1-........ ..................................... ............. ..... ......... ...........................
I^rreboard finches):
5100 Continued on back

Facility Number: 3 Date of Inspection 7 r11 Printed on: 7/21/2000
n
1, Are here any immediate threats to the integrity of any of the structures observed'? (iel trees, severe erosion,
❑Yes jNo
seepage, etc.]
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes ,VNo
(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 main tenancelirnproventent?
❑ Yes ANo
8. Does any part of the waste management system other than waste structures require ntaintenance/improvement?
❑ Yes _kNo
9. Do any stuctures lack adequate, gauged markers with required maximum and rninirnurn liquid level
❑ Yes jj�No
elevation markings'?
Waste AeRlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes �'No
11. Is there evide e f over application'? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
❑ Yes'ANo
f 2. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes -No
b) Does the facility need a wettable acre determination?
❑ Yes JgNo
c) This facility is pended for a wettable acre determination'!
❑ Yes �No
15. Does the receiving crop need improvement?
❑ Yes "*MNo
16. Is there a lack of adequate waste application equipment?
❑ Yes *No
Required Records & Documents
17, Fail to have Certificate of Coverage & General Pcrrnit readily available'?
❑ Yes jj�No
18. Does the facility tail to have all components of the Certified Animal Waste Management Plan readily available'?
❑ Yes J�(No
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes 5No
20, Is facility not in compliance w'sth'any applicable setback criteria in effect at the time oi'design'?
❑ Yes %No
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes RN
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
(iel discharge, freeboard problems, over application)
❑ Yes J�No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes K No
24. Does facility require a follow-up visit by same agency'?
❑ Yes KNO
25. Were any additional problems noted which cause noncornpliance of the Certified AWMP?
❑ Yes KNa
.. ,Nq•yi4i000s.or. dtl}eie'npim wr re hotgo, 00-ring f'his'visit, ;Y:oo ' ili -reegive -fio tur fte . ,
c0, rresouiidence. ab6UA this visit.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as ecessary):
f ryv( _ 1I �,
Reviewer/Inspector Name
Reviewer/Inspector Signature: _ A A6 Date: 5100

Facility Number: —1��r flute of Inspection Printed on: 7/21/2000
'lt3dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or Iagoon fail to discharge M/or below ❑ Yes , kNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes PRr-No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONo
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 )EINo
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 ,E�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 2'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ZNo
Additional ornments and/orDrawings:
AL
5100

13 Division of Soil and Water Consei-vation Operation Revicw
i- © Division of Soil and Water fi Cottser^vation!- oin ance Ins ectfon,
Cp.. P • , ,i � ..sj���
M Division of Water Quality - Clainpliance Inspection' ,
0
Other Agency -Operabon Reii vv ;. E a it
L Routine O Com taint 0 Follow-up of DWQ inspection p Follow -tip of DSWC review Q Other
Facility Number 'Z Date of Inspection
Time of Inspectic:tt M24hr.(hh:mm)
0 Permitted '® Certified 0 Conditionally Certified 0 Registered 0 Not Operational Ilsrte Last Operated:
T,,�} 11 ..........................
Farm Name: s.�Q.�.�i.�.d...... •+.416 ye � � County: -DVP . n..................................................
OwnerName:......... .r....... ...1.r....................................................... Phone Ntr:....................................................................................
Facility Contact:
Flailing Address:
Title:
f j�Ji
Onsitc Representative :.......
Q'...Q ........`�?y
..
CertifiedOperator: ................................................... .............................................................
Location of Farm:
Phone No:
................................................ .................................. ....... I ..........
........
Integrator:prerbi, C
s........................................................
Operator Certification Number: ..........................................
Latitude �� �•� Longitude • �� �_�
Design Current Design : Current Design Current
Swine Capacity Population poultry Capacity:, Population .- Cattle Capacity Pa ulation
❑ Wean to Feeder ❑ Layer ❑ Dairy
10 Feeder to Finis L470 1170 ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
ElFarrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capkity
❑ Gilts,
❑ Boars Total SSLW
=ill umber of.Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area 10 Spray l!ieid Arca
Holding Ponds 1 Solid Traps 10 No Liquid Waste Management System °
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. Ifdischarge is observed, did it reach Water of tltc State? (Il'yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min'!
d. Dues discharge bypass a lagoon system? (If'yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I
Identifier: 0
Freeboard (inches): .......2d..........
Structure 2 Structure, 3
❑ Yes Z No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes $ No
❑ Yes X No
❑ Yes ;K No
Structure 4 Structure 5 Structure fi -
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes A No
Continued on back

