310488_INSPECTIONS_20171231

NORTH CAROLINA ..�
Department of Environmental Qual

Type of Visit: p1compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visits . R1outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I �'jy Arrival Time: Departure Time: County: Region:
Farm Name: V'j l !.V &ago Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
On site Representative: V o yyj� �I �
Certified Operator: V 1 Itil J"}
Back-up Operator: "V ' �,��,r�
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: iq q..
Certification Number: 110 ( 3 1
Longitude:
Design Current
Design C►urrent
Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop.
-E
Cattle
Capacity Pop.
Wean to Finish
F[
La er
Dai Cow
Wean to Feeder
Non -La er
EI
—
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D_ P,oult F Ca aci P.o
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Curke s
Qther
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 9No ❑ NA ❑ NE
❑ Yes
[] No
N�r`NA
❑ NE
❑ Yes
❑ No
C!�NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [—]No ELNA ❑ 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 21412015 Continued

acili Number: - Date of -inspection:
Waste Collection & Treatment
4. Is storage, capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No [] NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) �[
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 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 t� No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Vf 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
I6. 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?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[;WNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
C� No
❑ NA ❑ NE
the appropriate box.
❑ WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[$ No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[R No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
CS No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes] No
25. Is the facility out of compliance with permit conditions related to sludge? If yes,'check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No
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
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
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 04 No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes N No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes q No
Reviewer/inspector Name:
Reviewer/inspector Signatui
Page 3 of 3
[] NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
5PNA ❑NE
❑NA ❑NE
❑NA ❑NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Phone: 330
Date: �ltj
21412015

type of Visit: O Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
leason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time:® County: LRegion:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
perp_"
Onsite Representative: C�ohll A �Q Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number: [N r3
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current
Design C•urrcnh
Design Crent.
Swine
C►►opacity
Pap.
Wet Poultry
Capacity Pop.
Cattle Capacty , l'op.' .
Wean to Finish
Laver
Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
It
Ca acit P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Beef Brood Cow
,
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
❑ 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 DW1Z)
❑ Yes
❑ o
❑ NA
[3 NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ 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 21412015 Continued

Facilit Number: 51 - LM IDate of Inspection:
l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA Gvd
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
[ZI/No
❑ NA
[] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ZNo ❑ 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 [2/No ❑ NA ❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Z40
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Pen -nit readily available?
o
❑ Yes ZWNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 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 Inspectiogo
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes WNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [/J 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? ❑YesWN
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
No
[DNA
❑ 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
2(No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E�(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
E�/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
o
EI�NE/)
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[No
❑ NA
❑ NE
Comments:(refer;to`:duestion,#). Explain:any YES answers and/or any additional; recommendations or any other comments.
Use"drawines oFfac lity to better exvialn situations (use= dditional pages as necess`ary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone — 73
Date: &
21412015

Type of Visit: 0 Co 'Nance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: C Zoutine Q Complaint 0 Follow-up 0 Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: 1 9T) -:] Departure Time: I I County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: J61J ,(`� Integrator:
Certified Operator: Certifleation Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
I
Design Current
Wet Poultry Capacity P. Cattle
ILayer I Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
I
INon-LMer
I
El Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
[ arrow to Feeder
Design urrent Dry Cow
Dr. P,oultr, Ca aci_ P,o . Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 10 ❑ NA ❑ NE
[:]Yes []No
[:]Yes []No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes ro
❑ NA ❑ NE
Yes ❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes C3 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: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IyNo ❑ 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 VNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 M/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP? Yes o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
© No
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
O l�
❑ NA
❑ NE
IS. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C3�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ 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 N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection:
24. Did & facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZVNo
o ❑ NA ❑ NE
s
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 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 F_
Vo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�No
0 NA
❑ NE
❑ Yes
No
[DNA
❑ NE
❑ Yes
❑ Yes
❑ Yes
E24 ❑NA ❑NE
k❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer. to question: ) °.Explarn any YES answers and/or, any additional recommendations or any other comments
Use drawings of facility to better.explain s►tu'ahons;Nse additional pages as:necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Date:
5
-13V

