310469_INSPECTIONS_20171231

g 7wSA
NORTH CAROLINA _
Department of Environmental Quality

of Water Resources
ti
�bacility Number � - � � Division of Soil and Water Conservation
Other Agency
Type of Visit: 7Routine
liance Inspection Operation Review Q Structure Evaluation t)Technical Assistance
Reason for Visit: 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 401 Arrival Time: Sri 9 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
OnsiteRepresentative: L� f P`j.� Integrator:
Certified Operator: Certification Number: 71 S
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
a Design Current lDesign Current Design Current
lSwiqne Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish La er Dai Cow
Wid-an to Feeder Non-La er airy Calf
Feeder to Finish 603,9 l DairyHeifer
Farrow to Wean ]Design :Current D Cow
Farrow to Feeder Dry �P,oultY. Ca acit P.o P. Non-Dairy
Farrow to Finish La ers Beef Stocker
Gilts Non-Layer Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other TurkeyPoults
Other Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made`? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWR) ❑ Yes ❑ Now❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 0'No [] NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Ld"""' ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - 44 Date of Inspection: 10 1'2ZIb
ti
Waste Collection &Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes 0<0 ❑ 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
r
Identifier: 2.-
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): J
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 l315o ❑ 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 ErNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [2-11o___`❑ NA ❑ NE
(not applicable to roofed pits,dry stacks,and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ffNo ❑ NA ❑ NE
maintenance or improvement? .
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes 6 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes,check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑ PAN> 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12.Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? 0 Yes I
NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [] Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes L I o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ NA ❑ NE
18. Is there a lack of property operating waste application equipment? ❑ Yes jNo ❑ NA ❑ NE
Required Records& Documents
19. Did the facility fail to have the Certificate of Coverage& Permit readily available? ❑ Yes EfX ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes,check [] Yes ; I ''o ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? lfyes,check the appropriate box below. ❑ Yes VfNo ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and 1" Rainfall Inspections ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ YesVNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:] Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili umber: - Date of Ins ection: 2
Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rN
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? [:] Yes ❑ No iA ❑ 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 rj- 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 EK0 ❑ NA ❑ NE
permit?(i.e.,discharge,freeboard problems,over-application)
31. Do subsurface tile drains exist at the facility?If yes,check the appropriate box below. ❑ Yes [�'I 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 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [;,PT-❑ 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).
0 J o.
Reviewer/Inspector Name: Phone: '0 7.L OJ
Reviewer/Inspector Signature: Date: Z
Page 3 of 3 22/4/ o

t • l)i'visiom of Whiter Quality
Facility Number - 0 Division of Soil and Water Conservation
OO Other Agency
Type of Visit: Com ' ncb Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: �!3 Departure Time: i�l �� County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
� l
Onsite Representative: e G h f ` n Integrator:
Certified Operator: Certification Number: 1 �j
Back-up Operator: 4 Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish Layer Dairy Cow
canto Feeder I INon-Layer I Dairy Calf
Feeder to Finish 6g YQ Dairy Heifer
Farrow to Wean Design C*urrent Dry Cow
Farrow to Feeder l)r, P,ouItr, C•.a aci P,o Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turke s
Other Turkey Poults
Other Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation? [:] Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
i
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWQ) ❑ Yes ❑ 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 observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

FEWility Number: - V Date of inspection: Z
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes,is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): :)2 t'
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0-No ❑ NA ❑ NE
(i.e.,large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes 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 �o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑'�lo ❑ NA ❑ NE
(not applicable to roofed pits,dry stacks,and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks,or compliance alternatives that need ❑ Yes [TNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes ['No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑ PAN> 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E 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 ❑i"No ❑ NA ❑ NE
Required Records&Documents Z
19. Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes [3-<o ❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑ Yes i No ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall [:]Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and 1° Rainfall Inspections ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:] Yes 6No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FAili Number: - Date of Inspection: YT
24.Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes �10 ❑ 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 L`J i o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? [:] Yes [] No [D-NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [ "No ❑ NA [3 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 u lqo ❑ 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 [�NNo [] NA ❑ NE
permit?(i.e.,discharge,freeboard problems,over-application)
31.Do subsurface the drains exist at the facility?If yes,check the appropriate box below. ❑ Yes F/7—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 ENo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes CEI—No ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes ❑7"No ❑ NA ❑ NE
Com 'menu(refer to questton#): Explain anyfYESanswersandlorany addiLtional.recomgmendations or'any other coiriinents ,
Use`.d"rawin s of;facih jo bettef. x lain situations; u"se a �p ggg g
dditional`"a es8as(,necessar yx
la -✓.= la ..d.. y)t4'i
Ic' font 2 • .. r�(� ct a S
Reviewer/Inspector Name: f1�V t "e 4 Phone: 7% D
Reviewer/Inspector Signature: Date: 5 2!�l�
Page 3 of 3 21412014

• i'vi`sion al`Water Quality j
Facility Number. - W Division of Soil and Water Conservation
Q Other LAge, e-
Type of Visit: QrCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: a�� Departure Time:01� County: Region:
Farm Name: �)AGV� 1f\ _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
`�S l
,Certified Operator: �/WA [1� Certification Number: 19)55
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish La cr I Cow
Wean to Feeder I INon-Layer I Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design U r. n I Dry Cow
Farrow to Feeder s acit Rop. Non-Dairy
Farrow to Finish La ers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turke s
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes No [] NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes Z No ❑,.NA„ ❑.NE' .
b. Did the discharge reach waters of the State?(If yes, notify DWQ) �❑ Yes No ❑ NA .❑ NE
t
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?I(if yes,•notify DWQ) ' ;'' :-❑ Yes ZI No ❑ NA ❑ NE
2.Is there evidence of a past discharge from any part of the operation?,' • ❑ Yes Z] No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to.the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge? r
Page 1 of 3 21412011 Continued

Facilif Number: 3 1 - Date of Inspection: 4C,
Waste Collection & Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ IAA' ❑ NE
a. If yes,is waste level into the structural freeboard? Q Yes No ❑'NA ❑ NE t'
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): _
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No QiNA° `❑Ki i'
(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 5n No ❑ NA ❑NE`i `,;
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:] Yes 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 m No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes,check the appropriate box below. ❑ Yes LZ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑ PAN> 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes J6 No ❑ NA ❑ NE
18.Is there a lack of property operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Required Records& Documents
l9. Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes YA 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 V No ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and I"Rainfall Inspections ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - UK—] Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0No ❑ 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. J'
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes _Z No ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes IL_I No 0 NA ❑ NE
permit?(i.e.,discharge,freeboard problems,over-application)
31. Do subsurface tile drains exist at the facility?If yes,check the appropriate box below. [] Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes VI No ❑ NA ❑ NE
Comments(refer to question#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings?vf facility to better explain situations(use additional pages as necessary).
Reviewer/Inspector Name: 7S � tiJW�/� Phone:
Reviewer/Inspector Signature: t 6 *1 Date: 6_�rY115)
Page 3 of 3 21412011

Divl"lion I f Water Resources
Facility Number - If 6 ?' Division of Soil and Water Conservation
Other Agency
Type of Visit: Com nee Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit7Roouutine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:I L/z 3 L..I Arrival Time: 210 Departure Time: 3 County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ) a C ((��1.1 Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design C*urrent Design ntl t
Swine Capacity Pop. Wet Poultry Capacity Pop. C*attle Capacity Pop.
Wean to Finish I JLayer I Dairy Cow
W E]
to Feeder I INon-Layer I Dairy Calf
eeder to Finish (19 Q Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder Dt; P,ou1t!yN, 16-a aci_ P.o Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
T
urkeys
Other Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:] Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes,notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes � EINA ❑ 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: - Date of Inspection: i r
tWaste Collection&Treatment ��
4. Is storage capacity(structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �IVo ❑ NA ❑ NE
a. If yes,is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental thr�at'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 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 [2-Po ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes,check the appropriate box below. ❑ Yes UNo ❑ 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
U. 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 E-N
NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes �No
o NA ❑ NE
18.Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE
Required Records&Documents
19. Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes No — NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes,check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑Maps ❑ Lease Agreements ❑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 ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YesEj-'No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faciili Number: 3 - Date of Inspection: '2. /
424:Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No 0 NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es)below.
❑failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [3 Yes Ej No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes F4�No ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA [] NE
permit?(i.e.,discharge, freeboard problems,over-application)
31. Do subsurface tile drains exist at the facility? If yes,check the appropriate box below. ❑ Yes 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 LLJ 1 c 0 NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes B'�Now❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes (' No 0 NA ❑ NE
Comments(refer to question#) Explain any YES answers andlor.any,additional recomm'endationsor any other com men.ts.`, s
. .B , a e as'. ecessary).Use drawings offacili ' to" etterez lain situations(useadditional
Reviewer/Inspector Name: a' " `"''� � Phone: f
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