Facility Number: �� — rj Date of Inspection
6. API. there Structures on-silc which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any cif the structures need maintenance/improvement? ❑ Yes ZrNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes B No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes %No
Waste Armlication
10. Are -there any buffers that need maintenance/improvetent? ❑ Yes XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes 9fNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 19 No
b) Does the facility need a wettable acre determination? ❑ Yes 10 No
c) This facility is pended for a wettable acre determination? ❑ Yes 19 No
15. Does the receiving crop need improvement? ❑ Yes PZ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes 'Pff No
Required Records & Documents
17,
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18.
Dees the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
'
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
;K No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
X No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
IPOC No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes
*No
(ic/ problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
gNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
23 No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
J4No
�'VQ yi6la4iggs ao fie# cierteies v►gre Owd. 0609 Obis" }sit; • Yop will teoiye Oo rut ft
.. .,
corres�onde' ' e. about. this ' isit_ ... . .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any bther'cnmi'nints. �
Use drawings of facility to better explain situations. (use additional pages as necessary):
�aG ► ! +�y j+r� e x cG+� 1�►r} Gahal i -� � a ►� .
Reviewer/Ins ector Name
Reviewer/Inspector Signature: . Date: /� Q
3/23/99

Facility Number: y f — Date (if Inspection
Odorlssues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
10 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
16 No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
M No
reads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
29 No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
YU No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
XNo
Additional omments an or.rawin s:
. ... � w ,. ...... • ..�,... �: �. �r�.� is a
3/23/99

.; p..
E3 Division of Soil and Water Conservation C]
M-.
Other Agency
iJI
Division of Water Quality
;T
:. .ek .F. ....1..•:.�f�.'.4::.::3Erc.:..
.. .. .r•.... .... .... ..... .. Y"`Yra-°''.'!¢r..-.....'7"."..
... .. .... ....
.. ...5?3".¢�::.�.::::�: �:'. zs„.'�'E':'�';:e.
Routine 0 Complaint Q Follow-up of DW2 inspection O Follow-u elf DSWC review Q Other
Date of Inspection Q— R$
Facility Number Time of Inspection �Q 24 hr. (hh:mm)
13 Registered Certified 1] Applied for Permit © Permitted [3 Not (? erationa! Date Last Operated:
Farm Name: �+.. i. ` �112�............................................. County:......................................................................
1�
Owner Name: ...
2.................... ................................................... Phone No: ...... a...`'°Leg.^.....1.......................
FacilityContact: ...........................n....... .......................... .......... �T}itle:.................................................................. Phone No:...................................................
Mailing Address:...... . �r......... S!!.�..s�1. !r .. ...........siaQ. !!L�`' ,� ..... r°� lJ g ................. .......................
i7nsite Representative:l,.1�r..! ..� lntegratrrr:...!...................... ................
Certified Operator;............................................................................................................... Operator Certification Number:
.ocati n of arnt:
�.5ai.+-1 ...... ...`Y....... ......% `.. ..... ........ .................... '....I.......... ..... .. .1....... A .......:.!.... .........................."
......G...... ......5.........................................................V ... !�
i►'
Latitude 0 ' " Longitude ' ' "
Design, Current Design . Current Design, Curr�iitt,..,,,;,.
.
swine Capacity Population Poultry Capacity Population Cattle: Capacity Population
❑ Wean to Feeder 10 Layer ❑ Dairy
Feeder to Finish JLJ 110 JEI Non -Layer I I IE]Non-Dairyl
❑ Farrow to Wean .
❑ Farrow to Feeder ❑ Other I I'
❑ Farrow to Finish Total Design Capacity'
❑ Gilts
❑ Boars Total SSLW
Number or.Lagoons tHpldint Ponds'; ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
❑ No liquid Waste Mana};emcnt System
General
1. Are there any buffers that need maintenance/improvement?
2. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge: is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaVmin7
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- Docs any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes 0 No
❑ Yes 0 No
❑ Yes Ej No
❑ Yes C�No
NA
❑ Yes 9No
❑ Yes 1XNo
❑ Yes No
❑ Yes No
Cl Yes P�No
❑ Yes KNo
7/25/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.11oldin2 Ponds, Flush„Yits. etc.)
9. Is storage capacity (Freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier:
............ I ......... f............................................... ....... I ...................
...
Freeboard(ft): ........... : 1.•....... •..................................... .......................
•.....
10. Is seepage observed from any of the structures?
❑ Yes C5 No
❑ Yes 0 No
Structure 4 Structure 5 Structure ti
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance./improvement?
(If any of questions 9.12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
_mteApulication
14, Is there physical evidence of over application?
(If in excess of WMP, or r[unof entering waters of the State, notify DWQ)
15. p............1............................................................................................................................................
16, Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22• Does record keeping need improvement?
I± or Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
l�iv.vialatinsnr de>Ficiencies:were Hated during this;visit::You.rvili receive nu further
:•icyrresp¢r�dej<tee�la'aut�this:visit:-::�:.:.-:.• •.:�.�.�..•�-.•:.•:�..�; '-::- •::�::�:�.•. .•
.; ..........
ents'r refer to question '#):::lip llain:any;YES..answers and/or auy t commeridutions or any other con
nowings of fudfity to better explain situ att+t ns. use addittona] pug v a5 necessstry}: F, F.
❑ Yes t No
❑ Yes No
❑ Yes No
❑ Yes OTNo
❑ Yes D�No
❑ Yes 53 No
❑ Yes IM No
❑ Yes K No
❑ Yes d No
❑ Yes Cd No
❑ Yes O No
❑ Yes ff No
❑ Yes N No
❑ Yes i No
❑ Yes No
7/25/97
Reviewer/Inspector Name
Reviewer/inspector Signature:
Date: to---'a-I-C �

4i.`.er��rel. �
DSWC Animal Feedlot Operation Review
«<:F
� '� x,=:;F€;
»!i•"� i�r''�
y€
i:ef
F.Fi.::S�:.
F: „
d
DWQ Animal Feedlot Operation Site Inspection
,F,;E?„FF,.
-
..
�
.�
., :�
:*..
"i
lGt Routine :O Complaint Q Follow-up of IM2 inspection D Follow-up of IIMVC review Q Other
I}ate of lnspec(iotr 9 9 1
F- Facility Number
Time of Inspectiutt 24 hr. (hh:mm)
13 Registered ® Certified © Applied for Permit 13 Permitted 113 Not Operational I Date bast Operated: ,,,
Farrar Name: -..l .A.n.a�.. ,............i.? t ... ,r.r:r......A... Zr-...................
Owner Name: ....... ]�.�.xs.tk�.L ..................................
Facility Contact:........................................,..................................... Title:
INtailirtg Address:... ......j....................
County:....�?u.�.�
...W.4..jL.o
Phone No:....1..�.....�..g.,..`., �a.�...4...i.
Phone No:
.5..S.1* y..►.,.1.. ,.... }., ,...................... z .5�....
Onsite Represent:rti►'e:,,,D.P.tn a.ld ....1.4.0.±..1kry ....... In(egrator:....f...e.4.E......................................................
Certified Operator .. Operator Certification ....... .._............. ... i,...�..tr, .....................,. (] cr ator Lcrtifrcatiott iVtttttfrer:....
Location of Farm:
Cl.�.....►!!! $.5..� ...... St, a ........5.. ! T.2 ..ix.r......c P..,na..�e..i..�rrrr a .... .......inn....L .....uti.c.. .. r ...�e. x:.�E Prrr.-.. AL
a.c..�� a..r........r�r.,.'k �....... ........_................... ......... ...................... .........:.... ....................................................................... ......
Latitude ©' ®1 ®« Longitude ©0 ®' it
Design Current
Swine Capacity Population
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
llcsign Current Design.. Current....:, :.
Poultry Capacity Population Cattle Capacity Population::::',
❑ Layer I 1 10 Dairy
❑ Non -Layer I 1 10 Non -Dairy
❑ Qther
Total Design Capacity C)
Total SSLW �}
Number of Lagoons 1 Holding fonds L� ❑ Subsurface Drains Present 110 Lagoon Area ❑Spray Field Are
❑ No Liquid Waste Management System
General
1. Are there any buffers that need rnaintenancelimproventent? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Dischanyc Miginatcd at; ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made? ❑ Yes 0 No
b. It'discharge is observed• did it reach Surface Water:' (IF yes. notify DWQ) ElYes ® No
c. if discharge is observed, what is the estirnsited flow in g:rllnrin:' �gj�
d. Does discharge bypass a lagoon systern9 (If ycs, iwlify DWQ) ❑ Yes RNo
3. Is there evidence of past discharge from any part of the operation'? ❑ Yes ELNo
4. Were there any adverse impacts to the waters of the State other than frorn a discharge'? ❑ Yes F[No
5. Does any part of the waste management system (ether than lagoons/holding ponds) require 9 Yes W No
mai n ten anceli rnprovement?
6. Is facility not in compliance with any applicable setback Criteria in effect at the time o!-design? ❑ Yes 2fNo
7. Did the facility fail to have a certified operator in responsible charge'? ❑ Yes 5allo
7/25/97 Continued on back

Facility Number: �j — y
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lap-oons,lloldint; Ponds. Flush Pits, -etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l
Identifier:
3 ..................
Structure 2 Structure 3 Structure 4
... ....... I ............... ............... I ....
........
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste_ Application
14, Is there physical evidence of over application'!
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes
® No
❑ Yes
B-No
Structure 5 Structure 6
❑ Yes
® No
❑ Yes
KNo
❑ Yes
® No
❑ Yes
Id No
❑ Yes
0 No
15. Crop type 9.r...rx......................... .... ............................ ..!rs] ti`Ard .........................
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?-
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Pennitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[] No violations or deficiencies were noted during; this visit.- .Yoil4111 receive no fuitlier
: correspondewe about this,visit:
❑ Yes O No
❑ Yes R No
❑ Yes [&N❑
❑ Yes KNo
❑ Yes B No
..Yes ❑ No
❑ Yes CKNo
KYes ❑ No
❑ Yes R,No
Comments (refer to question #): Explain any YES answers and/or any recominendations or any other �ommettts:'j,;_,,. 1?
Use drawings of facility. to better explain situations. (use additional. pages as necessary): _�T''
.
.:::::::::.::::::::.
16 • 2-4 - C.t,, +-; + t-,iL Pew,.. [ a I S r C-a r � v. .T +r � t a.r v.v. f * + T r
x s �-a w ;�^�q S 0 4 s4w..Y..3 a ,,�,L w k-R-+�.f . 'I�. e [� d.. I i-1 L C -V S
s- w. t-� �K, r 101 sV,,O-v t.j- s� e� 3•-� ss �.d . ,+ o d 11—" , 4 WV
aV'£-n. V < < Zr ►mod i S td wr
Z. Cs -* A, �+ • itl C D t v. , r0 A 4.v+ w� it S f
Cq cU I a. t4-d I'N F r e- CA V
A tl �4 t��-
7/25/97
Reviewerllnspt,ctor iti:tm .............w ..- .-..... _
e
A.'k�..Q�.,�-,.�._,r.�
Reviewer/Inspector Signature: ��,�y ,� - 9K I]ate:

❑ DSWC Animal Feedlot Operation Review
® DWQ Animal Feedlot Operation Site Inspection
Routine ❑ Com laint ❑ F(oflnr+,-u of l)w( iris L-etion ❑ Follow-u of DSIVC review ❑ Other
Date of Inspection 9 7 4 7
Facility Number �— Time of Inspection �� 24 hr. (hh:mm)
0 Registered ® Certified 0 Applied for Permit 0 Permitted' 10 Not Operational I Date Last Operated:
Fat'nt Name: ,. .A..r,,..a.�.. .t...7 �! .... F.v......vly. # 2— County: .... d.v.q..1.:. .I...............1�,1,,.. ..�
Owner Name' ....... .r ...t.l..... .................4-......................................... Phone No:.... �..... ms... ... 3-0..I...q...... I .........
....
FacilityContact; .............................................................................. Title:................................................................ Phone No' ....................
Mailing Address: ... 5 .......1! . �..�..�.1 �. ...... r1.............................................. ... ...`.........1. .. ..c,� .................... ... .�1.. . �. ....
C)nsite Represent:hive:...r�.G.1n.a.l�.....1...►!...... �—r............................................. Intel;r:stror:.... r.P.,i...P...1}.....,.......,..................................,....
�} t
Certified Operator: .................... ............................... ................................................ ............. Operator Certification Number:.........................................
Location of Farm:
... ...... ............................... ..
Latitude ' 4 0" Longitude ' 4 11
es gn �:: �:::i Current
Swine Capacity :Population Poultry
4`
F
sign`F :Current
paclty ; Population
❑ Wean to Feeder
Layer
❑ Feeder to Finish'
❑Nan -Layer
❑ Farrow to Wean
s4,0::€;: "A=.°_:;,€:;=j,p . ..,: V_.:; ..;. .
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
_ `Total Desi;
7
❑ Gi]ts_
❑ Soars
' rl _Design;;:. Current ,s
Cattle ' ;Capacity;; Population.
❑ Dai
❑ Non -Dairy
;n Capacity
otal SSL' W
Numberyof Lagoons l.Hblding Piini3s. j Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
'R;F'tit: 'r: t...... E •: .,
i uid Waste Lana ement System
General
I.
Are there any buffers that need maintenance/improvement?
❑ Yes
® No
2.
Is any discharge observed from any pan of the operation?
❑ Yes
® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, watt the conveyance. man -mane?
❑ Yes
® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
® No
c. If discharge is observed, what is the estimated flow in gaVrnin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
IS No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
ESNo
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
S. No
5.
Does any pan of the waste management system (other than lagoons/holding ponds) require
® Yes
® No
main ten anceli mprovemen t?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[2�No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
7125/97
Continued on back
ti

Facility Number: 7) — z15 2
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 19 No
'tru t I [OlLagoons.11old ing Ponds,Flush Pitsetc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes END
Structure t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...................................................................................................................................................................................................................
Freeboard(ft): ........,.,3........................................................................................................................................................................................ .... .......
10. Is seepage observed from any of the structures? ❑ Yes ® No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an Immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type t.9. f...................................... ................................... 71.`°-,? . t....................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or, PeroAl(�d Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additiQ.0.problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0: No.vitiiatioivts yr deficieneies.were:noted•durin-g this;visit. You.will receive no ftirther
' . ct)rresgbnde�kt= alioitt
❑ Yes [9 No
❑ Yes ® No
❑ Yes 0 No
❑ Yes U No
&Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes Q9 No
❑ Yes iS No
❑ Yes ® No
® Yes ❑ Na
❑ Yes END
Ej Yes ❑ No
❑ Yes ®-No
.�,[. n• s.y...as,•«:: , .:s+u3 n,s.h'.�....a,p, iii333:.»,•;35i;•;..;:•».,:�» to ...;::;:....� .,,;.
cot uife ts'(refer fg question #}; %E7tplain any;YES answers andln`ir;'any iotntrien atlons or. an" other comments..` ,;� 's
..r: ;:.. a»€ .. i :.::..... .:t ::. � . , , ��e•Q�1�n.,F,:y; r.i:.:F: _ .3?FRFFx?,.EFnr NFF :r ' , '? •:; e'ei » � i���,>��.:.�:
Use'drawin s of faeiltt to better exp�aIn sttuattons (use additional pages as necessary)
�:."'�:`�f�.€di1i�'•'.�g ';ice �� �¢' d3iee�43�i'�i5.aa �a:.�in�Ei� � i � •• •V�11in�Fs'i' •:>�F'Q�.'fjjiwi F FFi . L..•F�1�.s'+r T'�i•iisi�;<�i.�iii�sisl n_ 3'�•1;5�'''-,is 8iE'�i55Ff:.� : • Ali �� � ��€EFi(�"?Ee i'p' F� ^` � �i� Fkas: S�ss'�t�t $ 7 i -i
. v { !.� p n..-. L a S r C y.� 4,
plsy tiu3 SGy' -L C11--1L IV 'A.tif + NQif 0. Lei C✓_*i ri/S
�`:' U � � � � � .`�"�-C� � Li � l +A L Q • d t + n �-i..d � n 'f'0 { C�-••� i
S• W► I-e ..,,, y s r '�`�`� 4 t s Ito v t iL 1 b e
aye.« u „I} = i � Y c !� l.e..�.•, � S c.a � �-e � �-e� , � �
y. [�{{ q LJY• t,n+ 4rd�Q.
A Nilc �� a� I� e : ! = c. „� �,-�� r,� r i e t �... i �.� [ u r-r'. (-,
7/25/97
H
Mg- p �:°e�!s^ .^; ^'^s"„K«^*b:� :,:,"':M� ;t r^L^;n' •;Y' z . ii i:':'..31I P!' ,. ' ,3' :::,Y:':.':"f •.;;i,'N'::'I� : : sip""' ,Reviewer/Inspector ector Name �!. - 4 .. „ .
1 ].. Q..��—! h:�; �S?n;.��l".. !„$;� 1 , �� � .:I� i\:��<�ii�:. :. '.,s .:..'z .- F, .. i, .i;;...��, i!:;:�iiiiii::'i; ud �. -. .. `�;i..;iss:,'.. ls'di`sFt�"t.i: iSr:i .... ....
Reviewer/Inspector Signature: , Date: q