Type of Visit: t3 Co .Hance Inspection U Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: J�j j �Ad Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design C*urrent
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle @apacity Pop.
La er Dairy Cow
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
airy Heifer
Design C++urrent Dry Cow
13 , Poultr Ca acit P,o Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Tu-key Poults
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 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
6
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�70
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of inspection: !
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �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: LAi�j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 2(No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes Z o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes WNo ❑ 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 ZNo ❑ 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):
t4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes❑
VN9
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes � o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes F3No
❑ 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 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspecti8�N
[]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: -U'2nDate of Ins W low
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes VN4Ao ❑ 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 YNo'
NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes 40
❑ Yes ETo
❑ Yes No
[]Yes rNo
❑ Yes [:'<to
❑ Yes L-Yl"O
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comments {refer to question #): Explain any YES answers and/or any additional recommendations or any other comments:
Use drawings of facility to better explain situations'(use additional pages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
U � Fi; Phone
Date: 1
2/4 14

(Type of Visit: Q•Copipliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance " I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: O County: 1. Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Phone:
Onsite Representative: M, Ltrl Integrator:
Certified Operator: Certification Number: 2.Oj
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Poultry
Capacity
Pop.
Cattle Capacity on
Pop.
Wean to Finish
RWet
: (
La er
Layer
DairyCow
DairyCalf
DairyHeifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D�. P■oultr.
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layer;
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-.keys
Other
MT—urkey
Poults
Other
ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes I_J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
r?)o
❑ NA
❑ NE
Yeso
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: I J - $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?
Structure I Structure 2 Structure 3
Identifier: LA (Teo d
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 43
Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e,, large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No 0 NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environme l threat, notify DWQ
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2% /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
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 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 �No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes No
❑ NA
❑ NE
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes &o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Yo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes M/No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes dNo ❑ 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 [�40 ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: -qXg7 I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Wo ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yeso ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for.sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [�J/No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes [�No
❑ Yes L__l No
❑ Yes No
❑ Yes F2/N
❑ Yes "0
❑ NA ❑ NE
❑ NA ONE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #) Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
L
Phone: ('71 D
Date: 9 a L 3
21412011

Type ofiVisit: U Co liance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Timer Departure Time: l County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
OnsiteRepresentative: jWA-lA) Integrator:
Phone:
Certified Operator: Certification Number: -112 im
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
(j
Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
Dr, P■oultr. Ca aci
Layers
Current
P■o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non-Laye
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
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 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes YN
o ❑ NA ❑ NE
❑Yes
❑NA ❑NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: C1 It,0111
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: LA b>�
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Vo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
El Yes No ❑ NA ❑ NE
[:]Yes dNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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
dNo
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
o
❑ 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
Rio
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Vo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
0 Yes
Flo
❑ NA
ONE .
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�o
❑ 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
I No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3No
❑ 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
❑ No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑Yes
'No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PNO
TT
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facili Number: -98= Date of Inspection: 6 Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes VNoo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes
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
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
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
El"No ❑ NA ❑ NE
;No ❑ NA ❑ NE
�No ❑ NA ❑ NE
/No ❑ NA ❑ NE
rN
❑ NA ❑ NE
❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary):.'' �
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
b Phone:
Date:
2412

Farm Name:
Arrival Time: Departure Time: !O 4 D County:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: `i o�, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Design
Current
Design Cmrrent
ultry
Capacity
Pop.
Cattle Capacity Pop.
o Finish
La er
Dai Cow
o Feeder
Non -La er
Dai Calf
to Finish
a D
Dai Heifer
to Wean
Design
Current
D Cow
to Feeder
Lilts
1) , P,ault .
Ca acit
P.o ,
Non -Dairy
to Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

a
lFacility Number: g - y gZ5 j I Date of Inspection: 9 4q Ji,
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: L_ftf= P/
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 Z�/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 hreat, notify DWQ
❑WUP ❑Checklists ❑Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. E Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 1 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes 2] No ❑ NA ❑ NE
❑ Yes E/No ❑ NA ❑ NE
7. Da any of the structures need maintenance or improvement? ❑Yes �Zo
❑ NA
❑ NE
$. Do any of the structures lack adequate markers as required by the permit?
❑Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑Yes
�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑PAN > 10% or 10 lbs. ❑Total Phosphorus ❑Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑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 GAWMP?
❑Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
�o
❑ 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
�o
❑ NA
❑ NE
Required Records &Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
rNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes
❑ NA
❑ NE
the appropriate box.
Page 2 of 3 21412011 Continued

Facility Number: -Ll jDate of Inspection:
24..Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesVNo
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes EKO ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ��o[] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.c., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
nmments (refer to question #): Explain any YES answers and/or any addi
se drawings of facility to better explain situations (use additional pages as
'-r,) G-C-T c'oP '0( -t,010 s0zl_--rEST
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
v 14 t-�
❑ Yes Ldl<'o NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes l.a' o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �o ❑ NA
❑ Yes To ❑ NA
❑ Yes No ❑ NA
❑ NE
❑ NE
❑ NE
Lions or; any other,'cominents.r`::_-
Phone: B 7 I 4 4
Date: F /'T 41
21412011