- Division ofWaEer Quality
Facility Number - O Division of Soil and Water Conservation
Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: GrIoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: _ f Arrival Time: Departure Time: � County: LM Region:
Farm Name: 7 �� Owner Email:
Owner'Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: � � o1.V\ Integrator:
Certified Operator: �'�p��`;/� Certification Number:
17 155 I
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design t►urrent Design C•urrcnt Design Current
Swine Capacity Pop. WetxPoultry C►apacity Pop. C►attle Capacity Pap.
Wean to Finish La er Dairy Cow
Wean to Feeder Non-Layer Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder D_r, P.oultr, Capaci Non-DaijX
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:] Yes [ZrNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [R-No ❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters E] Yes [E'No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - 41a Date of Inspection:
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes (ZNo ❑ NA ❑ NE
a. If yes,is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: C
Designed Freeboard(in): �►".7
Observed Freeboard(in): IS4
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(i.e., large trees,severe erosion, seepage,etc.)
6.Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [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 EfNo ❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes [6 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 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes E] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes [2rNo ❑ 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 [?fNo ❑ 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 [jfNo ❑ NA ❑ NE
acres determination?
l7.Does the facility lack adequate acreage for land application? ❑ Yes [6'No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [�No ❑ NA ❑ NE
Required Records&Documents
19. Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [—]Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑ Yes 07No ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and I" Rainfall Inspections ❑Sludge Survey
22.Did the facility fail to install and maintain a rain gauge? ❑ Yes ET No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E!�No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: rS I - 4JA Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [2rNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes [TNo ❑ 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!TNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes Lallo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes Z"No ❑ NA ❑ NE
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 RfNo ❑ NA ❑ NE
permit?(i.e.,discharge,freeboard problems,over-application)
3 I. Do subsurface tile drains exist at the facility? If yes,check the appropriate box below. ❑ Yes E?rNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ' ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ETNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes allo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E2"No ❑ NA ❑ NE
Comments(refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations(use additional pages as necessary).
keor. Werg �04
�.a►f�oo�ns 1�oti+t. ���d •
Reviewer/Inspector Name: V►� L�p►�� Phone:
Reviewer/Inspector Signature: Date:
�5_D_Is
Page 3 of 3 21412011

� �D1VIS"ion o'f Wa'ter Quality
Facility Number - 0 Division at Sail and Water Conservation
0 Other Agency
Type of Visit: Pcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Arrival Time: Departure Time: County: r`LIlJ Region:
Farm Name: LXaL.Qqllv FARim Owner Email:
Owner Name: �>A OL Lr'la�/1� Phone:
>e -m� R - �� a sus
Mailing Address: 7 F9 E L F/�,ty�C1-� �Ol�N T D(..� {..)•i. ,
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ,Acc n [..aw/y Integrator:
Certified Operator: ��W 1 S ���IC S L2141/1q, Certification Number: 99
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current; Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pap.
Wean to Finish La er airy Cow
Wean to FeederIon-LayerN I airy Calf
14
Feeder to Finish Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder Dr, P,oultr Ca aci P,v Non-Dal
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turke s
Other TurkeyPouets
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 4kNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes, notify DWQ) ❑ Yes ❑ 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 observable adverse impacts or potential adverse impacts to the waters ❑ Yes10 ❑ NA ❑ NE
of the State other than from a discharge? TT
Page 1 of 3 21412011 Continued

lFacility Number: :31 Date of Inspection: 5 (U
Waste Collection &Treatment
4.Is storage capacity(structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: U✓i1�
Spillway?:
Designed Freeboard(in): 19 c-1 .5
Observed Freeboard(in): f
5.Are there any immediate threats to the integrity of any of the structures observed? Yes No ❑ NA [3 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? 1P
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 16 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) ;k
9.Does any part of the waste management system other than the waste structures require ❑ Yes ] No ❑ NA ❑ NE
maintenance or improvement? y�
Waste Application
10.Are there any required buffers, setbacks,or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes,check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc'
❑ PAN ❑ PAN> 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Coinl Fxe ft l/G 1.
13. Soil Type(s): LA 4 U iL Lr- L L
14.Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
IT 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 ❑ NA ❑ NE
Required Records&Documents
19. Did the facility fail to have the Certificate of Coverage& Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
OWUP ❑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 Q Weekly Freeboard ❑Waste Analysis 0 Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections 0 Monthly and V Rainfall Inspections ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili umber: 7> Date of Ins ection: 62 /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes ti No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal? `
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [ ] No ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately. ]�
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit?(i.e.,discharge,freeboard problems,aver-application)
31. Do subsurface tile drains exist at the facility?If yes,check the appropriate box below, ❑ Yes ANo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes tN
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? CO] Yes ❑ NA ❑ NE
Comments(refer to question#): Explain any YES answers and/or any additional recommendations orrani other comments: '.
Use drawings of facility to better explain situations(use additional pages as necessary).
10/9
Reviewer/Inspector Name: m A 0A N iC S Phone: !f 6 -*'-1(j t-�0)
ReviewerlInspector Signature: . Date: r
Page 3 of 3 21412011

"I" MI", "i, I
Dtvtsion of Waicr Quality 4
_ �'aCt�tty Numbers 3 $Drvtsion of Soil and=Water Conservation �
�Q OtherA enc _t � x
3F`3f. s`.s" � ,1ditc.b <<� 1?i4ir. ix-, ,4$ �: [g;4iiYa,
E
f Visit Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
n for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time:® Departure Time: County: u N Region:
Farm Name: AC1_ ALCMIA/ E99—Ply 1 — Owner Email: Q
Owner Name: �� �-Q�'� y Phone: 1 I 1 -e 052 G-!S 9117
Mailing Address: 1J 11-� L C�-#C•��-H F{�-0 f ��l/'C 7-0 U OE,/fi Y Z o`U VS
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: � GAL �-Qh� Inte rator:
Certified Operator: Wl � ' �t— Operat�-10o, ertification Number: J�
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =e =I Longitude: =°=d 0 Al
a
w
h Design ftj;Current k FDesign Current �; Design .Current
", a t3.. e sr1 r, �.a"s'sw. _ ::: t rY,
Swine ,t s SCa °Pott��ulxtion t WetPo`ultryg ;.Ca acty'Po ulationE Cattle p.. g Ca acrtPotlulaon
._H,C�. t-:afx yI - s.�, 4:X4 -. `prr:�.e.t Vmr....-.K._ykk.4s€=rrl"9 eat.-�
❑Wean to Finish �';❑ La er x❑ Dairy Cow
❑Wean to Feeder ❑Non-La er fi ❑ Dairy Calf IN
x 60 #* k I: ' ' ❑Dai Heifer
Feeder to Finish I ,' � l,� ,,r ;
u;�= t
El Farrow to Wean D'rykP,o'ultryE1. � '< _ ❑ D Cow
�] Farrow to Feeder '� '` `
'El Non-Dairy
El
i. Farrow to Finish al❑ Layers
' �; Beef Stocker
❑Gilts i ❑Non-Layers
El El Beef Feeder
.1❑ Boars a i ElBeef Brood Cow
[-I Turkeys
� IM7' 3 '' � AW
: a
Other,;r fry "1+ �4l s, ❑TurkeyPouets
❑Other , ❑Other Number of Structures
a :-.aq.._,- €•,.�. -� •r� . '. €._ .:;�� +� ��';< -s- �r� ,, r.t.. s��x �-a .�_ n,a.�r=x ;,��# ��;.� - i 'f4� �� . q ,_ ..d.'4. u`C.3"�
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 , o ❑NA ❑NE
other than from a discharge? JJJ
Page I of 3 12128104 Continued

Fpcility 14umber: Date of inspection
Waste Collection & Treatment
4. is storage capacity(structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes �qNo [I NA El NE
a. If yes, is waste level into the structural freeboard? ❑Yes El No ❑NA ❑NE
Struct re I Struc re 2 ' Structure 3 Structure 4 Structure 5 Structure 6
Identifier: WArX
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): 3�-i 3 t
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes [ No ElNA [I 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 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?
It. is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes 1KNo ❑NA [3 NE
❑ Excessive Ponding [I Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.) JJJ `�\
❑ PAN ❑ PAN> 10%or 101bs ❑Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s) 5 G m QE�Z_
13. Soil type(s) kkT(.�Ql ue NC54� tr-CSC-1�-
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 �4 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑Yes VZNo ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes t—No ❑NA ❑NE
Comments(refer to question#): Explain any YES answers and/or any recomtnendationstor a ny'othwcomments.'
Use drawings of facility to better explain situations.(use,additional pages as necessary):.
AL
Reviewer/inspector Name 1xJ 5 Phone: -`4% 4Ka
Reviewer[Inspector Signature: Date: j
Page 2 of 3 12128104 Continued

1
Facility Number: —G Date of Inspection I
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 )kNo []NA ❑NE
the appropriate box. El WUP ❑Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes,check the appropriate box below. ❑Yes�No ❑NA ❑NE
0 Waste Application 0 Weekly Freeboard ❑Waste Analysis ❑ Soil Analysis ❑Waste Transfers ❑>Aual Certification
0 Rainfall ❑ Stocking El Crop Yield El 120 Minute Inspections 0 Monthly and i" Rain inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑Yes jjeNo ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes D4 No ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes CdNo ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes *o ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes )4No ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes XNo ❑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 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 XNo [INA ElNE
33. Does facility require a follow-up visit by same agency? ❑Yes YkN-o ❑NA ❑NE
Additional Comments and/or Drawings.
�o j��I►� Ogg- 0-'i�
Page 3 of 3 12128104

Division of Water Quality
I=NuMker 3 t-J(Q Division of Soil and Water Conservation
Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: IT f!O I Arrival Time: Departure Time: County: N Region:
Farm Name: -Soar AL,nN)A/ f"AQM 1-9 Owner Email:
Owner Name: _�ACyK (ACQUI t/ y ,��} Phone: 919 -CoS g-sa(��c9r�
Mailing Address: : 1-1 f3 eTH EL if H LAZCH VZJ I/ IQU r 0(-,uE_,_/ Y C cQ0 J(P,5
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: - Acy- ALrn //� integrator:
Certified Operator: ,. LEwis ---Ai_ra91)V Operator C fication Number: f S
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑o Longitude: =° =1 ❑1i
Dcsign Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population C►attle Capacity Population
❑Wean to Finish I I I I[] Layer I 1 ❑Dairy Cow
ElWean to Feeder ❑Non-Layer El Dairy Calf
IS Feeder to Finish d d El Dairy Heifer
ElFarrow to Wean Dry Poultry El Dry Cow
ElFarrow to Feeder El Non-Dairy
❑ Farrow to Finish ❑ Layers
ElBeef Stocker
❑Gilts ElNon-Layers El Beef Feeder
❑ Boars ❑ Pullets
El Turkeys ❑ Beef Brood Cow
Other ❑Turkey Poults
❑Other ❑Other Nunn er of Structures:
Discharges& Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes
No [I NA [:IN E
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