WASTE UTILIZATION PLAN
DATE YllkI9 7
Producer: Donald Miller
Location: 305 Miller Road
Beulaville, NC 28518
Telephone: [phone]
Type Operation: Feeder to Finish
Number of Animals: 1470
The waste from your animal facility must be land applied at a specified
rate to prevent pollution of surface and/or groundwater. The plant
nutrients In the animal waste should be used to reduce the amount of
commercial fertilizer required for the crops in the fields where waste
is to be applied. This waste utilization plan uses nitrogen as the
limiting nutrient. Waste should be analyzed before each application
cycle. Annual soil tests are strongly encouraged so that all plant
nutrients can be balanced for realistic yields of the crop to be grown.
Several factors are important in implementing your waste utilization
plan in order to maximize the fertilizer value of the waste and to
ensure that it is applied in an environmentally safe manner. Always
apply waste based on the needs of the crop to be grown and the nutrient
content.of the waste. Do not apply more nitrogen than the crop can
utilize. Soil types are important as they have different infiltration
rates, leaching potentials, cation exchange capacities, and available
water holding capacities. Normally waste shall not be applied to land
eroding at greater than 5 tons per acre per year. With special pre-
cautions, waste may be applied to land eroding at up to 10 tons per
acre per year. Do not apply waste on saturated soils, when it is
raining, or when the surface is frozen. Either of these conditions
may result in runoff to surface waters which is not allowed under DWO
regulations. Wind conditions should also be considered to avoid drift
and downwind odor problems. To maximize the value of the nutrients
for crop production and to reduce the potential for pollution, the
waste should be applied to a growing crop or applied to bare ground
not more than 30 days prior to planting. Injecting the waste or
disking will conserve nutrients and reduce odor problems.
This plan is based on waste application through irrigation for this
is the manner in which you have chosen to apply your waste. If you
choose to inject the waste in the future, you need to revise this
plan. Nutrient levels for injecting waste and irrigating waste are
not the same.
The estimated acres needed to apply the animal waste is based on
typical nutrient content for this type of facility. Acreage require-
ments should be based on the waste analysis report from your waste
management facility. Attached you will find information on proper
sampling techniques, preparation, and transfer of waste samples to
the lab for analysis.
This waste utilization plan, if carried out, meets the requirements
for compliance with 15A NCAC 2M.0217 adopted by the Environmental
Management Commission.
Page 1

WASTE UTILIZATION PLAN
AMOUNT OF WASTE PRODUCED PER YEAR (GALLONS, FT3, TONS, ETC.)
1470 hogs x 1.9 tons wastelhogslyear = 2793 tons
AMOUNT OF PLANT AVAILABLE NITROGEN (PAN) PRODUCED PER YEAR
1470 hags x 2.3 PAN/hogs/year = 3381 lbs. PAN/year
Appiying the above amount of waste is a big job. You should plan time
and have appropriate equipment to apply the waste in a timely manner.
The following acreage will be needed for waste application based on
the crop to be grown, soil type and surface application.
TABLE 1: ACRES OWNED BY PRODUCER
Page 2
TRACT FIELD
SOIL TYPE &CLASS-
CROP
YIELD LBS
COMM '*
*LBS
DETERMINING PHASE
CODE
AW N
PER ACRES
AW
PER AC
AC
USED
APPI_IC,
TIME
5387 1
FOA
C
120 150
15 11.3
1525.5
5387 -1
FOA
W
55 110
11.3
1243
5387 1
FOA
❑SB
28 112
11.3
1265.6
0
0
0
0
0
0
0
0
Total
4034.1
Indicates that this field is being over seeded (i.e. interplanted)
or winter annuals follow summer annuals.
NOTE: The applicator is cautioned that P and K may be over applied
while meeting the N requirements. Beginning in 1996 the Coastal zone
Management Act will require farmers in some eastern counties of NC to
have a nutrient management plan that addresses all nutrients. This
plan only addresses Nitrogen.

