310468_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

F
(Type of Visit: UCom ante Inspection U Operation Review C) Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7 Arrival Time: 2 Z/J Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Y \ t C 6 < [ 3 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Certification Number: I Ys"'
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pnp. Cattle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current Dry Cow
lJ , I;oultr. Ca aci P,o , Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
urke Poults
ther
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 CyNo ❑ NA ❑ NE
[3 Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ 'Now
NA
❑ NE
❑ Yes
Ej No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ 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 E�[Wo ❑ 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 [31 o ' ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3 l"" 0 NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E5'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2J No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑i'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
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
10 ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
0 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
Io ^❑ 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 Co►rtinaed

Faoili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
QNo�❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�allo ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No []-tTX
❑ 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
� o ❑ 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? (Le., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
L.d f 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
� o ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Reviewer/Inspector Signature: ���/(�j Date:
Page 3 of 3 21412015

� e
j
Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 310468 Facility Status: MU11vd
Inpsection Type: Compliance Inspection
Permit: AWS310468 ❑ Denied Access
Inactive Or Closed Date:
Reason for Visit: Routine County: Duplin Region: Wilmington
Date. of Visit: 03125/2015 Entry Time: 09:00 am Exit Time: 10:00 am Incident S
Faun Name: 2U7
Owner: Murphy -Brown LLC
Mail]ng Address: PO Box 487
Physical Address: Sr 1700 362 Sarecle Rd
Owner Email:
Phone: [phone]
Warsaw NC 28398
Kenensville NC 28349
Facility Status: ❑ Compliant ❑ Not Compliant Integrator: Murphy -Brown LLC
Location of Fenn: Latitude: 34' 59' 15" Longitude: 77' 54' 35"
Northeast of Kenansville. On South side of SR 1700 approx. 1 mile East of Hwy. 11.
Question Areas:
Dischrge & Stream Impacts
Records and Documents
Certified Operator:
Secondary OIC(s):
Waste Col, Stor, & Treat
Other issues
Waste Application
Operator Certification Number:
On -Site Representative(s): Name Title Phone
On -site representative Michael Norris Phone:
Primary Inspector: Kevin Rowland Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS310468 Owner - Facility : Murphy -Brawn LLC Facility Number: 310468
Inspection Date: 03/25/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Structures
Dlslgnated Observed
Type Identifler Closed Date Start Date Freeboard Freeboard
Lagoon 1 19.40 24.00
page: 2

Permit: AWS310468 Owner - Facility : Murphy -Brown LLC Facility Number: 310468
Inspection Date: 03/25/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No No No
1. Is any discharge observed from any part of the operation?
❑
0 ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
E ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
N ❑
❑
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?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse Impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
Yes
No Na No
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not property addressed and/or managed through a
❑
E ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (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
❑
01313
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance altematives that need
❑ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
j]
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
[]
Application outside of application area?
❑
page: 3

Permit: AWS310468 Owner - Facility: Murphy -Brown LLC Facility Number: 310468
Inspection Date: 03/25/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yea
No Na No
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
0 ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need Improvement?
❑
N ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
01311
determination?
17. Does the facility lack adequate acreage for land application?
❑
❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
01313
Records and Documents
Yea
No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
00
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
0 ❑
Cl
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS310468 Owner - Facility: Murphy -Brown LLC Facility Number: 310468
Inspection Date: 03/26/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
❑
❑
23. If selected, did the facility fall to install and maintain a rainbreaker on irrigation equipment
❑
■ ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
0 ❑
❑
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 fall to provide documentation of an actively certified operator in charge?
❑
01311
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑
❑
Other Issues
Yes No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
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 regional DWQ of emergency situations as required by 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
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss reviewfinspection with on -site representative?
❑
❑
❑
34. Does the facility require a follow-up visit by same agency? -
❑
❑
❑
10
page: 5

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: � Departure Time: County: Region:
Farm Name: �r­ Y, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
1� • y,r
'A(q
l R�
Design
Current
Design Current
`Capacity
Design1 Cu r�rent
Swore
Capacity
Pop.
Wet Poultry
�.
Pop
Cattle
C*apacity Pop.
- ,. Ott t
Wean to Finish
La er
Dairy Cow
r
Wean to Feeder
Non -La er
Dairy Calf'
'
eerier to Finish
a
'
Dairy Heifers
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
l)r, P.oultr>
C.a tacit P,o ..
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
t
Other
Turkey Poults
Other
Other
Discharges and Stream_ Im"ets
1. Is any discharge observed from any part of the operation? ❑ Yes 4�!fNo ❑ NA ❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made? ❑ Yes 2fNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
Lio
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
[] Yes
PNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: 7- Date of Inspection: V (o
Waste Collection & Treatment
4.'Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o I—] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ffNo ❑ NA ❑ NE
Stru Structure 2 Structure 3 Structure 4 Structure 5 Structure b
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 Vo
❑ NA
❑ NE
waste management or closure plan? T
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 o
[] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes PVo
❑ 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 P3 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ONo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ;ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No
❑ NA
❑ NE
Required 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? If yes, check
.,ZNo
[:]Yes P'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" RainfaIl Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: Date of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [�No ❑ NA ❑ NE
T
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Z No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 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 No
❑NA ONE
❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes
;a No
❑ NA
[] NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
[:]Yes
o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary)
A t" G ay\ �, %' Co rd.s Ljd � zsoff ,
Reviewer/Inspector Name: �. ci 1 Y
Reviewer/Inspector Signature:
Page 3 of 3
Phone-,
Date: to 16 l
21412014

Date of Visit: I o Arrival Time: (2: 3G Departure Time: County: �/h Region: �JD
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish JLayer I
Wean to Feeder Non -La er
Design Current
Cattle Capacity Pop.
Dairy Cow
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean Design Current
Farrow to Feeder Dr, P,OUItr Ca aci, P.o
Farrow to Finish Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
keys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ;^No ❑ NA ❑ NE
❑ Yes E!�No
❑ Yes ET —No
❑ Yes gNo
❑Yes o
❑ Yes ,No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: jDate of Inspection: Q :Z c
Waste Collection & Treatment
Is storage 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 ZNo ❑ 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 [2'No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes , 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 Z No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes eNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ;2No 0 NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P
No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 71 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 allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes J2TNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �TNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes JZ 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 ZfNo ❑ 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 d0 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �yNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: L
24. Did the facility fail to calibrate waste application equipment as required by the permit: ❑ Yes j� o ❑ NA ❑ NE
29. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes J�Ko ❑ 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 ff No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes Ea"Ro
❑ 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)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes lo [7No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes 'C2rNo
[—]Yes 7NO
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes VNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [ rNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ONo NA ❑ NE
Comments (refer to question #): Explain any=YES answers and/or any Additional.recommendations or. anyoother comments.
Use drawings of facility to better explain situation's (use additional 'pages, as, necessary).
q11611 tl o , g 7k
r 5G°9'
60
1(7eF
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
14120

(Type of Visit:,, TCompliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: _�) Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: .�p IV Arrival Time: 00 Departure Time: County:
Farm Name: r Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ia[ Wit S
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:@
Design Lurrent
Swine Capacity Pop.
Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
Feeder
Non -La er
DairyCalf
o Finish
FFarrow
DairyHeifer
o Wean
Design Current
U.
D Cow
Non-DaIry
Beef Stocker
o Feeder
1) , Pmoult Ca aci P,o
Farrow to Finish
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
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)
❑ Yes J;?rNo ❑ NA ❑ NE
❑ Yes -�ffNo ❑ NA ❑ NE
❑ Yes JEI"Ro ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes JEE'fT0 ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes fTNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 'E2'No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