Facility Number: 1 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes "ANo ❑ NA ❑NE
a. If yes, is waste level into the structural freeboard? ❑Yes ❑No ❑NA ❑NE
Structure I St ruc ure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: n
Designed Freeboard(in): `7
Observed Freeboard(in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes No [INA ElNE
(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 [ ,,No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes No [INA ❑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 Ai mlication
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes No ElNA ❑NE
maintenance/improvement? �A
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes 0 No ❑NA ❑NE
❑Excessive Ponding [I Hydraulic Overload El Frozen Ground [I 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) fL(�— nu R EQ
13. Soil type(s) /Y 5 A I io& _ AoS
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes P(No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes A No ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑Yes �k No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑Yes O'No ❑NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑Yes ❑NA ❑NE
s/:;`"���'
Comments,(refer,to..question`#) 'Explain$any YES answersmand/orany=recommentlationa;dr_a othe co uy r ►nments � .r
: -...� . better.
� � qx..-za.'�t sra?:.•h°: .':.�.: § .e.t1.
Zse drawings of� ality,.to.better.explAin'situations:�(use.additional pages as necessary);
i
nn T
Reviewer/Inspector Name Phone: Qd
Reviewer/Inspector Signature: Date: 2
12128104 Continued

Facility Number: 1 — 1p Date of Inspection
Required Records& Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes No [I NA [I 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. Q WUP El Checklists
0 Design El Maps El Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes )XNo ❑NA ❑NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑ Soil Analysis ❑Waste Transfers ❑A/nual Certification
El Rainfall ❑ Stocking ❑Crop Yield 0 120 Minute Inspections El Monthly and 1" Rain Inspections El 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 ANo ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes ANo ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes 'AN o ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes %LNo ❑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 KNo ❑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 ANo ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes o ❑NA ❑NE
Additional}Com erns and/or Djraw n s: � `
L s yr tom., NCB G3i9
12128104

Division of Water Quality
Facility Number 3� ivision of Soil and Water Conservation
Q Other Agency
E
f Visit (kCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: d Arrival Time: Departure Time: County: Region:
Farm Name: . ACY—, r H n— QH i N N PAR'M I r Owner Email: eC" 7
p
Owner Name: QCyi Q 1)/ ,/y� Phone: 1119" �0 58""S
Mailing Address: 19 gG7HEL CftaZE1 I r i iVT 01-JC1E ,/VG zQ830S
Physical Address:
Facility Contact: (� Title: Phone No:
Onsite Representative: �\v4c \H ucwml Integrator:
Certified Operator: LEWIS J • �Z--Iny�N Operator Certification Number: S __
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 e �" Longitude: ° "
i
T
Design Current Design Current Design Current
Swine Capacity Popes lhtion Wet Poultry Capacity Population Cattle C*opacity Population
❑Wean to Finish ❑ La er ❑ Dai Cow
❑Wean to Feeder ❑Non-La er {❑ Dai Calf
Feeder to Finish 0 ❑ Dairy Heifer
❑ Narrow to Wean Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder El Non-Dairy
El Farrow to Finish ❑ Layers
❑ Beef Stocker
❑Gilts ❑Non-Layers
El Pullets ❑ Beef Feeder
❑Boars ❑
[I Turkeys Beef Brood Cow
Other ❑Turkey Pouets
❑Other ❑Other Number of Structures.
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes XNo ElNA ❑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 o ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes No ❑NA ❑NE
other than from a discharge?
Page I of 3 12128104 Continued

Facility Number: 3) —2-169 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes I$No ❑NA [IN E
a. if yes, is waste level into the structural freeboard? ❑Yes ❑No ❑NA ❑NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: nn
Designed Freeboard(in): /`I-
Observed Freeboard(in): 3 S
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 Cl 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 t No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes 4No ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes 19No ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes fANo ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes 4-No ❑NA ❑NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑ PAN> 10%or 10 lbs ❑Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s) SG (6� ca a Q Fi=�C�
13. Soil type(s) l4TCLA I N1 LLtr 41 oLC:��
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes A No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes_[P 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 'ELNo ❑NA ❑NE
� , ; i L - `�': x:' ,�•t.��, .:.��=tx tS §y Y;*�a h'�<� � '.�.�. S...�--,5: y�. �
C mmenfs(refer to,questign;#} Explajn:,any�YES:�answersxgnd/8r any recnmmersdatipns or any ntner;comrtients:
u
Useidrawtngs of,factlt(y,to better eicplain sittuations:{use additronu[�pages,as;Hecessary . . �;. ° *
T. t 4• ' x r - Stirs �.. �, ;;.s
i);3ioq a
8 �.3 Lac-S Cody �,
q po/os
Reviewer/Inspector Name }j S Phone: l/(3 43
Reviewer/inspector Signature: _ Date: f�
Page 2 of 3 12128104 Continued

ry
Facility Number, 1 — 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 *o ❑NA ❑NE
the appropirate box. 0 WUP 0 Checklists
0 Design 0 Maps [3 Other
21. Does record keeping need improvement? If yes,check the appropriate box below. ❑Yes X No ❑NA ❑NE
El Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑/aste Transfers ❑/nual Certification
0 Rainfall 0 Stocking 3 Crop Yield ❑ 120 Minute Inspections El Monthly and V Rain Inspections ❑Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑Yes A 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 KNo ❑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 D�No ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes KNo ❑NA ❑NI.
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes b�No ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes VNo ❑NA ❑NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑Yes KNo ❑NA ❑NE
If yes,contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑Yes XNo ❑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 1LI No ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes �. o ❑NA ❑NE
Additional Comments and/or Drawings:
1
Page 3 of 3 12128104

�1
0 Division of Water Quality
Facility Number � � y�� 0 Division of Sail and Water Conservation
0 Other Agency
E
of Visit Compliance Inspection 0 Operati4n Review Q Structure Evaluation 0 Technical Assistance
on for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /0 v Departure Time: County: Q At Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: /� Title: Phone No:
Onsite Representative: �A QS A L 91AI Integrator:
Certified Operator: Operator Certification Number: 1 4155
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑e Longitude: 0°❑6
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑Wean to Finish ❑ Layer ❑ Dairy Cow
❑Wean to Feeder ❑Non-La et ❑ Dairy Calf
FKI Feeder to Finish 110080 ❑Dairy Heifer
❑ Farrow to Wean Dry Poultry ❑Dry Cow
❑ Farrow to Feeder El Non-Dal
El Farrow to Finish El Layers
❑Beef Stocker
❑Gilts ❑Non-La Non-Layers
❑Beef Feeder
❑ Boars ❑Pullets
❑Turkeys
Beef Brood Cow
❑
Other ❑Turke Poults
❑Other 1 ID 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 0 No ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes U4 No ❑NA ❑NE
other than from a discharge?
12128104 Continued

i
l
Fsaility.Number: 3 —y(p9 Date of Inspection
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes 0No ❑NA ❑NE
a. If yes,is waste level into the structural freeboard? ❑Yes ❑No ❑NA ❑NE
/ ,,Structure 1 // Structure 2n Structure 3 Structure 4 Structure 5 Structure 6
(A Identifier: CaOOJS/ crH(�OC7'!(oC
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): 3 V
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes No ❑NA ❑NE
(ie/large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes No ❑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 I�No ❑NA ❑NE
8. Do any of the stuctures 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 KNo ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks,or compliance alternatives that need ❑Yes O'No ❑NA ❑NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes gNo ❑NA ❑ NE
❑ Excessive Ponding ❑Hydraulic Overload ❑ Frozen Ground ❑Heavy Metals(Cu,Zn, etc.)
[:] PAN ❑PAN> 10%or 10 Ibs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑Application Outside of Area
12. Croptype(s) Sm�bi'R/nIC� �61 Goiw� g�RtHuD��G�A�c�
13. Soil types) I b,4 , /Vo l�j ,Ay ifl
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes .X No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes f�'No ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]Yes 1;�No ❑NA ❑NE
17. Does the facility lack adequate acreage for land application? ❑Yes E�No ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes ZNo ❑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):
Reviewer/Inspector Name Phone: rr��U-�9(a'��j7
Reviewer/Inspector Signature: Date: O� ��U
12128104 Continued

Facility Number: 3 1 —�}(qr] Date of Inspection
Required Records& Documents
19. Did the facility fail to have Certificate of Coverage& Permit readily available? ❑Yes ANo ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑Yes KNo ❑NA ❑NE
the appropirate box. ❑WUP ❑Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes 4No ❑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 KNo ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes V 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 PNo ❑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? (icl discharge,freeboard problems,over application)
32. Did.Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑Yes kNo ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes [S�No ❑NA ❑NE
Additional Comments and/or Drawings:
12128104