WASTE UTILIZATION PLAN
TABLE 2: ACRES WITH AGREEMENT OR LONG TERM LEASE
(Agreement with adjacent landowners must be attached.)
(Required only if operator does not own adequate
land. See required specifications 2.)
TRACT FIELD SOIL TYPE & CLASS- CROP YIELD
DETERMINING PHASE CODE
Page 3
LBS COMM ** * LBS
AW N PER ACRES AW
PER AC AC USE❑
0
0
0
0
0
R
n
Total 0
— Indicates that this field is being over seeded (i.e, interplanted)
or winter annuals follow summer annuals.
" Acreage figures may exceed total acreage in fields due to
over seeding.
* Ibs AW N (animal waste nitrogen) equals total required nitrogen
less any commercial nitrogen (COMM N) supplied,
The following legend explains the crop codes used in tables 1 and 2 above:
LBS N
APPLY
CROP CODE
CROP
UNITS PER UNIT
MONTH
BH
HYBRI❑ BERMUDA GRASS -HAY
TONS
50
APR-SEPT
C
CORN
BUSHELS
1,25
MAR-JUNE
SG
SMALL GRAIN OVER SEED
AC
50
SEPT-NOV
SA
SUMMER ANNUALS
AC
110
APR -MAY
WA
WINTER ANNUALS
AC
100
SEPT-NOV
BC
HYBRID BERMUDA GRASS -CON GRAZED
TONS
50
APR-SEPT
BP
HYBRID BERMUDA GRASS -PASTURE
TONS
50
APR-SEPT
FC
TALL FESCUE -CON GRAZED
TONS
50
SEPT-APR
FH
TALL FESCUE -HAY
TONS
50
SEPT-APR
FP
TALL FESCUE -PASTURE
TONS
50
SEPT-APR
SB
SOY BEANS
BUSHELS
4
JUN-SEPT
❑SB
DOUBLE CROP SOY BEANS
BUSHELS
4
JUN-SEPT
W
WHEAT
BUSHELS
2
FEB-MAR

WASTE UTILIZATION PLAN
Page 4
TOTALS FROM TABLES 1 AND 2
ACRES LBS AW N USED
TABLE 1 22.6 4034.1
TABLE 2 0
TOTAL 22.6 4034.1
AMOUNT OF N PRODUCED 3381
'"' BALANCE -653.1
*** This number must be less than or equal to 0 in order to
fully utilize the animal waste N produced.
Acres shown in each of the preceding tables are considered to be the
usable acres excluding required buffers, filter strips along ditches,
odd areas unable to be irrigated, and perimeter areas not receiving
full application rates due to equipment limitations. Actual total
acres in the fields listed may, and most likely will be, more than
the acres shown in the tables.
NOTE: The Waste Utilization Plan must contain provisions for periodic
land application of sludge at agronomic rates. The sludge will be
nutrient rich and will require precautionary measures to prevent
over application of nutrients or other elements, Your production
facility will produce approximately 5'y3. 9 pounds of plant
available nitrogen (PAN) per year in the sludge that will need to be
removed on a periodic basis, This figure is PAN when broadcasting
the sludge equipment, may be needed when you remove this sludge.
See attached map showing the fields to be used for the utilization of
waste water,
APPLICATION OF WASTE BY IRRIGATION
The irrigation application rate should not exceed the intake rate of
the soil at the time of irrigation such that runoff or pond ing occurs,
This rate is limited by initial soil moisture content, soil structure,
soil texture, water droplet size, and organic solids. The application
amount should not exceed the available water holding capacity of the
soil at the time of irrigation nor should the plant available nitrogen
applied exceed the nitrogen needs of the crop.
Your facility is designed for 180 days of temporary storage
and the temporary storage must be removed on the average of once every
5 months. In no instance should the volume of waste being stored in
your structure be within J. 7 feet of the top of the dike.

WASTE UTILIZATION PLAN Page 5
If surface irrigation is the method of land application for this plan, it
it is the responsibility of the producer and irrigation de signer to
ensure that an irrigation system is installed to properly irrigate the
acres shown in Tables 1 and 2. Failure to apply the recommended rates
and amounts of Nitrogen shown in the tables may make this plan invalid
Call your Agriment Services representative for assistance in determining
the amount of waste per acre and the proper application rate
prior to beginning the application of your waste. ! I
NARRATIVE OF OPERATION: SDK. �rcksr+►r