� � `i`r+'4 '' „� I' ¢i. '>f'f ,. ,, a; ' 7' ; .F 9 ap ,rl� !y � i } a r, 4*s� ;�•, i L 3 v .aw �� t; ta{r �..� jsr�i�, tirT'�"'� 3'°yM 2r,
., 4
Type of Visit:(© Compliance Inspection V Operation Review V structure Evaluation U Technical Assistance',
Reason for Visit: R Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: .�d Arrival Time: 0Q Departure Time: County: , Region:
;y Farm Name: / ff Owner Email:
c j
r
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
/ a
•• Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
s
Design Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
Dairy Calf
El
Feeder to Finish
Dairy Heifer
Wean
Design
Current
D Cow
eeder
Dr, Pxoulti,
Ca aei
P.o
Non -Dairy
inish
Layers
Beef Stocker
Non -Layers
Beef Feeder
FG
Pultets
Beef Brood Cow
Turke s
'9HOther
Turke Points
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?
❑ Yes jai `No ❑ NA ❑ NE
❑ Yes ,ffNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes; notify DWQ)
❑ Yes
Oi 'No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
�j 0
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
•-No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
allo
❑ NA
❑ NE
` of the State other than from a discharge?
Page I of 3
21412011 Continued

Facility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ yes/En
es No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
1 Structure 2 Structure 3 Structure 4 Structure 5 tructure 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 C2'&o ❑ 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 Rj'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 177'1Do
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes E; 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 )3`No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes . fTNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0--No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Ycs',EE�'No ❑ NA ❑ NE
l5. Does the receiving crop and/or land application site need improvement? ❑ Yes JD -No ❑ NA ❑ NE
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes_12frNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes )JNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes E3 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes EnNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes -El—No
❑ NA
❑ NE
the appropriate box.
❑WUP [—]Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J2-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 ET No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes,4D'No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

J '.Ii � "1 -� a C.+� y h ...''.Y'. (ti.: • r . F �..h.�i•� 1. - ,f(.. '. 5'%• < q'7 � :4 - l,. ti'i, y
w} � - sir', .-'a ���f C'L. '.C.'.f�..ri .M -i.. 4 i'T.. 'YC}- � �� �f^ .i'f"'!�3'..{,?�nr ^"1 n..!�r..�-c'S. M'. 4. �! i� •,4 `r'.
Fa yi r ber: jDate of Inspection:
WasteCollection& Treatment ;
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Fj No ❑ NA . ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes j 'No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 T 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 ;2'No ❑ NA ❑ NE y
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which. are not property addressed and/or managed through a ❑ Yes 0"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? ❑ Ye!,Z 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 ErNo ❑ NA ❑ NE
maintenance or improvement?
i
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,EI—No ❑ NA [] NE
maintenance or improvement?'
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes rE]�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?
❑ YesU;tNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes JD -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?
J
17. Does the facility lack adequate acreage for land application?
❑ Yes allo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes ,,�No
[D NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes .O-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J2-No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and 1" Rainfall Inspections
t, ,
1..": '22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E}-No
❑ NA ❑ NE Fy
❑ Weather Code
i
❑ Sludge Survey
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes�allo ❑ NA ❑ NE ,
Page-2 of 3 21412011 Continued
Y�4612J. •,_. t�..wc:� ��?`!�, }�. r,..i�vE., .r5, ,...li:.M;S�n•....u4C a.°.-: �ia..ay.4�Y�.f .�"��.rf, �.G. ay�i.�?d^:�...ai�.,r �-..... ..,, �:�: i",u., .i,�..�za nu .- ,"� } t•Z:'.9:�fi }� 1 _�J'lir .. ^.r. .,n,.-.�{: 5 .��:F �t ..,.0 s l'�n••:.,.s�. te,_k Ji.�..n.Fia_.�ri

Fa iflty Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes 0-No ❑ NA
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NE
❑ NE
❑ Yes 9-No ❑ NA ❑ NE
❑ Yes ,fNo ❑ NA ❑ NE
❑ Ye�No ❑ NA ❑ NE
❑ YesNo ❑ NA ❑ NE
❑ Yes .6No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ZNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Z_'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes PNo ❑ NA ❑ NE
Comments (refer to. question ft Explain any YES answers and/or any additional recommendations or any other comments.:
Use drawings.of facility to better explain situations (use additional pages as necessary).
ReviewerlInspector Name: _np l r� VNIOW (Q Ji_trX Phone:
ReviewerlInspector Signature: Date: _�)oL
Page 3 of 3 2141201

- .'- y '.>::r ` . ..r � I i. r x cN'•\-• ,/1�. .{.,. .�.. �...JA- ,C._ k ^'- S •il: A: .. ie1�l Ay:t f', .i5
F il' „ vinber: - Date of Ins ection: �J
24. Did the facility fail to calibrate waste application equipment as required by the permit ❑ Yes 'ffNo ❑ 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 to provide documentation of an actively certified operator in charge? ❑ Yes E�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues f
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? ❑ Yes p No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes .En —No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �3`No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use d> arvings_ of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
G
❑ Yes', ] No ❑ NA ❑ NE
❑ YesjZ_No ❑ NA ❑ NE
❑ Yes -6No ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
Phone: C�/
Date: � , 4
7/
,2/4/201

E4�hityN' uthber
�
Conscrr
5.
Type of Visit 'QfCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 1_6
Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: a`1�
Farm Name: -' -` Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 2Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = f =16 Longitude: ❑ ° = 1 =
is
_;,�Y4�6 �';F �i'�;, g-7Sii �,$»� gz��a: . ,1 � "y...s 4 �s 4amk��ir Y�...?�a.i ¢,
3.
i Design It .Current, k` k t p) }i .Deli n Current= :1;.1� t �t:s, ,Design ���Current ^:
z,g. �1, 1, j�9 �,}ba :�. ^Y'� ib': ati � a b�h��'9 MOO
ae�+
:Capacity: Po ulation� .N'etPoultrrCa aci Po ulatl©itlei,�';i Ga act F�Po uta
. #.rp 1'= s�� .p:ax,,p...
El Wean to Finish ? ElLayer El Dairy Cow
❑ Wean to Feeder illEl Non La e I F ❑ Dairy Calf
El Feeder to Finish Ta gas ' �w��i� .Fr;`, ❑Dai Heifer
y� � ��aja;r'
❑Farrow to Wean i ,� + j f +�x ❑ D Cow
�Dr�y,PoUltry, �:�t 44'z4 `s.
❑ Farrow to Feeder, ❑ Non -Dairy
1 ❑Farrow to Finish( ❑ Beef Stocker .;
❑ Gilts ❑ Beef Feeder
�.,
❑ Boars El Beef Brood Cow
Other^ibyi ,"?'
3� sty'..4,S4��
❑ Other be -0 Structures. a �t
-g g
'��..�.'_�_,, ,--•,�-r:41- '%, p.� ��a�4 :f�T.. �q ad., ;,t�'. w -n. &. a„3,t'a ��t.>.�°�'�5�� 4 ���.. � ���
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 2'Ro ❑ NA ❑ NE
❑ Yes A'No
12
❑ NA ❑ NE
❑ Yes to
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes FzKo
❑ Yes �No
[]NA ❑ NE
❑ Yes /O No
❑ NA ❑ NE
/28/04 Continued

Facili Number: 7 7 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes WE� No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes PNo ❑ NA ❑ NE
StructureStructure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: jew V AY
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,-{V
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) T
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ZNo ❑ 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 P�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
rmo
9. Does any part of the waste management system other than the waste structures
require ❑ Yes ;2rVo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ONo
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo
❑ 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 ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ff 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 9�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes J^No
❑ NA
❑ NE
Required 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? If yes, check
j[3No
❑ 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. VYes [:]No
❑ Waste Application ❑ Weekly Freeboard [,-2<aste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

+Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes , ffNo ❑ 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 ZNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes dNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ZNo ❑ 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 ONo ❑ 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 C7rNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) fir_
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes 0 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 ZNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
rnl Cru 2 J eej-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
1/4120 1

1 , , 7��'� Rvis�ono$f Water Quality,'
Type of Visit j"Compliance Inspection Q Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: % t'] (Arrival Time: r Q. eparture Time: County: Region:
Farm Name: - o� Z Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = ° Longitude: °
'4 xDesign S C,LIrreLLtB x '', c >> t ; Design; CUCreltt.a.L# k De5i..CUPI en�t r
:SHIIIC '. a` i l tlit�Ciittle�Ehsx,a r.>
,,. C pac ty .,1'�opu :Capacity p Popalat�ontiCapacityl'o�lah..on
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -Layer
❑ Feeder to Finish
`'� �4, �� �i 4�'i
#� ❑ FaI70W to Wean �DrPouli��� x>: si4xs:.i�
❑Farrow to Feeder ��.cyE �� d
❑ Farrow to Finish k ❑ Layers
Gilts ❑ Non -Layers
El Boars ❑ Pullets
g " ❑ Turkeys
ANY �,a �"
�t��
'1 ..sM ❑ Turkey POUR$ ,� '-
❑Other ❑ Other Number of Stru tur s;
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Fleifer
❑
D Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes /'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ;gNo ❑ NA ❑ NE
❑ Yes ,_(e,No [I NA El NE
El Yes I(J No ❑ NA ❑ NE
12/28/04 Continued

r?
Facility Number: — Q Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V(No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes [;'No ❑ NA ❑ NE
Stnicture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: — - Z
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 ElNE
(ie/ large trees, severe erosion, seepage, '0
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ENo ❑ NA ❑ NE
through a waste management or closure plan? 77
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 perm it? ❑ 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 ❑ Yes I No El NA El NE
maintenance or improvement? v
Waste Auulicfltion
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�l No
/
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination i ❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
,� o
El NA
[I NE
18. Is there a lack of properly operating waste application equipment?
El 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
Reviewer/Inspector Name Phone:
09
Reviewer/Inspector Signature: Date:
1212810 Continued

Fatillty Number: 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 PNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [3 Maps 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 ❑ 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 VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yesr-E�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes R4o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes No
El NA
El 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?
ElYes
41
❑ 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
�f
ILI No
❑ NA
ElNE
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
P/No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
in s ' {'
AddifionalCoinnnenfsandlorDraw1;
R
l>rt� i +lt 3, i� {�tt„�..wt �,
fati ' a�'a�'i � r5nt����i��'� ���,ss .k•s :�;ck
4-
H
Page 3 of 3 12128104

I y5 i �' °, rdm -. �:: ° .+ .° ►#x �; _., '. x `114.11.­0!.,
. ,` 'I ,dqq i ;
a�Dtvisin'of Water Quality `
Type of Visit .0-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Oioutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: o; Departure Time: County:
Farm Name: _T� , / Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Region: L___ _TJ
Facility Contact: Title: Phones No:
Onsite Representative: Integrator: __" /
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = 6 �" Longitude:
G..a g�q ,-;�._ ..P, g°.w"g' .fhb +g a
�, z �a I a�^ t' 8�i A.�:. a4 d: k'��n« !i �- �kki s �f'3
s } Design CurrentE, :t �; ;�v<; ;Des�gri 'Current l allersgn�Cturrent:
Swine Capacity Population Whet Poultry°p`Capacityj Pop�ulatton 3, '�Cattle':Capacity,iPapulatron'
❑ Layer
❑ Non -Layer El Dairy
i
v i erg r�z � "
E'
y
4
r
i'gNyumber4oS7r Structures
: �. '.+N .k. .K fi A $� i:'X .E �1�i 1�.5' O: �'a _�- E a 11,T,,
ry
711
A
Non -Layers
El
El Wean to Feeder .b
❑Wean to Finish
t
El Feeder to Finish
El Farrow to Wean
❑Farrow to Feeder
' El Farrow to Finish
❑Gilts
� El Boars
SOther'� �
❑Other
❑Other
l)ary
_ El Layers
ers
Pullets
❑ Turkey s
❑ Turks Poults
❑Other
l)ary
_ El Layers
ers
Pullets
❑ Turkey s
❑ Turks Poults
Calf
Discharges &Stream Impacts
1, I5 any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? ([f 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 ,6No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes�No ❑ NA ❑ NE
❑ Yes XJ�No El NA ❑ NE
❑ Yes Id No ❑ NA ❑ NE
Page 1 of I2/28/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. 'If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier; I
❑ Yes ;3'—No
❑ Yes o
Structure 5
El NA ❑NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;jNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ti lNo ❑ 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? El Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZNo ❑ NA [:]'NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect 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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes J:�FNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0No
❑ 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
L�No
❑ NA
❑ NE
Comments,,(refer to question #) :Explain an y.YES,answers and/or any recommendatiops or any other comments &,
Use drawings of facility to better explain situations. (use additional pages as necessary)
kl, �T.,5 .k.
Reviewer/Ins ctor Name d 'q ` 3 `' t�" ' i ' Phone:
- 'AI�.
Reviewer/Inspector Signature: Date: e,
Page 2 of 3 12128104 Continued

Facil ty Number: — Date of Inspection
r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment?
❑ Yes
No
y
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
❑ NA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
wo
❑ 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
//////P
ElNA
El 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
2(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
JZ/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
1-011,o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
/VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
.S-
Page 3 of 3 12128104
Page 3 of 3 12128104

Ao vision of Water Quality
Facility Number � � O-Division of Soil and Water Conservation_-
O other Agency
Type of Visit
Reason for V
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
ompliance Inspection 0 Operation Review 0 Structure Evaluation
� Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency
Time: �Apparture Time: County:
Owner Email:
Phone:
0 Technical Assistance
0 Other ❑ Denied Access ,
Region:
Facility Contact: Title: one No:
Onsite Representative: C_2e�z .� �� Integrator:
Certified Operator: Operator Certifi ation Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0 = 6 0 « Longitude: ❑ o = , =
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity; Population
10 Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
LJ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
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?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
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 ZNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes 2No
❑ Yes ��No
❑ NA
❑ NE
❑ Yes �Wo
❑ NA
❑ NE
12128104 Continued

Date of Inspection
Facility Number: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes PNo
❑ 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):
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 ;2No
❑ 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
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
/�fNo
❑Yes
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
IV
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
❑ Yesio
❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes 9<o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > 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?
❑ Yes
CJ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
'VNo
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No.
❑ NA
❑ NE
Comtnentst(refer.toquestiong#) Explamany fYES;answersyan dLor.any%recommendations orany othecommen�ts:. ,
Use drawin stof facili to.better;ex lean situatyonsr use additional a es=as necessar, ; :
}�_ ,� p,...�,�•�r3 • .- :��.t�.E1 ,::'eY. ?:k'ia '-'� =�,i, roc'r4�'fr,Yti:�a�2F.?•rwr>'�;.>.��.�F.
w
Reviewer/Inspector Name
Phone: 9/G
Reviewer/Inspector Signatn e:
Date:
Page 2 of 3 12128104 Continued

Facility, Number: -- Date of Inspection
s�y
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
[]Yes
`4
❑ NA
❑ NE
20,
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
��No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
[--IN E
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
El
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
,I^^� NNo
❑ 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
❑ Ko
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�ZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
' No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ElYes[ -o El NA El 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?
❑ Yeso ElNA
ElNE
1f yes, contact a regional Air Quality representative immediately
//////
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes 0 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 Na ❑ NA
[INE
33.
Does facility require a follow-up visit by same agency?
ElYes No ElNA
❑ NE
Additional Cbmmentsand/or Drawings
a
Page 3 of 3 12128104