Division of Water Quality
FFacility Number ��� O Division of Soil and Water Conservation
0Ather Agency
Type,of Visit Ocompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 10 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Arrival Time: CJ i Departure Time: * ounty: t1PGz Region:Date of Visit: 3 fJ
Farm Name: A�k GP�yn1 Owner Email:
Owner Name: z1 C"01 45JJ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: dIsc k Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: e ` Longitude: =° =` "
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑Wean to Finish ❑Layer I ❑Dairy Cow
❑Wean to Feeder JEJ Non-La et E—d ❑Dairy Calf
Feeder to Finish ® ❑Dairy HeifeF
Farrow to Wean Dry Poultry ❑Dry Cow
❑Farrow to Feeder ❑Non-Dairy
❑ Farrow to Finish ❑La ers
❑Beef Stocket
❑Gilts ❑Non-Layers
El Pullets El Beef Feeder
El Boars ❑Beef Brood Cow
❑Turkeys -
Other ❑Turkey Poults
❑Other ❑Other Number of Structures: ®�
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 ❑No ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes '0 No ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes XNo ❑NA ❑NE
other than from a discharge?
12128104 Continued

i
Facility Number: 3 — _r Date of Inspection
Waste Collection & Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes ;�'No ❑NA ❑NE
a. If yes,is waste level into the structural freeboard? ❑Yes ❑ No ❑NA ❑NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:Spillway?: ` 1p O
Designed Freeboard(in):
Observed Freeboard(in); �J
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes No ElNA ElNE
(iel large trees, severe erosion,seepage,etc.) 10
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes No [INA [INE
through a waste management or closure plan? 0
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 gNo ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes JZ(No ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes No ❑NA ❑NE
maintenance or improvement? /
Waste Application
10. Are there any required buffers, setbacks,or compliance alternatives that need ❑Yes f No ❑NA El NE
maintenance/improvement? /
11. is there evidence of incorrect application? if yes,check the appropriate box below. ❑Yes 0 No ❑NA ❑NE
❑Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
❑PAN ❑PAN> 10%or 10 lbs ❑Total Phosphorus ❑Failure to incorporate Manure/Sludge into Bare Soil
ElOutside of Acceptable Crop Window ElEvidence of Win Drift ❑ pplication Outside f Area
12. Crop type(s) C.�-, �i�1 L� 7� D o f�
13. Soil type(s)
14. Do the receiving crops d/ fer from those designated in the CAWMP? ❑ Yes /VNo ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes gNo ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑Yes VNo ❑NA ❑NE
17. Does the facility lack adequate acreage for land application`? ❑Yes ONo ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes VJ No El NA [I 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):
A,
6�z
S d�
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date: Q
12128104 Continued

Facility Number: — Date of Inspection
Required Records& Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes.0"No ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑Yes �No ❑NA ❑NE
the appropirate box. ❑ WUP ❑Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes,check the appropriate box below. ❑Yes XdNo ❑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/11 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 ZNo ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes PKNo ❑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 El NA ❑NE
If yes,contact a regional Air Quality representative immediately /
3 I. Did the facility fail to notify the regional office of emergency situations as required by El ye; ONo ❑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 (,No ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes / No ❑NA ❑NE
Additional Comments and/or Drawings:
AL
12/2VO4

r'
Division of,Water Quality.
Facility Number Division of Soil and Water Conservation
Q:Other Agency
E
f Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other El Denied Access
Date of Visit: / Arrival Time: 0110A -Departure Time:
/County: 404ZN, Region:
Farm Name: Qer, kt� eA-Zr1 ARlYI Owner Email:
Owner Name: ACk E Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: hone No:
Onsite Representative:- �CK ka4--f'4" Integrator: >�
Certified Operator: �� �� l�eP'>r=r)= Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ° Longitude: °
Design Current Design Current Design . Current .
Swine Capacity Population`' :;Wet Poultry. Capacity Population Cattle" Capacity Population
❑Wean to Finish El Layer Dairy Cow
❑Wean to Feeder 10 Non-Layer I ❑Dairy Calf
Feeder to Finish ❑Dairy Heifer
Farrow to Wean Dry Poultry ❑ Dry Cow
❑Farrow to Feeder ❑Non-Dairy
❑ Farrow to Finish ❑Layers
El Beef Stocker
' El Gilts Non-Layers
❑Pullets ❑ Beef Feeder
❑ Boars ❑ Beef Brood Cow
_ -� _ ❑Turkeys
Other El Turkey Poults
❑Other ❑Other Number of Structures: �I
Discharees&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 past discharge from any part of the operation? ❑Yes 9.No [I NA [I NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ElYes�No El El NE
other than from a discharge`?
Page I of 3 12128104 Continued

1
Facility Number: — Date of Inspection
Waste Collection& Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes No ElNA ❑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: / S
Spillway?: /�D O
Designed Freeboard(in):
Observed Freeboard(in): Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes �No ❑NA [I 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 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 11No ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes No El NA ❑NE
❑Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals(Cu,Zn,etc.)
[:] PAN ❑ PAN> 10%or l0 Ibs ❑Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Cro^Wnin-dow El Evidence of Wind Drift ❑Applicatio/n�Outside of Area
12. Crop type(s) �. tt (ts4��f� CO2/JA&em 6aA (j
13. Soil type(s) T Ak 46
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? El 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):
Reviewer/Inspector Name rZ12 �49T Phone; q10'906—
Reviewer/Inspector Signature: Date: 6
Page 2 of 3 121 8104 Continued

J �
Facility Number: — Date of Inspection
Required Records& Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes XNo ❑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 [I Design ❑Maps El Other 2,_,(
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes / No El NA NE
[I Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis El 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 No ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes A`/ No
No ElNA [INE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ElYes / ❑NA ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes R�No ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes JZNo ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes VfNo ❑NA ❑NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑YesNo ❑NA ElNE
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 ElNE
If yes,contact a regional Air Quality representative immediately /I
31. Did the facility fail to notify the regional office of emergency situations as required by ❑YesNo ❑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 XVNo
No ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes ❑NA ❑NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

J
Division of Water 11 aunty
-WC , Number Division of Soil.and Water Conservation
11111101111 Q Other Agency
FReasonforVisit
Visit u}Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑Denied Access 7
Date of Visit: Arrival Time: Departure Time: County: Region: ' /J
Farm Name: I -R A ZrJ FAZ/n t- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
r
Onsite Representative: AC' lntegratar:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 t 0 Longitude: =°=4 0 41
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑Wean to Finish ❑ Layer ❑ Dairy Cow
❑Wean to Feeder ❑Non-Layer- I ❑ Dairy Calf
21 Feeder to Finish ❑ Dairy Heifei
❑ Farrow to Wean Dry Poultry ElD Cow
❑ Farrow to Feeder ❑Non-Dairy
❑ Layers
❑ Farrow to Finish ❑ Beef Stocker t
❑Gilts ❑Non-Lavers ❑ Beef Feeder
❑ ❑ Pullets
Boars
❑Turkeys ❑ Beef Brood Cowl X
Other ❑Turkey Poults
❑Other ❑Other Number of Structures:
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes [Z 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? [:1 Yes V]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

Facility Number; — Date of Inspection
Waste Collection & Treatment f ,
4. 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 ❑No ❑NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L
f� 'd-2
Spillway?: U 11Io
Designed Freeboard(in):
Observed Freeboard(in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes A 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 Vj 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 ®No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes VNo ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes P No ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes Z No ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑ Yes ,0 No ❑NA ❑NE
❑Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
[]PAN ❑PAN> 10%or l0 Ibs ❑Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑Application Outside of Ar a
12. Crop type(s) /4 WD
13. Soil type(s) ketq�l to�s
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes P No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes Vf No ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`❑Yes F]No ❑NA ❑NE
17. Does the facility lack adequate acreage for land application? ❑Yes 0 No ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes to No ❑NA ❑NE
Camme�nts(referto question#)Sx Expl�ainanyYES�enswersandlor any recommendations or any other comments.
Use d.rawingsgoffac►lityito,better�eaplaintsituarti+ottrns t{use ad{drtlonal'pages a�nece_ssary,
� iWx� id Li.+4'iv.�l.F_..,kaa�..��a,.- .�� 1r,..�k+eYA,.i.`�hi{ ��!7.i�'S•���:�Y, i�ei
20) nJ4.f_p r,66,na4 &Szc-d Fop- L PtconnJ S . Owe Zq z- p-7gs Z�4src
21J /�f--�D �rtgc T A00UA& CF.�7Z�-f-4C'�7Z4r1 �t
R�1Zt*- LL I EhAs -(0
Reviewer/Ins Pector Name a Phone: Q7
- _� s. r � k
Reviewer/Inspector Signature: Date:
12128104 Continued