WASTE UTILIZATION PLAN
Plans and Specifications
Page 6
Animal waste shall not reach surface waters of the state by runoff,
drift, manmade conveyances, direct application, or direct discharge
during operation or land application. Any discharge of waste which
reaches surface water is prohibited. illegal discharges are subject
to assessment of civil penalties of $10,000 per day bythe Division
of Water Quality for every day the discharge continues.
2. The Local NRCS office must have documentation in the design folder that
the producer either owns or has long term access to adequate land
to properly dispose of waste. if the producer does not own adequate
land to properly dispose of waste, he shall provide NRCS with a copy
of a written agreement with a landowner who is within a reasonable
proximity, allowing him/her the use of the land for waste application
for the life expectancy of the production facility. It is the
responsibility of the owner of the facility to secure an updated Waste
Utilization Plan when there is a change in the operation, increase in
the number of animals, method of utilization, or available land.
3. Animal waste shall be applied to meet, but not exceed, the Nitrogen
needs for realistic crop yields based on soil type, available moisture,
historical data, climate conditions, and level of management, unless
there are regulations that restrict the rate of application for other
nutrients.
4. Animal waste may be applied to land that has a Resource Management
System (RMS) or an Alternative Conservation System (ACS). If an ACS
is used the soil loss shall be no greater than 10 tons per acre per
year and appropriate filter strips will be used where runoff leaves
the Feld. These filter strips will be in addition to "Buffers"
required by DEM. (See FCTG Standard 393-Filter Strips and Standard
390 Interim Riparian Forest Buffers).
5. Odors can be reduced by injecting the waste or disking after waste
application. Waste should not be applied when the wind is blowing.
6. When animal waste is to be applied on acres subject to flooding, it
will be soil incorporated on conventionally tilled cropland. When
applied to conservation tilled crops or grassland, the waste may be
broadcast provided the application does not occur during a season
prone to flooding. (See "Weather and Climate in North Carolina" in
the NRCS Technical Reference - Environment file for guidance.
7. Liquid waste shall be applied at rates not to exceed the soil infil-
tration rate such that runoff does not occur off -site or to surface
waters and in a method which does not cause drift from the site during
application. No ponding should occur in order to control conditions
conducive to odor or flies and to provide uniformity of application.
8. Animal waste shall not be applied to saturated soils, during rainfall
event, or when the surface is frozen.
9. Animal waste shall be applied on actively growing crops in such a
manner that the crop is not covered with waste to a depth that would
inhibit growth. The potential for salt damage from animal waste should
also be considered.

WASTE UTILIZATION PLAN
Page 7
10. Waste nutrients shall not be applied in fall or winter for spring
planted crops on soils with a high potential for leaching, Waste
nutrient loading rates on these soils should be held to a minimum
and a suitable winter cover crop planted to take up released
nutrients. Waste shall not be applied more than 30 days prior to
planting of a crop on bare soil,
11. Animal waste shall not be applied closer than 25 feet to surface
water. This distance may be reduced for waters that are not perennial
provided adequate vegetative filter strips are present. (See standard
393 - Filter Strips)
12. Animal waste shall not be applied closer than 100 feet to wells.
13. Animal waste shall not be applied closer than 200 feet of dwellings
other than those owned by the landowner.
14. Waste shall be applied in a manner not to reach other property and
public right -of ways.
15. Animal waste shall not be discharged into surface waters, drainage ways,
or wetlands by discharge or by over -spraying. Animal waste may be
applied to prior converted wetlands provided they have been
approved as a land application site by a "technical specialist'.
Animal waste should not be applied on grassed waterways that discharge
into water courses, except when applied at agronomic rates and the
application causes no runoff or drift from the site.
16. Domestic and industrial waste from wash down facilities, showers,
toilets, sinks, etc., shall not be discharged into the animal waste
management system.
17. Lagoons and other uncovered waste containment structures must maintain
a maximum operating level to provide adequate storage for a 25-year,
24-hour storm event in addition to one (1) foot mandatory freeboard,
18, A protective cover of appropriate vegetation will be established on
all disturbed areas (lagoon embankments, berms, pipe runs, etc.).
If needed, special vegetation shall be provided for these areas and
and shall be fenced, as necessary to protect the vegetation.
Vegetation such as trees, shrubs, and other woody species, etc. are
limited to areas where considered appropriate. Lagoon areas should be
kept mowed and accessible. Lagoon berms and structures should be
inspected regularly for evidence of erosion, leakage or discharge.
19. If animal production at the facility is to be suspended or terminated,
the owner is responsible for obtaining and implementing a "closure
plan" which will eliminate the possibility of an illegal discharge,
pollution and erosion.
20. Waste handling structures, piping, pumps, reels, etc., should be
inspected on a regular basis to prevent breakdowns, leaks, and spills.
A regular maintenance checklist should be kept on site.

►u►l �t4IIj111IIM111191OR1:2■-IM
Page 8
21. Animal waste can be used in a rotation that includes vegetables and
other crops for direct human consumption. However, if animal waste
is used on crops for direct human consumption it should only be applied
pre plant with no further applications of animal waste during the crop
season.
22. Highly visible markers shall be installed to mark the top and bottom
elevations of the temporary storage (pumping volume) of all waste
treatment lagoons. Pumping shall be managed to maintain the liquid
level between the markers. A marker will be required to mark the
maximum storage volume for waste storage ponds.
23. Waste shall be tested within sixty days of utiiixation and soil shall
be tested at least annually at crop sites where waste products are
applied. Nitrogen shall be the rate - determining element, Zinc
and copper levels in the soils shall be monitored and alternative crop
sites shall be used when these metals approach excessive levels. pH
and waste analysis records shall be kept for five years. Poultry dry
waste application records shall be maintained for three years. Waste
application records for all other waste shall be maintained for five
years.
24. Dead animals will be disposed of in a manner that meets North
Carolina State regulations or other States' regulations.