Type of Visit ..(EY-Zqutine
Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit i O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: fJ Arrival Time: i 0 Departure Time: County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: C/-P
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certific tion Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: 0 0 =' = Longitude: ❑ ° =' = "
Design Current
Design Current
Design Current
Swine Capacity Populatinn
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non-Layet
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifei
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder:❑
Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharses & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes Q'<o ❑ 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
,'No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�' o
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [YNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes o ElNA ❑ NE
Struct re 1 Structure 2 Structure 3 Structure 4 Structure Structure 6
Identifier:
Spillway?:
Designbd Freeboard (in):
Observed Freeboard (in):
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 PNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [TNo ❑ 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 171-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/improvement?
1 L Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VfNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 1 0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ;�Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:) Yes ZNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes PNo ❑ NA ❑ NE
❑ Yes k] No ❑ NA ❑ NE
Comments (refer to question ft 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):
js Ski 5rA
ee. , W e _ijcow-Vf a) 1
,A6
e cCf
i
Reviewer/Inspector Name
P1 Phone:
Reviewer/Inspector Signature:
Date:
12128104' Continued

J-VaciilityNumber�3 Date of Inspection l/
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,,ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes P No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JFefNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ 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
Q"No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EfNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EJ/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
JYNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional Cornigents and/or Drawings:
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Z Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: OG Arrival Time: Departure Time: County: 60t RegionC�
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 [= 4 = Longitude: = ° = L = «
Design Current
Capacity Population
p Design CurrenDesigni
Wet Poultry C•apaci Po ulation
p
Cattle
Current Y y
Ca aci Poulation
.o..pt3 Kp.�
7W2ant2Finish
❑ La er
❑ Dai Cow
Feeder
❑Non-Layet
❑Dai Calf
Jj:
❑ Feeder to Finish
4.
'r
El Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Da Cow
Farrow to Feeder
❑ Non -Dairy
❑ La ers
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Broad Cow
❑ Turkeys
=t
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
'
Discharges & 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 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
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

lFacility1lkumber: 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 ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste 'Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

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: i/
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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ 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 Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptabje Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Arpa
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments:
Use drawings of facility to better explain situations. (use additional pages as necessary):
�12«�s Ae0A10
Reviewer/Inspector Name Phone: O-"
Reviewer/Inspector Signature: Date: l3 G
Page 2 of 3 12128104 Continued

Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Vlsit.,,eRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: /O Arrival Time: Departure Time: County:
Farm Name: l / Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: %� Title:
Onsite Representative: ap-z" I �r
Phone:
Integrator:
Phone No:
Region: _l C-l-/ _
yz/"�
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e ❑ I ❑ « Longitude: 0 ° 0 ` = "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 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
❑I No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
.12[No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Flo
❑ NA
❑ NE
other than from a discharge?
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?
Stru ture I Structure 2 Structure 3
Identifier:
Structure 4
❑ Yes SZNo
❑ Yes Plqo
Structure 5
❑NA El NE
❑NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Zo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes -dNo ❑ 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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes RNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [Ao ❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s)
j -
3. Soil type(s) .:)� CTlL1L�L=
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes IffNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes'j[2`No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes No
iiXNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes (VNo
❑ NA
❑ NE
Reviewer/Ins ector Name 1, k ""y J " '" �' WRI
p lvj t::..s w <,. f , .. .: Phone:
Reviewer/]nspector Signature: Date:rL <
r-
121281041 Continued

Facility Nutn�cr: 3 — Date of Inspection / B
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 ZNo ❑ NA ❑ NE
the appropirate box. 7
❑ WUP El Checklists [I Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ; ,_No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes 0No
❑ 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 J?No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes OMNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes �J 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 ❑xo ❑ NA El 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 nonnal?
,�Ao
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 0"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 2No
❑ 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 ZNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes E�4o
J
[I NA
❑ NE
Adtfittonal ComthimU an or
�. '° : �� �'
��. ,� ,:. _
� � .. , t , a � v �.° ,,r= . �"', "4a`1
0
12,128104

r
�f
Hype of Visit it;r ompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit f0"Aoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: 1 ntl Time: Si S
rO Not Operational C Below Threshold
ermitted Or Certified © Conditionally Certified 13 Registered Date Last Operated
� or Above Threshold: .........................
FarmName:.............................................................................................................................. County: ........ fl.w4al.....................................................
OwnerName:........................................................................................................................... Phone No:......................................................................................,
MailingAddress: ................................................................ . ................ . ......................... . ...... ..................................................................................... ..........................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
OnsiteRepresentative ........r �..Q�[......... .............................................. Integrator:......................................................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude ' t 66 Longitude ' 4 66
Discharges & Stream 1mQacts
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. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
S�/cture 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .......... /................ I..... ............................................................................ ............................................. .......
Freeboard (inches): 3 �7
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Zo
❑ Yes
❑ Yes ��O_
Structure 6
12112103 Continued

facility Number: Date of Inspection 9 O
1 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes UlNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes /No,
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 2NVVNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 10
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type _LsCq.jE(4j geg lrn C Sc,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Usues
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? ❑ Yes7No
19. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
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 . o
Air Quality representative immediately.
k�u.Id'�� .I'..ihiit Y. tr:o��' :.S""9 !. #-�rr3'r.l:'lrs ;a ,71,'.,":2i..:�'• ";,:lC :. I:.ar.i,.tk's.. .S; .•�; rv+11"" .¢. i,"%'_��... .f �L��,.r,� ��,�� Sfn
! Camments�{refer to guest�on #) ^Explain -any YF.S;answers andlor any, recommend ations-4f.any of er comments: , sP(S � � , { % al ;,, ;fit ilk
l;t: ' L tfP r� L." y �."'a 4 -at < - k�.. tyf - - , L - r L a i.Jf �iy f; t - i xrs wy« - �� .rs,arw+a:,.� e ..w��:.a.:r�-ilk
!,Use drar�ngs of facility,�to better expla�n:sitoat�ons: (useddihonal,pagesias necessary) r1 €i..❑Field Copy ❑Final Notes
r ' -�-� L � a r ! {�u lar., �L � ;✓ pl L,J t -s `��y i arl�;h ;- � iFi �t��t{t��
y
f PI[Lf i a r ^`� ( K i { 31 • (''& ail , srr3ii'1' Is p?sri"i?
Reviewer/Ins ector Name >� �.� +1 , C c ICJ' )P a �E
P dx> s, � �,« 11+/!+ 4. L Eti ., � f it a u �.� � I
Reviewer/Inspector Signature: Date: Z(fi D
uiu�w awassnaea

Facility Number: Date of Inspection d
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?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ 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
0160Z
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
VNo_X
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
ElYes
No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
LdN0
28.
Does facility require a follow-up visit by same agency?
❑ Yes
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
o
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit '0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit jZRoutine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
acility Number
Date of Visit: y Z D Time: 3sd
F4
O Not Operational O Below Threshold
0 Permitted 0 Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ..... _.
FarmName:.......Z...�..�...................................................................... County:: .!..,1.'.�...............----.....................
Owner Name: •----� r�p �l-�-- �ad-r :�: h...._ _ _------- Phone No: = -------------------------------------------
Mailing Address:
Facility Contact: ..................... ..................................Title:............................................... Phone No:......................................
Onsite Representative: Integrator: °j'rrdl� S -_-_- _-_------_-_-_-----.
Certified Operator: ...................................................
Location of Farm:
Operator Certification Number: ...........................
''Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 66 Longitude • 6 «
S
:Design Current :,,` Design `' Current
n .Poultry Capacity iopulation Cattle Capacity Population
wrne Ca'acit
Poftulatio
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
L2rVarrow to Feeder
/ 3 5',0
❑ Farrow to Finish
❑ Gilts
❑ Boars
Non -Da
❑ Other
so
Tofal Design'Ca
„
Totalc-
N
s F Number of Lagoons , i0 'r ago Spray Field
l �.� Subsurface Drains Present ❑ Lagoon Area ❑ Area
3 ?;. w> hq t : R
„t �"a t4111,{- }�� �' _. - -.__ ... ... ...
Holdmg IPonds / Solid Traps�'�O.x ,` ;_ ❑ No Liquid Waste Management System
Discharges & 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 ZNo
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 P0
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...--•----' ............... ... ........................ .......................... ........................... ........................ _.........--•--......._.._...
Freeboard (inches):