5
Facility Number: Date of Inspection
Required Records&Documents T�
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes 23 No ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?.If yes,check ❑ Yes W No ❑NA ❑NE
the appropirate box. ❑ WUP ❑Checklists ❑Design ❑Maps ❑Other G'Q6
21. Does record keeping need improvement? If yes,check the appropriate box below. Yes ONo ❑NA ❑NE
❑Waste Application ❑Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑Waste Transfers 0 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 0 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? jo
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑Yes ONo ❑NA ❑NE
If yes,contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑Yes XNo ❑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:
Dr- L AA"L t4Aof-
�Pt7E G
�- vF C)WrJjEp CbPkf �f fnODSrF �D R�--2 FoQ� `� Usk
12128104

ji'3aa
€fi
,_ ❑s d t' 1 f € F �,.€, r..F-=s�'.- a+;F#€{°77°3 t f:..'"�' rr#1 :.xr t ,.'#ta.i>#s,t.#k:,tYi,r_.d t7 �€:d}{rj ,y 11 r r �,}. ..fir s �}'' `€t
{ 7 � a (:!._O-�]IVt51aA'Af r�flllYaad Wat6FiC.4[tSel'VAt101E
7 `..ate•'>r a. E. H€.:
F-. �.,�, f- tray ,v�r
',€€;€+3; +a E ar€}3 idt=atr a .¢ F :ae r $ - •d r F, d ,4 a P '�€{.'8dk�,° ! 'r7 ".rl�_fir
QtOther"Agency. f # �t. .tf
s
,.�£N8 F 3=
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit f fRoutine O Complaint O Follow up O Emergency Notification O Other ❑Denied Access
Facility Number Date of Visit: 11104 1Time: v r`S
1 Not Operational C Below Threshold
Permitted#Certified 0 Conditionaa {lly Certified ©Registered Date Last Operated or Above Threshold:
FarmName: ............. �<-.....Q q:�'r ........L-...I......................................... County: .........L)U?G"�........................... .......................
OwnerName: ................................................... ........................................................................ Phone No: .......................................................................................
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
FacilityContact: ..............................................................................Title: ................................................................ Phone No: ...................................................
OnsiteRepresentative: �;AC-K ��.r�J�:�.sa 1............................................... Integrator:...........cftg L:.�-.:.........................................
.... .. . .. ..... ..
Certified Operator:................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
[]Swine [:)Poultry ❑Cattle []Horse Latitude Longitude �• �� ���
! R r D�SNpryby CUTreat i ';' } E 'FiF "� g13..1ItDeSs h¢=CurrentF {t tPt. £1 y]Q@SIp� CUrreat" c
E 4 r � a �
Swine „^J ,R„ d.;.C'd SCi „ POtUlatlOJai{i =P1 ItryP',,.ar€tl�{Caalacit ni;,Po£uatloaL L`8tttler�E ti jiCa net ! `PO rUlBttOn;}i
❑Wean to Feeders}❑Layer �.< ❑Dairy :u
Feeder to Finish O 'i"❑Non-Layer ' ❑Non-Dairy
Farrow t0 Wean
❑ ❑Other a � E1 rtdi e� 9x §€ i
Farrow to Feeder
d Fa t fed# id€ 1. -sr ': 3 i ,a U
❑Farrow to Finish r� ,, e,f ,;€ j E�sF,
!�'Ot8���.�� 4Sp2' t�€,�
i❑Gilts $t sp�.r°!#Ed€ ��c 5 L, f tqi rg£.e r 7Ys f�F� arti. Ip df Y�?�t
❑Boars „ Ir ��, utBt�SSLW
r3=
fej '}�d�€� , r >� P
€rNumberr of Lagoons{� 2 r
fh' S4Ptrr,r
£i W
Discharges&Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes CdNo
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed,was the conveyance man-made? ❑Yes ❑No
b. If discharge is observed,did it reach Water of the State?(If yes,notify DWQ) ❑Yes ❑No
c. If discharge is observed,what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system?(If yes,notify DWQ) ❑Yes E�;/o
2. Is there evidence of past discharge from any part of the operation? ❑Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes
Waste Collection&Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes o
Structure I Strycture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...........L..................... ................................... .................................... ................................... ................................... ...................................
Freeboard(inches): 32 3
12112103 Continued

Facility Number: Date of Inspection 1► a
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes 7No
:. seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑Yes
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? /Ye ❑
8. Does any part of the waste management system other than waste structures require maintenance/improvement? [I Yes
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum Iiquid level ❑Yes ' No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑Yes VN
11. Is there evidence of over application? If yes,check the appropriate box below. ❑Yes
❑Excessive Ponding ❑PAN ❑Hydraulic Overload ❑Frozen Ground ❑Copper and/or Zinc
12. Crop type p t s'(j() 0UE
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 Zo
b)Does the facility need a wettable acre determination? ❑Yes ;; e_
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
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑Yes �To
liquid level of lagoon or storage pond with no agitation?
18, Are there any dead animals not disposed of properly within 24 hours? ❑Yes ;�O/
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 No
Air Quality representative immediately.
�trc+�t.�:.r�:. , .,,�„=.d,�' ,;Fw;.,,_ ;,��,:., �a•�r:� a: E;t.':t:.ah ,,;,;:i3=..,:a::¢t:�re �, °°r.<a,< re"<r�:;.:,r al:rx>:t,�...>,r, a•. :GIs n 3rr�3::e='s,� , zk-°;;q .:w�Wk�,�w�x�t?(r y'rr1'�1 uih'� 1�'�r�tr,
Ct
: ainrnents{refer to questron#) Explaun any YE,S aaswers,and/ar any recomanend"ations,or any th5er�omments , e ,z ,.,rt ryh a E,a.
i,"
Use dr w,ngs,o fa¢ility�to better Eracplam sttuatrons (use addrtronal pages_as necessary) 1: ❑Field Copy ❑Final Nates ;'� ;i ..
�'j�e�y ��.
!:a.r,> nl.as r,:. .1 s:."..�„ r.,3..r•.......rur,..?... ,>,.._1,X t�.:. :f„.,.n.,.f.,r.,s....tr.0 l�tf..,.dz�.� �:...�X? :: 1,.7.._a K.h.z.Jl�...l..¢tf#,.L"-r.irr # -g' � h¢?r,rl.,,i+,r.;,. «"wclu• Gana"§.tli,r ...�i.,.1. ...Qe.
L
�.} LA&OU) 1 014CE wY%L"E%pS �n.,C WorL jr 01�j GaA SS (4Vt2,
L�h�P�TF Gft.oP `�!FL0 F6P fy-1
f ZE C_*� ENO FA Q-w� La 0
' T
u%,,. t{ ...f .�l am �t !r ,Reviewer/Inspector Name . ll
Reviewer/Inspector Signature: Date: � fl
12112103 Continued

Facility Number: 31 — � Date of Inspection �I n
Required Records &Documents /No
21. Fail to have Certificate of Coverage&General Permit or other Permit readily available? ❑Yes
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) El Yes N
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 No
25. Did the facility fail to have a actively certified operator in charge? ❑Yes ❑4110
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge,freeboard problems,over application) ❑Yes �/o27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ElYes [ 'N
28. Does facility require a follow-up visit by same agency? ❑Yes N
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? El Yes o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit?(If no,skip questions 31-35) Yes []No/
31. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes [L�N
32. Did the facility fail to install and maintain a rain gauge? El Yes
33. Did the facility fail to conduct an annual sludge survey? ❑Yes ;,N<Oo-
34. Did the facility fail to calibrate waste application equipment? ❑Yes
35. Does record keeping for NPDES required forms need improvement? If yes,check the appropriate box below. ❑Yes No
❑Stocking Form [:]Crop Yield Form [:]Rainfall [:]Inspection After 1"Rain
❑ 120 Minute Inspections ❑Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
iti ....,... r3 ,tt¢ _i ,r '�i'-ry ¢. t.:� ,F. 13 I"`i7ry cF.. H
dditianal'Gomments`;and/or,Drawtn S pil `¢E€ .rt,'U'I;."", ;rt�r Er';�a 'r,.a n3 ' ��a ,' , ,{.,f fit?, x:te,r t t r d„ q
#( +,a { �r 14¢'�tjt�M�;.., "I,-��<<,..». ,.,�e,a,rn�zss;,•st:;s,.c:..,a,:x:rnwr-a.r._.fr.s,.r<.:.r;rx.=P..,....n.,..rv,. t::Sufi__'fW '',]r.,3u.r�s .t�.:. i'».,-, de {. Er�rt+L` �{t
7
12112103

- � t �. , _oIIof+_s," z.
t 7 5 r
� � a d a � ¢ D1v1s1WAtErQtfB�tya}$
r t�aa ` O Division of Soil andaWater�ot1SC1'Ya�OA t $ P$ 1 p f l id tt fr' r s
a U^ _(P41, F it a '!i'-t ° - ; t r t _ _ r e i s r a r
a x O Other Agency i u ff h ! of tt 3
3
°l s<ddi
Type of Visit Compiiance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit A Routine O Complaint O Follow up O Emergency Notification O Other ❑Denied Access
Facility Number hate of Visit: / I Time:
IQ Not O erational 0 Below Threshold
Permitted ©Certified ©Conditionally Certified © Registered Date Last Operate r Above Threshold:
Farm Name: _ , ,�G_�'W111 J y,Q��_ z County: SeAfA.EN
Owner Name: _ � �� � Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
LYG�1/✓�� Integrator:Onsite Representative: � ,_, g3 G
Certified Operator: Operator Certification Number:
Location of Farm:
rr
Swine ❑Poultry ❑Cattle ❑Horse Latitude Longitude
R.
'Design ., ,;Current. Desi�►itCurrent " Destgn Cbrrent
Swine—-: , Ca acity>>'Population ... ,PouIt Ca acity "PtPo uhitiort Cattle Ca acity Population
❑Wean to Feeder '"+❑La er Apia Dairy
Feeder to Finish ❑Non La er [f ❑Non-DairyI
Farrow to Wean 1
❑Farrow to Feeder 10Other
(]Farrow to Finish € Total Design Ca ail
❑Gilts p
Boarsr
Number of Lagoons s t i 3 Subsurface Drains Preseat ❑La oon Area `❑S rav Field Areaj tt
Holditig Ponds is'Sabd'Traps 'a i ❑No Liquid Waste Mana ement.S stem ,'; zzi Y; x'=
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes /No
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed,was the conveyance man-made? ❑Yes ❑No
b. If discharge is observed,did it reach Water of the State?(If yes,notify DWQ) ❑Yes ❑No
c. If discharge is observed,what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?(If yes,notify DWQ) ❑Yes ❑No
2. Is there evidence of past discharge from any part of the operation? ❑Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes o
Waste C9111kctin & Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes No
S ucture I Structure Structure 3 Structure 4 Structure 5 Structure
Identifier:
Freeboard(inches):
05103101 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of,any of the structures observed?(ie/trees,severe erosion, ❑Yes No
seepage,etc.) /
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes No
(If any of questions 4-6 was answered yes,and the situation poses an
immediate public health or environmental threat,notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑Yes No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes No
11. Is there evidence of over applicati n? Excessive Ponding ❑PAN ❑Hydraulic Overlo ' / El Yes VNo
12. Crop type LJ �N
13. Do the receiving crops differ wi those designated in the Certified Animal Waste Manageme an(CAWMP)7 ❑Yes A No
14. a)Does the facility lack adequate acreage for land application? ❑Yes No
b)Does the facility need a wettable acre determination? ❑Yes No
c)This facility is pended for a wettable acre determination? ❑Yes .No
15, Does the receiving crop need improvement? ❑Yes No
16. Is there a lack of adequate waste application equipment? ❑Yes [�No
Required Records&Documents
17. Fail to have Certificate of Coverage&General Permit or other Permit readily available? ❑Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) ❑Yes !4No
19. Does record keeping need improvement?(ie/irrigation,freeboard,waste analysis&soil sample reports) ❑Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge,freeboard problems,over application) ❑Yes No
23. Did Reviewer/inspector fail to discuss review/inspection with on-site representative? ❑Yes q No
24. Does facility require a follow-up visit by same agency? ❑Yes QJ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes I!1 No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. T
Comments(refe queti n#) Expininsany YIJSYanswers'tind/or, ny'recammendations,or any,�oth�e�omments
Use drawings nffarili ty to ttertxplainisttuationsseradilitionalpgesasnecessery) .� ❑F py w �
Field Coinal Notes
�j W�1-7L�i Dp,��y5 A') �� Z0941 OPAI &L SAS,
� /I�jrf�o f}-��or� ,�,ESr-C�✓ l��rs�- �--��eos �ui,,/,�,e .��.�
p
_z r ..
Reviewer/Ins ector Name:
Reviewer/Inspector Signature: Date:
05103101 Continued