WASTE UTILIZATION PLAN
Page 9
NAME OF FARM:
OWNER 1 MANAGER AGREEMENT
I (we) understand and will follow and implement the specifications
and the operation and maintenance procedures established in the
approved animal waste utilization plan for the farm named above.
I (we) know that an expansion to the existing design capacity of
the waste treatment and storage system or construction of new
facilities will require a new certification to be submitted to the
Division of Water Quality (DWO) before the new animals
are stocked. I (we) also understand that there be no discharge
of animal waste from this system to surface waters of the state
from a storm event less severe than the 25 year, 24 hour storm.
The approved plan will be filed on -site at the farm office and at
the office of the local Soil and Water Conservation District and
will be available for review by DWQ upon request.
I (we) understand that I must own or have access to equipment,
primarily irrigation equipment, to land apply the animal waste
described in this waste utilization plan. This equipment must be
available at the appropriate pumping time such that no discharge
occurs from the lagoon in a 25-year i-day storm event. I also
certify that the waste will be applied on the land according to
this plan at the appropriate times and at rate that no runoff
occurs.
NAME OF FACILITY OWNER: Donald Miller
NAME OF MANAGER (if different from owner):
SIGNATURE: DATE:
NAME OF TECHNICAL SPECIALIST: RONNIE G. KENNEDY JR.
AFFILIATION: Agriment Services Inc.
PO Box 1096
Beulaville 1$
SIGNATURE: //"DATE: �� ¢

NARRA TI VE OF WASTE UTILIZA TION PLAN:
DUE TO THE NITROGEN DEFICIT ON THIS FARM MR. MILLER
MAY HAVE 2 ACRES OF TRACT 5387 FOR USE OF TOBACCO
PLANTING FROM YEAR TO YEAR. HE DOES NOT NEED THIS
ACREAGE TO FULFILL THE AGRONOMIC REQUIREMENTS OF THIS
FARM. HOWEVER, NO WASTE SHOULD BE APPLIED TO TOBACCO
UNLESS AN APPLICATION IS USED FOR PREPLANT.
ALL FIELDS MUST MEET MONITORING AND REPORTING
REQUIREMENTS WHEN USED. MR. MILLER PLANS TO APPLY HIS
WASTE IN ACCORDANCE WITH HIS SPECIFIC WASTE ANALYSIS
NOT TO EXCEED THE HYDRAULIC LOADING OF THE SOILS. 25
FOOT BUFFERS WERE TAKEN IN ACCOUNT IN THE CREATION OF
THIS PLAN TO PROTECT " WATERS OF THE STATE".
9/ 16/97
RONNIE G. KENNEDY JR.
TECHNICAL SPECIALIST

NORTH CAROLINA COOPERATIVE EXTENSION SERVICE - NC_NMP
Field Background Information
Field Name: T5387 F1
Soil Map Unit: FORESTON 0-8
Total ASCS Acres: 25.55
Total Useable Acres: 22.6
Soil Sampling Date ; <ENTER>
Soil Test Class
Soil Test Results:
pH Acid CEC CBS P-1 K-I Ca% Mgt Mn-I 2n-I Cu-I
Field Irrigation Information
Average Soil Depth : 3.0+
Available Water Holding Capacity - 1,5 feet 1.3
Maximum Irrigation Rate - inches per hour 0.50
Maximum Amount per Irrigation Event - inches: 0.72
LIMITATIONS: This program is based on the best available data.
Since many uncontrollable variables can affect plant growth
and nutrient requirements, North Carolina State University Cooperative
Extension Service is not resposible for any lasses incurred from
the use of this program. The software is provided 'AS IS' and
without warranty as to performance.
Printed :911611997

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Site Requires Immediate Attention: 4
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION4 SITE VISITATION RECORD
DATE: ' 9 24 , 1995
Time:
Farm Name/Owner: _ I SIR Ll�
Mailing Address:
County:
Integrator:
L,
On Site Representative:
Physical Address/Location: _
Q�
6k /7/0
SIC
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_51D6 lop
MAI IFRJ�.11 A
Phone:
Phone:
Type of Operation: SPoultry Cattle
Design Capacity: w' e , '0 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: �V ' _r2' _92.3 " Longitude: '27' ' d7 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)(oes
r No Actual Freeboare_� _Ft. � Inches
Was any seepage observed from the lagoon(s)? Yes o was any erosion observed? Yes tNo
Is adequate land available for pray? Yes or No Is the cover crop adequate Or
No
Crop(s) being utilized: v � [? 41
Does the facility meet SCS minimum setback criteria? 200 Feet from DwellingskTesj�r No
100 Feet from Wells?%Yesbr No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Ye 6No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
If
cc: Facility Assessment Unit
Use Attachments if Needed.