r
1 UJ/UJ��/l
Facility Number: -- q(—
Date of Inspection Z p
4—unrinueu
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. 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 Annlication
❑ Yes 0No
❑ Yes '0"No
❑ Yes 2!(No
❑ Yes IRTNo
❑ Yes 'dNo
10. Are there any buffers that need maintenance/improvement?
❑ Yes O No
11. Is there evidence of over application? ❑ ExcessivegPAN ❑/Hydraulic Overload
Yes ❑ No
1Pondin
12. Crop type refc-t/G Ne e y-rn �/dc, /�� Sr 4 G !" ru• �pL
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ONO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ;]"No
b) Does the facility need a wettable acre determination?
❑ Yes P No
c) This facility is pended for a wettable acre determination?
❑ Yes E3/No
15. Does the receiving crop need improvement?
Yes ❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes )21No
Required Record_s_& Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
[]Yes EfNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(ie/ WUP, checklists, design, maps, etc.)
❑ ETNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes 2fN0
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ,PI No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes J!rNo
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 'INo
25.. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes PNo
[] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
:emu .. �aa�t& W1 nmtcd aa�t,. !
Comments (refer quest# Explama�4�YE5.an`" swe ssandlor°any recommendationstarany o hercarnments,.
UsTe d"ra mgs of facility to, ter'explam situations: {use additional'pag❑Field Copy ❑ Final Notes
i!• 7L,erc 7.� 2. Ib. uv�ra��ic�,.�;an oy, �l�e Loo) $e✓r�vdh Crv� An
-
_r,c d� S1415ff A,-Ar Aeclefcd Legi
i y ecds u4) 61le, d, 4 rertvVed , ►w ed; Or e/y , ate Sc
�;21d Gia.s ��P wh,'rk zleed -flee -rescue slk;id ;mrYoved .
�I,ifln� Cali" Ana
Reviewer/]nspector Name ;3 i
Reviewer/Inspector Signature: Date: Z P Z#d_
..�r.,--�..-� _. _. ... ... .r 1�,-.er...x_..-.-. ,. ..___,..•xmc,:n.•.rrv.cr.�ri:r_�t:.y�:t��.:r: rrrr.x.•:•.rr:,.r-.r,,,.,v�-,t4,..c-�^cr-w,-,�vrr...-rrr.•.n•-.....�-..,.�>.-a�amvctiv,vccr.�•.-.--.-....: .. ..•..:. .s..-...-...-_.,.�

r�
Facility Number: Date of luspection Z ti O Printed on: 7/21/2000
Odra Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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 )2rNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNO'
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 RfNo
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 ZrNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes J No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments and/orDrawings:
04 'Qr 4kan r?04ed aba��� �l�e Fa t,,'/i-i7 � Gra� � a►� reCofdf
apfe�i well kerl ,
5100

Divisiop of Water Quality
3 r ,
Q ivision of Soil and Water Conservation
t N• 0 Other Agency
of Visit b Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit o Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date ur Visit: �Ur'A�j) '1'imc: i> L} Printed on: 10/26/2000
Nat O erational Q Below Threshold
k
ermitted 0 CNYM.11.1.5
fied © Condition Illy Certified © Registered Date Last Operated or Above Threshold:
l,L�]3Farm Name: ...........� . �! 7 I County:..........yLl.. ll..........................:..........
.......................................................
OwnerName. ............................ ............................................................................................... Phone No:.......................................................................................
FacilityContact: ..............................................................................'I'itle:................................................................ Phone No: ...................................................
MailingAddress:..........................�.}}....................................�Y/...........................................................................................r
Onsite Representative:... .lh.v.�.............. t Integrator: .YV-v..I.r5
....................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Uf Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 '4 Longitude • 6 66
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer I I I[] Dairy
❑ Feeder to Finish JE1 Non -Layer I I❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
h. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. II'discharge is observed. what is the estimated flow in balhnin? _N,q
d. Does discharge bypass a lagoon system? Of yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes allo
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 Pt
Structure 1 Su•ucturc 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier...,.......rr...... .................................................................................................. ........................ ............................................................
Freeboard (inches):
5/00 Continued on back

Facility Number: Date of Inspection Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures obse ed? (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 Q� 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 ONO
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONO
_Waste Application
10. Are there any buffers that need maintenance/improvement? Cl Yes allo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ONO
12. Crop type Jr-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes KNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes $�No
b) Does the facility need a wettable acre determination? ❑ Yes E.No
c) This facility is pended for a wettable acre determination? ❑ Yes KNo
15. Does the receiving crop need improvement? Ayes ❑ No
M. Is there a lack of adequate waste application equipment? ❑ Yes P�No
Reauired Records & Documents
17.
Pail to have Certificate of Coverage & GeneraI Permit readily available?
❑ Yes
X No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
A No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
� N0
`\
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ONO
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
)KNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P(No
O:-NQ.*i01A0$i}s.oar• defgantries 40re ppted-O><orifg thls;vis}tt• Y:60 wail•tooiye fo fuli ftf
..;Torres• ondence:a�aut:thisvisit:• .•.•.• ... -'-' - ...............
-'
Comments'(refer to question #) Explain any YES answers and/or' any recommendations or., y other cominea#s ` ' ;�
Use drawings of facility to better'explain situations (use'additiortal,pages as necessary) °; `i" fix ,r �t k' , a' ;;' l", .. E , ik� { "
/` j �i �ij�!- -Gr .S %%�( fi(J•� G'D�t�a�t3� �C�qfi�C� ,� �c� j- ' �1 A
� J
-�- w
o"V"ft1_ owl
ReviewerlInspector Name {�1��' dY "g r : : t7 ='-;
Reviewer/Inspector Signature: Date: (� 5/00

Facility Number: Date of Inspection ' Printed on: 10/26/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ Yes
ixNo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
eN 0
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
kNo
roads, building structure, and/or public properly)
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
)8fNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
t�No
5100