a 1
Facility Number: gz Date of Inspection
Odor ImxI
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below []Yes [--]No
liquid level of lagoon or storage pond with no agitation? /
27. Are there any dead animals not disposed of properly within 24 hours? ❑Yes XNO
No
28. 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)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑Yes /PINo
30. Were any major maintenance problems with the ventilation fan(s)noted? (i.e.broken fan belts,missing or
or broken fan blade(s),inoperable shutters,etc.) ❑Yes o
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Cl Yes []No
Additional Comments and/or Drawings: ,
r
/� � (i/�!�rc'L/(� �/✓ l/�`/�2�1/� v`"�J►STi� Sfi/j't J�L�.S.
'04
O;M E40,
05103101

�Division of Water Quality,
I ,
O Division of Soil and Water.CnnservatioII
O,gutter A ,CnCy
E Ei
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification O Other ❑Denied Access
1)atc of Visit: �� Time: Printed on: 7/21/2000
Facility Number
O'Not Operational O Below Threshold
Permitted [3 Certified ©Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
FarmName: ..... . .....................I............................................ County: ........... 11 .......... ..............
OwnerName: ................................................... ........................................................................ Phone No: .......................................................................................
FacilityContact: ..............................................................................Title: ................................................................ Phone No: ...................................................
MailingAddress: ..................................................................................................................... ....................................................................................... ..........................
Onsite Representative: .... L.J`'' t ....................................................................... Integrator:... `' .1.1. ................................................
CertifiedOperator:................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑Swine ❑Poultry ❑Cattle ❑Horse Latitude Longitude �•�� �«
Design Current' Design Current Design y Current
- Pout Cattle C'
a ''Peataacouon on
rFeeder'
eder ❑Layer ❑Dairy
inish Non -Dairy
ean .... .. .:
Feeder ❑OtherFinishTotal Design,Capacity
"! Boars Total SSLW
t,.
Number of Lagoons ❑Subsurface Drains Present ❑Lagnan Area ❑Spray Field Area
Holding Ponds I Solid Traps ❑No Liquid Waste Management System
Discharges &Stream ImRacts
1. Is any discharge observed from any part of the operation? ❑Yes No
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed,was the conveyance man-made? ❑Yes ❑No
b. If discharge is observed,did it reach Water of the State'?(If yes, notify DWQ) ❑Yes ❑No
c. II'discharge is observed. what is the estlinaled flow in gal/min?
cf. 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 JoNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes 51 No
Waste Collection & Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes IQ No
SUUCtUre I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
IdentiFier: .................................... .................................... ................................... ..........................I.... ............I..................... ....................................
Freeboard(inches): "3{j 13O
5100 Continued on back

Facility Number: — q Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees, severe erosion, ❑Yes XNo
seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes kNo
(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? d Yes J (No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑Yes N(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? 9Yes ❑No
_Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes tR No
11. Is there evidence of over application? ❑Excessive Ponding ❑PAN ❑Hydraulic Overload 1 ❑Yes NrNo
12. Crop type 5 s —Cm f d
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes t5No
14. a)Does the facility lack adequate acreage for land application? ❑Yes KNo
b)Does the facility need a wettable acre determination? ❑Yes ❑No
c)This facility is pended for a wettable acre determination? ❑Yes ❑No
15. Does the receiving crop need improvement? ❑Yes No
16. Is there a lack of adequate waste application equipment? ❑Yes "'�No
Re wired Records &Documents
17. Fail to have Certificate of Coverage&General 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.) tYes ❑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 O No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes NTNo
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems,over application) ❑Yes ZNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes 9No
24. Does facility require a follow-up visit by same agency'? ❑Yes tRrNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes ZNo
. :�(oyiQla�iQ>t'js:op d�fcier�c;es w�re pgteddt*`it�g�h�s:v�slt; Y:oilt ivi��-l;ee�iye Irio:]Further.-: '
cories oridence:abo' uk this visit.:
Cnmrnents refer to, iiestion# Ex lain an YES answers and/or any recommendations 6iany other comments Fai,; ii i"`,4d71 ,{;
Us ;drawui(gs of 1[ac€lity;to r`ezplain situations`(use additional.pages as necessary) .; ,' ", ', ' '",
liette #i 3 ;t t£,'
�l
U4AV A.
Reviewer/Inspector Name ►� r, f i �� t f `el ,fie"�
Reviewer/Inspector Signature: Date: 5/Qp

a �u q
6 `
Facility Number: `?J 1 — Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑Yes -9No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑Yes )eNo
28. Is there any evidence of wind drift during land application? (i.e.residue on neighboring vegetation,asphalt, ❑Yes qNo
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 KNo
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 WNO
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑Yes J�`No
Additional.. omments an or:Drawings:
'kt--, y4e_,s3� .
C�,���-.-e �- �`c•t--s '���a .�... s�wj4.5 soY�e��o�'�1� �-e
-jfv,--w Arck at-\. V-o",
Se� ��st�c� S�-1..� G►- �wo l� �►- atir�s�c�..s-e
f
T
5100

t
Division of Water Quality
Q Division of Soil and Water Conservation
0.9ther Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification O Other ❑Denied Access
Facility Number bate of Visit: Oot
Tilne: � Printed on: 7/21/2000
Operational Q Below Threshold
Permitted 0 Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold
FarmName: ......... ............. �} ....... ......... County: ............... h . � P.. ................... .......................
OwnerName: .........)ALL...................... Phone No ........................................................................
Facility Contact: •SG!.. ......Title �.Klf. .. Phone No: ...................................................
. ........... ..... ....................
MailingAddress: ............ ... ....................................................................................... .......................................... ......... ...................."""
Onsite Representative: .... ., ..a.V..Y.I.................�. ............................. integrator:................. .......................................
AS
Certified Operator:................................................... ............................................................. Operator Certification Number:............................
Location of Farm:
A�
Swine ❑Poultry ❑Cattle ❑Horse Latitude Longitude �• �_ �__
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish �j S-b D ❑Non-Layer ❑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 ❑Lags+nn Area ❑Spray Field Area
Holding Ponds/Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Imuact5
L Is any discharge observed from any part oi'the operation? ❑Yes No
Discharge originated at: ❑Lagoon ❑ Spray Field ❑Other
a. II'discharge is observed, was the conveyance man-made'' ❑Yes ❑No
b. If discharge is ohserved.did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑No
c. II'discharge is observed, what is the estimated flow in gal/ruin?
d. Does discharge bypass a lagrwn system? (If yes, notify DWQ) ❑Yes ❑No
2. Is there evidence of past discharge from any part of the operation? ❑Yes VJNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes 1KNo
Waste Collection & Treatment
4. Is storage capacity(freeboard plus storm storage) less than adequate? ❑Spillway ❑Yes INo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
I[e 1 a f!l E: ....................2........"........ 31
..........I........I ...............I...,............... .................................. .............................. .....................................
Frechoard (inL�hcs):
5100 Continued on back