e N•3.., 43r .. "
.� _ A , fitib1DiVIS.Di1;dSb1anIWaterrOneIV3¢ �01CIAfOnRCVIew€a, '
n€d Water C ser�varon Co pliance77lnspection .� fi0iv
Ei�' !•v,.l"1 S ! '� ,! ! .. E [`� <#?.
Water<,QUahty,'=,COmplianCC in
0 Other Agency .3 Operation Revtew3 !" I #:, !.l.... }.: € „.s .rid mL 3!, ,'.lt,!!.¢.',�..r iIN!'",#„1<`::. m e,h n:np
. < c.. �.. ...,.ev �..E,
Routine Q Com laint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection ?A hr. (hh:mm)
Permitted 0 Certified 13 Conditionally ertitied [] Registered Not Operational Date Last Operated:
lr County:... ................
Farm Name: ............... f..`........ ....................................
OwnerName:............... .... ... /... �! ........ .�J...................... Phone No:......................................................................................
Facility Contact: ..,:..�i0.. .. 1f .............Title:........ :....L... Phone No:1�....?�".
-->
Mailing Address: ..................... .........
Onsite Representative:........ ::..... f i!...:.................................................. Integrator:............. I.[:Ylf:-S(.......................................I...........
CertifiedOperator: .............................................. . .................................. I .......................... Operator Certification Number:..........................................
Location of Farm:
w
........... ............ ............ ........ ............... ...... .. ...
Latitude • 4 66 Longitude • ' «
' D"esj Current' Deli Cur're : nt 3 ,�Destgn 'Current'
Swine Population Poultry Capacity,
rY 'Po Population Cattle Ca aci a: Population `
❑ Wean to Feeder ❑ Layer ❑ Dairy.
❑ Feeder to Finish ❑ Non -Layer 10 Non -Dairy
❑ Farrow to Wean
arrow to Feeder ❑ Other
x
❑ Farrow to Finish Total Desi i) Ca ae>It
y
El Gilts
P
❑Boars `,TotaLSSLW;.is`
Number of Lagoons 10 Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
,Holding.Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-made'?
b. If' discharge is observed, did it reach Water of the State'? (If ycs, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Dues discharge bypass a lagoon systein? (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) tess than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
�.
Freeboard (inches): ..... ........ ..................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes �(No
❑ Yes ❑ No
❑ Yes ❑ No
A A
❑ Yes ❑ No
❑ Yes No
❑ Yes ONO
❑ Yes 3` No
Structure 6
❑ Yes (.� No
Continued on/ back
3/23/99

Facility Number: Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plarr?
(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
12. Crop type )`V 9_(! X�
❑ Yes O�No
❑ Yes *0
❑ Yes �No
❑ Yes ;6-No
❑ Yes 5 :No
❑ Yes P Awo
13, Do the receiving crops iffer with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes O�No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes DJ�40
b) Does the facility need a wettable acre determination? ❑ Yes SPIo
c) This facility is pended for a wettable acre determination? []Yes 5CNo
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0;Rio yiol;at�itjnjs;o� cl¢Ccaencies were 00 ed- OW.irig this'visit; • ;Y;o� ;wilt Teegiye �o' fu>i•thgr; ;
' COr'resporideh& about: this :visit: .......:::::: ' ::::.: :...:........ .
d i_' E 1`11, f - 1 f I `J! '; FE
#)c Explain any YES answers and/or any recommendations or any other comn
i.. - rp.� 6 i TL 1 p � 4 t r
tter explatrrsituattogs" (use Wditlonal1pages as IIeCPSsarj') pz rd 'l'#ttrf �P '
Ryes ❑ No
❑ Yes gNo
❑ Yes �&o
❑ Yes RID
❑ Yes I)TNo
❑ Yes �10
❑ Yes KNNa
❑ Yes �'No
❑ Yes �(No
❑ Yes Xfo
❑ Yes '07"'No
Reviewer/Inspector Name
Reviewer/Inspector Sig re: �j/f�/lj��, Date:

Faelriity Nuinber: 3 1-11671Date
of Inspection we '
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or.lagoon fail to discharge at/or below
❑ Yes
J 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)
�l.
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
Wo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
V No
32.
Do the flush tanks lack a submerged fill pipe or a permanenUtemporary cover?
❑ Yes
[�No
ts,an or rawmgs:
Additional ommen, ,. ...
lD-19AI
07 d k�
]lys
1,w 64t
w
3/23/99

-zr Cf 7
Facility Number: `- i�(,$ Date or Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes IdNo
(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 ONo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes )?j"No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes No
elevation markings?
_Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes VrNo
12. Croptype
13. Do the receiving crops differ with those desi noted in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14. a) Does the facility lack adequate acreage for land application?
"I-ONo
❑ Yes ;^o
b) Does the facility need a wettable acre determination?
EfYes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ZNo
15. Does the receiving crop need improvement?
❑ Yes ZNo
16. Is there a lack of adequate waste application equipment?
❑ Yes gNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes �Yo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(te/ WUP, checklists, design, maps, etc.)
❑ Yes ZN0
19. Does record keeping need improvement? (iet irrigation, freeboard, waste 6'nalysis & soil sample reports)
❑ Yes eNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes JZI'No
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes 6 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes ONo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes EfNo
24, Does facility require a follow-up visit by same agency?
❑ Yes eNo
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes KNo
1..'....'
io viol ali6ns;o:r• &rJejeneies -were nat;ed dot -ring •tjiis;visit' • Yoix ;WHI-receive Rio furt'gtr
comes• oridehee: a U this visit« ' • ......... .
Comments (refer to question #. Explain any YES answers audlor any'recomm_ endations or any other comiments: i
.. � �. �,. E., ,t _ _.� � r I. r • fit. � � id � (-. T �.,3 �
g f faciltt to� b .. �r !; , t ,
etteg�ez lattt�situations use,addtttobal °ages ab necessary �� ( i t�.,F �P� i ; - USe,draWlll 5'O 'j' . .p (_ pages �� i e€'.�ga ,3� i{l,y� +
�) C1ot►L9 d c4' C o GAr<_ Sb R.C. �- 1 Q,'r Flo of C-CASErn� 174, rJ�Oif LEA0& S't M
Alm &V%'L o&D 'o 60rr'_Ac4'y C:uLL'F_csr r A r-v,.r O-W11lLV-Z Cz4-LLZWs TDT-AL
.r+ o s T- fIAS So A-1-E-n IW T'o c_-ow f� r-zA, _
A4Q 4-fA:t>' 1EKZO-T �
AP Pe++ls vn a Q uS 0 rya^/ r- V_A r` W c �',f - u�u-� Or v reEv
T% , M P" O E- cis s cA,I �. � 4-LTce-WA-7'r- o.J-
f_""CLp f14 OAC-r-'rfjAtr eS Re"IrX SV,rCp Tri 7-,d�S- ffI'CLP.
Reviewer/Ins ector Name t n
�j
p i ! €d-�ti.L'�,`!�/,�}
Reviewer/InspectorSignature• �� .� ( '. Date: -"e
3/23/99

"'- z/ y7
Facility Number: y Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation? Pl
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 WNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ?Z No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 1Z No
31. Do the animals feed storage bins fail to have appropriate cover? les XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
Additional Comments and/or DrawingsA.
I
3/23/99

r
State of North Carolina
Department of Environment RECEIVE
and Natural Resources
Division of Water Quality APR 17 1998
James B. Hunt, Jr., Governor By:
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
April 17, 1998
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Carro 's Foods Inc
2147
PO Box 856
Warsaw NC 28398
Farm Number: 31 - 468
Dear Carroll's Foods Inc:
You are hereby notified that 2147, in accordance with G.S. 143-215.1 OC, must apply for coverage under
an Animal Waste Operation General Permit. Upon receipt of this letter, your farm has sixty (60) days to submit
the attached application and all supporting documentation. In accordance with Chapter 626 of 1995 Session
Laws (Regular Session 1996), Section 19(c)(2), any owner or operator who fails to submit an application by
the date specified by the Department SHALL NOT OPERATE the animal waste system after the specified
date. Your application must be returned within sixty (60) days of receipt of this letter. Failure to submit the
application as required may also subject your facility to a civil penalty and other enforcement actions for each day
the facility is operated following the due date of the application.
The attached application has been partially completed using information listed in your Animal Waste
Management Plan Certification Form. If any of the general or operation information listed is incorrect please
make corrections as noted on the application before returning the application package. The signed original
application, one copy of the signed application, two copies of a general location map, and two copies of the
Certified Animal Waste Management.Plan must be returned to complete the application package. The completed
package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Non -Discharge Permitting Unit
Post Office Box 29535
Raleigh, NC 27626-0535
If you have any questions concerning this letter, please call Mike Lewandowski at [phone]
extension 362 or Dave Holsinger with the Wilmington Regional. Office at [phone].
Sincerely,
A. Preston Howard, Jr., P.E.
cc: Permit File (w/o encl.)
Wilmington Regional Office (w/o encl.)
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

MAY 2 11111
* BY:
FOODS, INC.
P. O. Drawer 856
WARSAW, NORTH CAROLINA 28398
May 22, 1998
Mr. Brian Wrenn
NCDENR
127 N. Cardinal Drive
Wilmington, NC 28405
Re: Response to Deficiency
Farm #2147
Facility #31-468
Dear Mr. Wrenn:
We presently have 19" of freeboard and are 2" into the temporary storage at Farm #2147.
Pumping will continue as weather and crop requirements permit until the stop pump point
is reached. The lagoon will be routinely checked for aborted fetus and they will be
removed on a regular basis.
Sincerel ,
Fred Cumbo
Environmental Technician
FC:cs

0 Division of Soil and Water Conservation 0 Other Agency
10 Division of Water Quality
� Date of Inspection
Facility Number %B Time of Inspection � 24 hr. (hh:mm)
CIRegistered qjCertified F3 Applied for Permit U Permitted JE3 Not Operational Date Last Operated:
FarmName: .......... .2A4.l....................................................................................................... County: ....
.i%Darr.................I.r..............................................
OwnerName: ....... cad:�'9lh..........._riA`h..................................................................... Phone No:..%.11.P..i..L?. ..............................................
Facility Contact: ....... Cirx, ...........GUt"�tl� Title :...... nY.,". C.(..................................... Phone No:...................................................
MailingAddress:..... a...[110.......I%........................................................................... .........N to �,t.7... k...!�%L........................................ ..Z i�9.�.........
OnsiteRepresentative:......... cxtT`......"................................................................ Integrator: .........Cai..IJS..........................................................
Certified Operator................................................................................................................ Operator Certification Number;......................:..................
Location of Farm:
Latitude Longitude �• �' �"
tienerai
1. Are there any buffers that need maintenance/improvement? ❑ Yes P1 No
2. Is any discharge observed from any part of the operation? ❑ Yes Q 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 Surfaci Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated Flaw in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
® No
3. Is there evidence of past discharge from any pan of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any pan of the waste management system (other than lagoons/holding ponds) require
Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
r1tNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
b No
7/25/97 Continued on back

m
CL
A
O
O
LL-
J
J
O
Q
V
E
0D
m
f`
m
m
m
m
}
Q
E
rn IRR-2
REPORT DATE:
Farm # 1 Field #
Fields Size (acres) = (A)
FARM OWNER:
Owner's Address
-Owners Ph one
Crop Type
(1)
Dale
mmtddlyr
Lagoon Irrigation Fik . Report -
211198 One Form for Each Field per Crop Cycle
--2147 _ —__-1 _J COMPLEX. al
r 8.90
_ :_r ` _ I[rigalion Operator iA
P O Sox 856 1 irrigation Operators t� +
;Warsaw - _ NCNC 9B Address
(910}293.3434 Operators Phone
From Waste Utilization Plan
f BERMUDA/RYE ; Reoommended PAN 28Q 2501050
E c I naAinn llhelnrral 0 1R1 -^—_
(2) (3) (4) (5) _ (6) V) (a) _
Start End Total tF of Sprinklers Flow Rate Total Volume Volume
Time Time Minutes Operating per Acre
(gallrnin) (gallons) (gallacre)
3121197 1 3703 37DB 300 1 i no 105,000 11,798
5112197 3831 3934 180 1 360 F 64,601) 7,281
5112197 3834 3036 120 1 360 43,200 4.854
5112197 3836 3837 6p 1 +--360 21,600 2,427
El14197 3837 3839 120 1 360 43.2DO 4.854
7/29197- 3994 39DT 1B0 1 360 64,800 7,281
814197 3551 3555 240 1 360 86,400 9,708
814197 3555 3557 12D 1 360 43,2DD 4,854
815197 — 3557 356D 1580 1 - 360 64,800 7,261
911T197 4109 4116 420 1 360 4 151,200 15,989
9118197� 4116 4120 24D 1 360 86,400 9,700
----------
9T30197 Ai2S 4130 �120 1 360 43,200 4,854
g/3D197 { 4130 4132 12fl 1 360 1 43,200 4,854
1i0I719T 4140 4143 iB0 1^� 36D T 64,80D 7,281
10/8197 4142 4148 360 1 36 i29,600 114,562
1D18197 1. -4148 - �4153- 300 — --' 1 I� 36D 108,GDD # 12,135
(9) NCDA Waste Analysis or Equtvalenl or NRCS Estimate. Technicai Guide Section
111)Enler thevalue resevedby subtracting column (10) born (B). CDnlinbe
sublracAhq column (10) trom column (11) following each irrigation event,
1 of 10
(9)
(10)
(11)
Waste Analysis
PAN Applied
Nilrogen 13atance
PAN
`
(Iba11000 gal)
(lbsfacre)
(lbslacre)
See (9) Mow
(8))49)11000
See (11) Below
1,B3
21.6
i3.3
8.9
4.4
+ 258
1.83
+ 245
1.03
236
1,83
+ 232
1-83
8.9
r 221
1.40--
- 10.2
213
1.40 - -
13.6
6.9
+ 199
1.40
192
+ 182
1.40 -~- - 10.2
1.40
-23.0
+ 155
i
1.40
113.6
145
1.40
6.8 —
138
1A0 -
- 6.8 -
+ 131
1.40-
- i0.2
+ 121.._�
1.40 -f -=
20.4
t 101---
1,40
i7 D
+ -- B4
Owner's Signature
Certified Operator (Print)----
Operatoi s Signature- --- - --- — --

Facility Number: 3j — tf6g
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (Lagoons.Ilolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? tA Yes ON No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard{ft}:..............:.5 ............... ...... ............. ........... I...........
10. Is seepage observed from any of the structures'? ❑ Yes ESNo
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 WM1P, or runoff entering waters of the State: notify DWQ)
15. Crop type ...............)JRx )...................5 4�i....�xt,la................................ ............................................................
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/[nspector fail to discuss reviewtinspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes 19 No
❑ Yes l9 No
❑ Yes M No
❑ Yes ,® No
....................................................
❑ Yeti
53 No
❑ Yes
No
M Yes
❑ No
❑ Yes
l9 No
Yes
❑ No
❑ Yeti
No
❑ Yes
No
0 No.violations or deficieinde's.were-noted-durin� this:visit.-.You4ill receive no further
cyrrespotidence about this',visit
❑ Yes K) No
N Yes ❑ No
❑ Yes ❑ No
Comnaenfs ('refer to question #} Explain any 1'ES answers and/or any recommendatYans or any other comments
%U drawings of facility ttibetter eXplairi:situations (use additipnal pages as nece556iv)
Syr t;ha��a �p be err rctj 4r 516aF �aQyMVdk..
G. �, p sc�an tnas i ns`^rC� oray_ uWr� SW
� L (Owit eel + ti a ft-syh %i L T
I;g. 6Pj,nja sl.Wja �e 3@""GAd iA w GtrOvJ a.g sOO►, a% Oje .
7-J.('aXruSug S,U d�sLO Gl j� �illtr���a�
w"(c s"1,otlld be of- (_OJW&N,
yYS.ko, tU -� rml�r� ttirih.
7125197 V
Reviewer/inspector Name
` f
Reviewer/Inspector Signature:
Date:
gp