Facility Number: — Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obsery '? ic/trees,severe erosion, ❑Yes XNo
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes kNo
(If any of questions 4-6 was answered yes,and the situation poses an
immediate public health or environmental threat,notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑Yes No
8. Does any part of the waste management system other than waste structures require maintenancelimprove men t? ❑Yes )(No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes No
Waste Auplication
10. Are there any buffers that need maintenance/improvement? ❑Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑PAN ❑Hydraulic Overload ❑Yes No
12. Crop type
13. Do the receiving crops di fer 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 ❑No
c)This facility is pended for a wettable acre determination'? ❑Yes ❑No
15. Does the receiving crop need improvement? ❑Yes NNo
16. Is there a lack of adequate waste application equipment? ❑Yes 7-NO
Rec uired Records & Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes N0
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design, maps, etc.) . ❑Yes No
14. Does record keeping need improvement'?(ie/irrigation, freeboard,waste analysis& soil sample reports) ❑Yes o
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
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems,over application) ❑Yes XNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes No
24. Does facility require a follow-up visit by same agency? ❑Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes No
. . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . ..
. . .. .. .. .
�'�N,O yiolatitjris'oi-dgficiebdia:s *C-re noted•during•this'visit'•:Y:oit:Will ree�iye fio;!rurther''
Tories• orideRce.about:this visit. ' ' ': ' ' ' ' ' • -
Comments(refer to question#): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations.(use additional pages as necessary):
)A` Ki k V\pS Vv U.iO amt: S 6K) I yI^L L
V � cr,
.
r f t oajP) rV
Reviewer/Inspector Name f —e y
Reviewer/Inspector Signature: - Date: 5100

Facility Number.
3 �— -15TDate of Inspection Ninted on: 7/21/2000
7 d ;V
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge a/or holow ❑Yes No
liquid level of lagoon or storage pond with no agitation? q
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, ❑Xes VNo
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 VNo
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 UNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes ®No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑Yes gNo
Additional comments and/orDrawings:
i
T
5100

Division of Soil;and`FWater Conservation Operation Review "' e
�Q Division Of Soil,and WBteC'ConSerVatlOn Conipfiance 1600ectlon t�
a �ivision of Water Qi;Mity Compliance Inspecgon' ' i
n '� .r z
'{ F !I i t 3 ,
'� +4. i 13 Other Agency,-Operatlon.Revie st;i s i �yi!' °
outine O Complaint O hollow-u of DW ins ection O Fallow-u of DSWC review O Other
Facility Number Date of Inspection 7
Time of Inspection IS=�� 24 hr.(hh:mm)
Permitted f,,�'Certified © Conditionally Certified C]Registered 113 Not O er ationall Date Last Operated: ..........................
Farm Name: !hGG ALPA County: ...... lil�
, . ......................................�Y�M................................................... } ..........................................
OwnerName: ................................................... ........................................................................ Phone No: .........-...........................................,.....,.........................-.
FacilityContact: ..............................................................................Title: ................................................................ Phone No: ...................................................
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
Onsite Representative:
................................................... Integrator:....S.r ...........................................
Certified Operator;................................................... ............................................................. Operator Certification Number:..........1.11..!T .........
Location of Farm:
............................................. ........................................................................... .. ..................
Latitude Longitude
Design Current ,� Desrgp Current Design 'Current
"Swine Ca acit Po ulation I,:1.'oultry, i„ Ca acit Population, .Cants Ca a'ity Po elation
❑Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish ❑Non-Layer on-Dairy
❑Farrow to Wean
❑Farrow to Feeder ❑Other
, ". e
I ❑Farrow to Finish r:, Total Design Capacity
❑Gilts, I ��
Boars
Tota1s�w
Number of Lagoons �'� ❑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? ❑Yes No
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made? ❑Yes ONO
b. If discharge is observed,did it reach Water of the State'?(If yes, notify DWQ) ❑Yes ;eNo
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 JZINo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes Qlfg0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes FNo
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): .......... .............. ......Z'cf.4... .............................. ............................ ................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes �No
seepage,etc.)
3/23/99 Continued on back

Facility Number: 3 l — 69 Date of Inspection
6, Are there structures on-site which are not properly addressed and/or managed through a waste management or '--'�--`�—��'
( /
closure plan'? ❑ Yes 12110
(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? '21l'es ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑Yes �No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes 101NO
Waste Application
16. Are there any buffers that need maintenance/improvement? ❑ Yes P'No
11. Is there evidence of over application? ❑Excessive Ponding ❑PAN ❑ Yes JCYNo
12. Crop type %Jv � „(
13. Do the receiving crops differ with those designated in the Ce Tied Animal 'Waste Management Plan (CAWMP)? ❑Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ,❑No
b) Does the facility need a wettable acre determination? ❑ Yes ❑No
c)This facility is pended for a wettable acre determination? ❑Yes ❑No
15. Does the receiving crop need improvement? ❑Yes P*ANo
16. Is there a lack of adequate waste application equipment? ❑Yes pltlo
Required Records & Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes Q'No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP,checklists,design,maps, etc.) ❑Yes j2`No
19. Does record keeping need improvement?(ie/irrigation, freeboard, waste analysis&soil sample reports) ❑Yes O'Vo
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes P Nc
21. Did the facility fail to have a actively certified operator in charge? ❑Yes',El"No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems, over application) ❑YesRj`No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes ONo
24. Does facility require a follow-up visit by same agency? ❑Yes�0<0
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes
Ell
N6.0olaiiotis'et.dgficWncies-mere noted•ditr tag xltis;visit:•Y:o4 w ii-i eeoiye Ito;f�ti•thgt:
Corres� 6Tidei><ce.about:this visit. • • • • • . . . . . . .
Comments refer to_ ht n# Ex ues lam`an YES ansjweirs andlor an 'recommendations oc'any other comments
q ) ,,
. P y Y ,9
Use drawings of facility tor.better,,explain situati6ns (use adchaonal pages as necessary)
Z) AI D T, Mo.../ v^1 /V. tA/ CZRri`i2,Apra 4,A/ALL �►✓ otDe c A6c> J_ •
SznaE, -rams -r4l ►.r6- �.r�r.G}r3�-t`S 4 flu
c f"pry rib
'ram
r- dd .4jOj9j�►tC•P1 W CA/Tf4C, PQ'J+J A
LAJ, l0 3 ��3 Dp •.
a C "y.._."'"'T""..."'"""' -tr•rr �-"rr�rvn. 1 ti e fr �tw 2 S�.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 1
3/23/99

y
Facility Number: 3 1 — ( flat,of Inspection 7
Odor Issues -
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑Yes VNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes YNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation,asphalt, ❑Yes ONO
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes /No
M 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? El Yes �4
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes �No
Addi.filona.'lo me is A m R n or raw ERgs
5d 1 .fir
A.
3/23/99

❑Division of Soil and Water Conservation ❑Other Agencyg
Division of Water Quality s
aw
10 Routine' O Com plaint O Follow-upof D%VQ inspection O Follow-up of DSWC review O Other
Date of Inspection �lG S
Facility Number
Time of Inspection 2: 4 '24 hr.(hh:mm)
13 Registered [,Certified ❑Applied for Permit Wermilted 0 Not Operational Date Last Operated; ,,,,,,,,,,,,,,,__.......
FarmName: .................3.faG.I�........kt�p4^•.VJ..,....fn.tlM..... . ..�........................... County:......Dc' .i.la...................................... .......................
1 '` 1 n ' f f
Owner Name:..........................1kSX,........ .................tkL ir................................. Phone No: .....
f ����.. .-.. 27�.................................
FacilityContact: ..............................................................................Title: .....................:. ..... Phone No: ................
Nlailing Address: .....:t- •L......4..pf¢'. a1.�....._ UXS h�......�........................... ....... ..........0.1'.V S ..t.fV1 C ........................ Zg 4 .....
Onsitc Representative:
,.......c 1PCC, ...p ........................................................ Integrator:.........OILY come).11's.....................................................
Certified Operator...I.!..10:S........( 5 .1 Vl.....................:................................. Operator Certification Number,...I....Z.L5..,��.................
Location of Farm:
......(�C1....1(�.Qr�J....S.\ . ....:.Q.. .......7.1.......l.�j�Q �..Al..... M.J.. N.....nacii........01.....�t;......t. ....:..........................................................:........................... �
....................................................................:.....................................................................................................................................................................................................
Latitude F5_2?_�" Longitude ©•
:Design .Current " _ Design 'Current k Design ' Current"
Swme, `Capacity`'Population .Poultry �Capacity ,Population- "°Cattle, Capacity.,P6pulation,'
.,:❑Wean to Feeder r'❑Layer ❑Dairy
Feeder to Finish ILI Non-Layer I I I I0 Non-Dairy.❑Farrow to Wean F
❑Farrow to Feeder ❑Other
❑Farrow to Finish Total Design Capacity..(po8o
❑Gilts
❑soars s s Total SSLW e ZO �Op
Number'of Lagoons/Holding Ponds ❑Subsurface Drains Present ❑Lagoon Area I[]Spray Field Area
_v 5 < 2:° " " b❑No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑Yes [No
2. Is any discharge observed from any part of the operation? ❑Yes No
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed,was the conveyance man-made? ❑Yes No
b. If discharge is observed,did it reach Surface Water?(If yes, notify DWQ) ❑Yes No
c. If discharge is observed,what is the estimated Flow in -aVmin? 0�
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 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 bffect at the time of design? ❑Yes ')0 No
7. Did the facility fail to have a certified operator in responsible charge? ❑Yes J2 No
7/25/97 Continued on back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes Da No
Structures(LaLmons,Holding Ponds, Flush Pits,etc.)
9. Is storage capacity(freeboard plus storm storage) less than adequate? ❑Yes P No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1. . .....................Z-
.... .Ld . . .. .................................... .................................. ...,.,.............,......,........ ...................................
Freeboard (ft): .............Z:. .......... ............ ...................................
10. is seepage observed from any of the structures? ❑ Yes No
11. Is erosion, or any other threats to the integrity-of any of the structures observed? Yes ❑ No
12. Do any of the structures need maiiitcnancelimhrovement? PYes ❑ No
(If any of questions 9-12 was answered yes,and the situation poses
an immediate public health or environmental threat,notify DWQ)
a
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes ®No
Waste Application
W. Is there physical evidence of over application'? ❑Yes No i
(if in excess of WMP,or runoff entering waters of the State,notify DWQ)
15. Crop type .......LD.+!.n...........5&Vm. ..O.....c�Y"Aia..........&-.Yrxu&........... � 1jv...........................................................................I.............................
16, Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ,Yes ❑No
l
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes M No
1
18. Does the receiving crop need improvement? ❑ Yes A No
19. Is there a lack of available waste application equipment? ❑Yes X No
20, Does facility require a follow-up visit by same agency? P Yes ❑ No
21. Did Reviewer/inspector fail to discuss review/inspection with on-site representative? ❑ Yes No
r
22. Does record keeping need improvement? Yes ❑No
For Certified or Permitted Facilities Only
23. TDoes the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes ;j No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑Yes No
0 No.violations or deficiencies were note' d-during this:visit. .You.will receive no flirth�er
correspondence about this.vis f.•.
Commen6.(refer'to question*):,;Explain any YES ans-wers and/or ring recormnendattons or any'other commyents � �r r
Use drawings of,fueihty to better explain situations:(use additional pages as necessary)
E f$f '•Y
.k J.
s"pet)141 *Z, L;ALr -5hoJ x 10e_ V-C _1,
"'hi, �YestiOr. 4r+a5 On ;nmr fli4 L tf Df- t x)c7�+ �t,�Se ov-&s sta�tU
rts"dej. FvbTior artm C"W") in cx+r. in, Sr!oW r c ktU 4-
rC e
8,wc wv et,, skojo be Meet\ed • 0 50 '5 vvuld be- Oseo -t-o f rtss �LSe. atc .!s tc,
tG+nZep,r Y4. .s �or C � �ta -� ��', 'IN, W '
z. 0a k. s� aN- (L s� � e v� '. •-� t�l�NO� berm Sv9c� L
�P 7/25/97 �
Reviewer/Inspector Name { µ
r
Reviewer/Inspector Signature: IAL Date:

` � J
T
'a::: ' Division of Soil and.Water Conservation Other A ene
` � �Divtsion of Water QualityF
�'��""ram ,..�y,,��^�:�: ,�z s• �:,�^me ,�:� F �+ �m �n ;�r� �,�r � -� �rr�;;:, a� �^r�r�^ 4 K,:�r���, .,ti �'�_i'I
® Routine 0 Complaint O Follow-u of MV(2 inspection Q Follow-up iif DMVC review O Other
Date of Inspection
Facility Number
Time of Inspection 24 hr.(hh:mm)
❑Registered ®Certified ©Applied for Permit ❑Permitted 10 Not O erational Date Last Operated: ............•• „••••.
Farm Nante: ..�i sK.1�....A 1.�.lr►s.. ......,,F-sxnr......l. —... ............I—......... County:..p.�..�.1�.u.....................................
.G�i
Owner Name:.. .k: ...t �. .4ti.i.x......................................................... ....... Phone No: �9.�a..�..�.5..g...' S.�."�..�.....................
Facility Contact: ............................................ '...............................Title: . Phone No:
lblailin Address:
OnsiteRepresentative:. ..dl..L& V^......... ..... g . ►.�r�rC..�.�..d.........................
Into Integrator:.... .......................
Certified Operatort.................................................. ............................................................. Operator Certification Numbert.......
Location of Farm:
on....%A11.1...... ........ ..... ..... ......a . ........
........................................... ............................. ..... ..... ... T
Latitude �•�'�" Longitude Q• 0' 0"
# Design'N Current F; 7 DEsign ,Current I fesign Curren H.E�
Swute ;Capacity Popultionv Poultry , „Capacity Pop:lation CatEle - ,�Capcity,Population
. .
❑Wean to Feeder ❑Layer Dairy
Feeder to Finish ❑Non Layer ❑Non Dairy
a'❑Farrow to Wean y: IR
❑Farrow to Feeder ❑Other r , '
Farrow to Finish Total DesignCa pacity, Qj
_❑Gilts .,, 5 •
❑
, I,
F e, x,
. To
Boars
,x
�� Number of Lagoaiis/Hvldxng Pvnds ©a ❑Subsurface Drains Present ❑Lagoon Area JO Spray Field Area
r
' ti ❑No Liquid Waste Management System " _ e r
�'. .. ..: .. =
General
1. Are there any buffers that need maintenance/improvement? ❑Yes ,09 No
2. 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 RNo
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 gaUmin? tV
•d. Does discharge bypass a lagoon system?Of yes, notify DWQ) ❑Yes RNo
3. Is there evidence of past discharge from any part of the operation? ❑Yes K No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes N,No
5. Does any part of the waste management system(other than lagoons/holding ponds)require HLYes ❑No
maintenance/improvement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes H[No
7. _Did the facility fail to have a certified operator in responsible charge? ❑Yes RNo
7/25/97 Continued on back
1

r
Facility Number: 31 —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑Yes CO No
Structures_ffiagoons.Holding Ponds Flush Pits etc.
9. Is storage capacity(freeboard plus storm storage less than adequate? ❑Yes 9No
Structure l Structure.2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2.S �..-..,
................................... ............
Freeboard(ft): .................................... .................................... ........
10, Is seepage observed from any of the structures? ❑Yes EI No
11. Is erosion,or any other threats to the integrity of any of the structures observed? ®Yes ❑No
12. Do any of the structures need maintenance/improvement? Yes ❑No
(If any of questions 9-12 was answered yes,and the situation poses
an immediate public health or environmental threat,notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑Yes No
Waste Application
14. Is there physical evidence of over application? ❑Yes No
(If in excess of WMP,or runoff entering waters of the State,notify DWQ)
15. Crop type x x,s r..s?u.r....,.5✓wry�.�.....t�caw.�.►r s.................�A.?�`.:1.............................
lb. Do the receiving crops differ with those designated in the Animal Waste Management Plan(AWMP)? ❑Yes '0 No
17. Does the facility have a lack of adequate acreage for land application? ❑Yes No
18. Does the receiving crop need improvement? 1 Yes ❑No
19. Is there a lack of available waste application equipment? ❑Yes $2 No
20. Does facility require a follow-up visit by same agency? ®Yes ❑No
21, Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes ,KNo
22. Does record keeping need improvement? ®Yes ❑No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑Yes 19 No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes ffNo
25. Were any additional problems noted which cause noncompliance of the Permit? ❑Yes RNo
U No.violkionsor. deficiencies;were-notes d d 'Afig this:visit.,Yoia"Will i&e' ire-it`ftirther,:•
vrrespondettce about this:visit:•:•;:.'
-'iiwAn a� - - •ax, s•. �. ,z4 x. �. '"Ta.- �xa ^ x g cx.,E.M zaaea�--a., ze r xs •.= t,.-a U t. p.;r�
Comments(refer,-.toquest�on#) Explatt�anyYES answers aiidlnr any reCt3tplendattnttSoxany Othercomments.°..' .
Use d�angs of factltty tobekter;explatn sttuahatns'(usE'additional pages as necessary) r '� 4uR
5.��a�t-�1c or„�,� o-•M.e.. a-v-a.-a�� �h tee...,.i��. c._a..r`f-i.e.
41,f IZ- C-tiros i 4 r- a r-�-a.g wa�v-� 0 1 i.�+r-'.r-�-� a-�' c...c r•..a�L o� �o...� �e.n.'�'r . T'L►..'S
u-w--a s ko 1s tvd 1�-R- .-t t-k [ lam- %—4- Y:" -e- �--�-,�d . �A-t y o, G a ►„- -c t
.S iro •-..,.,. w�.�� d+�.;'��` � cwo.� v�d-. -�
p �-v+rH1Rs�- ��-d �^-n v E S • `Y i ri-v.C l��
i 0. W D r t 4.L Cry v-v`2 c `l'"j V p L J w. �-�.A�r S S�2 t�l v� d-,-1 1 w�
0-�-F S v V'-t �•o v -o r-d_ j v S•� r I�.r N , '�-�2 qa�w a[ Lp t,.� 0.+� ~Qt O I
g� vcu.t Vim.-•E--o �.�. V cam+.-3 0-..... � Uu bGwi 1 ,
��.�� ,�,a � I 4�e. ��.�.f '�o-� enr+o s ► H trt.�. t o� tt-r)-vt w rt,l
7/25/97
ReviewerAnspector Name
Reviewer/Inspector Signature: - Date:

f
i Site Requires Immediate Attention: ttio
Facility No. .-I q
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE." @� a � , 1995
Time:
Farm Name/Owner:
Mailing Address: _ Q j 71_X I-y,4.-O I r vc a-8 J k -7
County:
Integrator. G am- Phone:(q jq,j Ca-V-h—
On Site Representative: Phone:
Physical Address/Location: i S" 0
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
s= Latitude: SS' _' a 0, 63 Longitude: Elevation: Feet'�
l 3 SS Q b 5 .93 Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot +25 year 24 hour storm event
(approximately 1 Foot+7 inches Ye or No Actual Freeboard: �+ Ft. '_Inches V'
Was any seepa;e observed from the lagoon(s)? Yes o Was any erosion observed? Yes or
' to
Is adequate land available for spray? 0 or No Is the cover crop adequate? Yes or No
co � t_ d�C.
Crop(s) being utilized: S 1 Sn
Does the facility meet SC minimum setback criteria?. 200 Feet fro Dwellings s or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Ce or No
Additional Comments: S ` l o
. ti L
-tom ! JA tfftV,�M11
�Q 7
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.