❑ Division of Soil and Water Conservation ❑ other Agency
Division of Water Quality
Routine O Cam faint O Follow-up of DW ins action O Follow-up of DSWC review O Other
Date of inspection
Facility Number �$ Time of Inspection == 24 hr. (hh:mm)
© Registered JA Certified M Applied for Permdt 13 Permitted 113 Not Opera Date Last Operated:
Farm Name:...........L4........................... I....................... ........ County: P.V. l .....................
......................................... .................................................
OwnerName:....... poi ............ ...................................................I................. Phone No:.. tlD�.,Ls3:.'� . ..............................................
Facility Contact: ....... �,j........... C Unn!fb? ............................... Title:......%!ti, 4, ff.......... . Phone No:......................
MailingAddress:.... .+?... &...... %{4........................................................................... ........ f[ �sa2...;.....NL........................................ .?iz8........
OnsiteRepresentative:.......... ...... VYt............................................................... Integrator:......... cx.r.ds................... ......................................................................
Certified Operator;............................................................................................................... Operator Certification Number:.....................
Location of Farm:
RI.«a.............................................................................................................................. A
.. ....... ........ .......... ...........
Latitude Longitude C�• 0' �"
Dest n urgent
g"C
3Y ah� 5 a
;Dest ' Current'`
Design Current
"e �� { -Y#.:} :..: ":..
YN y, C. k, ,� � 4F �
Capac[ty Population =Poultry =,Capacity "Cattle
,Populattoq :r ; ,:3,Capac(tyPopulattan4
❑Wean to Feeder
❑ Layer Dairy
❑ Feeder to Finish
.41
r ❑Nan -Layer I I❑Non-Dairy
❑Farrow to Wean
Wit. '..a� r £2..- ... }„u'YYx,y l ....... ` l: Q4
�" . �.�"LL � �� �. � �� � � -� ��� � n
,�
❑ Other F n�
(� Farrow to Feeder
❑Farrow to Finish
Design Capacity
.:Tota[
❑ Gilts
:,'
f E
Total SSLW
❑ aaIS
B
Number of Lagoons 1 Holding Ponds
y
' ❑Subsurface Drains Present ❑ i.agoon Area ❑Spray Feld Area
❑ No Liquid Waste Management System
,Msa ;
ggneral
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
2.
Is any discharge observed from any part of the operation?
❑ Yes
(��, No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gai/min?
fj
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
1@ No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
M No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
® No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
Yes
❑ No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
C$No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
6 No
7/25/97
Continued on back

facility Dumber: 31
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.11olding fonds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure
Identifier:
Freeboard(ft): ............................,...................................
10. Is seepage observed from any of the structures?
Structure 3 Structure 4 Structure 5
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?
o (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 ............... A...lt..............................................................................................
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 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'?
0 No.violations or deficiencies were'noted during this visit..You.will receive no further
correspondence ii oiit -this. visit:• . • -
❑ Yes No
Yes No
Structure 6
❑ Yes ISNo
❑ Yes IN No
❑ Yes [9 No
❑ Yes No
❑ Yes ,�] No
............. I .............
❑ Yes
- ....... .......
10 No
❑ Yes
N No
NJ Yes
❑ No
❑ Yes
[9 No
;] Yes
❑ No
❑ Yes
No
❑ Yes
No
❑ Yes [I No
(Z Yes ❑ No
❑ Yes ❑ No
Cotnments (refer to question #).
Explgiti any 1 ES answers'andlor anv recommendations or any other cotnmeetts E x
E
Use drawingsrvof facility to-b'e'tter,explain situati6ns (use additional pages as necessary} z£ R � k
cl asta) �1. � �}fMr 61
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7/25/97
_
Reviewer/Inspector Name
�.`.
Reviewer/Inspector Signature:
Date: j

19 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection 1Ihil
Facility Number
Time of Inspection �24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ® Registered ❑ Applied for Permit (ex:.1.25 for 1 hr 15 min)) Spent on Review
A Certified ❑ Permitted I or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: ............... ....... ............ ....... ......... .......................... ........................ .......... ......... ........................
FarmName: .....................r... ��+.:.3.}........................................ ............................................... County:........1-tin ...................................... .......................
Land Owner Name: .............1i.YYX us.....rw�st..... .hLr.%....................... -............... Phone No:�..1.5-A............ ............... ...........
FacilityConctact:....�h........................................... Title:................................................ Phone No:. �G °��e.....� ate. .................
MailingAddress* .....P.0.ZQ)(......qj................................................................................... 4w....J...&L.....................� ux... .........................
OnsiteRepresentative: ...... .......................... ................................. ........................... ........ Integrator:.......................................................................... .....
Certified Operator: ......... 0046rx..... Sw0dl
................................................ Operator Certification Number:...1.$135.........................
Location of Farm:
Latitude 0 6 " Longitude ' • t4
Type of Operation and Design Capacity
yDesign'� Current �..iDesign , ' Cu ent3 ""f a `�DesigGurke t
a
Swine .�, Poult ��. -, Cattle..
->; ,Ca aci .' I?o ulation = . «, �Ca `a`ci+Po ul'ation Ca aci Pa ulation
❑ Wean to Feeder B.❑ Layer ❑ Dairy
❑ Feeder to Finish *I❑ Non -La y ❑ Non-Dai cr
y` Farrow to Wean s 5 a d
Farrow to Feeder '.0tal�Deslgn�Capae�ty
Farrow t Finish
�23
❑Other
hk
El'
Number`of ll.agoons/ Holdli3gPonds� ❑ Subsurface Drains Presente
❑ Lagoon Area ❑ Spray Field Area
Gentral
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes q 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 P No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 04 No
4, Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes P4 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes [R No
4/30/97 maintenance/improvement?
Continued on back

Facility Number: ... 1.t ..... —... ..
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (laagoonsitnd/or Holding ands)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4
1.1.(k ............ ............................ ...........................
10. Is seepage observed from any of the structures?
❑ Yes �kNo
❑ Yes q No
❑ Yes [,No
❑ Yes (A No
Structure 5 Structure fi
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)
I5. Crop type ................ Lai"1......6.'rmj jG..................................................4 E.........................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
2I. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilitig&Only
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 [3 No
❑ Yes No
ta Yes ❑ No
❑ Yes ® No
❑ Yes O No
❑ Yes E,No
❑ Yes 3 No
M Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes (R No
❑ Yes V No
❑ Yes ® No
❑ Yes 1$ No
IZ- Eros kar. exyra-S c rovnr} WFEI gild der �46d ('-'d 4
+reWdec . 'groikv' inlv�
OV\ alzbo 'fo)c Skwjj 6- r'tQv
cc: utrtston of crater Lluatiry, crater. Sjuattry aectron, racutry Assessment unit 4/3U/97

•
! Site Requires Immedi.ate'Attentiori:
Facility No..31 r
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL_FEEDLOT OPERATIONS SITE -VISITATION RECORD
DATE: .1995
Time: 12, �
Farm Name/Owner: S 47reu)5 6�1�Z7
Mailing Address: �� QQ: ��� W/��� YI�C _ iA83f_$ _
County: A
Integrator:
On Site Representative:
Physical Address/Location:
)V7R
S�le )
Phone:
Phone: /2 V
OF- �G bgb_3
Type of Operation: Swine - Poultry Cattle _
i rr
Design Capacity: 13 S U So J� 13v umber of nimals on Site:
DEM Certification Number: ACE DE;vl Certification Number: ACNEW
Latitude: ° Longitude: Elevation: _ Feet
v�s Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inche Yes r No Actual Freeboard-A_!�'_Ft. 6 Inches
Was any seepage observed from t agoon(s)? Yes No 'Was any erosion observed? Yes r N
Is adequate land available for spray? Yes or No Is t e cov r crop adequate? Yes or No
Crop(s) being utilized: - l�L'iL� l� G�OJ¢srri'�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es r No
100 Feet from Wells(S)or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is anin ial waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes Ir No
Is animal waste discharged into waters of the state by mart -made ditch, flushing system, or other
similar man-made devices? Yes 9D
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 Sig azure
cc: Facility Assessment Unit Use Attachments if Needed.