Type of Visit 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
ReasonforVisit 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: iD Arrival Time: 0 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c ❑ A = H Longitude: 0 ° = 4 = "
Design Current Design Current Iiimi
Design Current
Swine Capacity Population Wet Poultry Capacity Population
C►attle
Capacity Population
❑ Wean to Finish
❑ i~a er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
® Feeder to Finish I
❑ Dairy Heifer
❑ Farrow to Wean
Ury Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
El Layers
El Farrow to Finish
El Beef Stocker
Gilts
❑Non -La Non -Layers
El Beef Feeder
PCIBoars
❑ Pullets
❑ Beef Brood Cow
❑ Turke s
Other
❑ Other
❑Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes NJ No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ❑ NA
❑ NE
❑ Yes
❑ Yes
[ ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection
.L
%Vaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LA (;aZ}
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): / 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
Yes dl�o'
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
26 o
ElNA
❑ NE
ElYes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2� o ElNA ElNE
(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 Nj ElNA ElNE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El
20 El NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
:No❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
El
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
t3 esO�,,iS:�a� k ■
'Comments (,C efer to,Question #)., .l:xplam any YE$, answers andlortany;recommendahons orsany, other; comments .
r
f_ti -
Use drawings .of facilityto bettei E explain s , ituatidns '(useaaddtt�nnal pagesFas necessary)r `'� a < . ` ¢ , y` rr, :.
'-1��k3 � .���.< aq?s-.z a;£'!• hs� ,t".,r< o''l ..d. :, t",5 ..�2: z•; ±J .'��*T xY;-. .+l
�% l f�f•► �� r, r� .� its a f •� ►. a /� �' a R wit s n e,
f �,
[,/sue/<r^✓1� n W ��� R. !✓ �l ✓�o y� RAI
�,r� �A n`a�i � �v�•��
� Y �-
3
P
f1 �� ✓. L,� w� s n4 �r M ►A ,
V
Reviewer/Inspector Name,>?—
Phone: ,3
Reviewer/Inspector Signature:
Date: /6 /` /11
Page 2 of 3 12128104 Continued

V
Facility Number: — Date of Inspection 6
'of'
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Mans El Other
❑ Yes 121 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1`io
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
D<o
❑ 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
��N
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
I1V0
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes Yes
L
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0' o
❑ 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
040❑ NA
❑ NE
if yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
tjNo
❑ NA
❑ NE
F
Additional Commeriks and/or Drawings:
T
Page 3 of 3 12128104

Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason far Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: o� Arrival Time: ® Departure Time: County: t�.1PI Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
i
Onsite Representative: �aNIQY
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =o =] ' = Longitude: ❑ °. = ' = "
Design Current Design Current WEaesent
acityPopulation Wet Poultry Capacity Population Cattlpacity Population
..
❑ Wean to Finish
❑ La er
❑Dairy Cow
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑Non -La. er
❑Dairy Calf
G 0ry
Dry Poultry
❑ La ers
❑ Non -Layers
Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Cow
❑ Turkeys
Other
Number of Structures:
❑ Turkey Puults
❑ Other
❑ Other
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
NNoNa
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
,,,_,
I
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued
6d

{
Facility Number: It—�
Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes O No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes o ElNA [INE
ElYes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [,d No ❑ 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/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes [ /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C3 No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
� o ❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1_J o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
Yo ❑ NA
❑ NE
Comments (refer to question #} Explain any YES answer`s andloraany `recommendattoffi any other ccooments ' l�, �'
Use drawin s of facility to better explain situations. use addrtig1tal a es_`as necessar �°� `��� i%"£�
g ty p (. 1gY)e�
5�,� D (�-� GZ� Y✓•�v-� n %� P �. Z 1 ! rjs� '� s LUn6-C
Reviewer/inspector Name 4 r�} I—,' _' s Phone: �� g
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection I_a 1__19107 _I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
2NO
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E2 N
❑ 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
,{3 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�hlo
I No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0"N�o
❑ NA
ON F
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2 [No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
I/� No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
`LJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E3<o
❑ 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
�,
LJ 'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
��
f/J N
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑yes
L'J No
❑ NA
❑ NE
..
Addi#ional Coinments�and/or Drawings 4 t; � '' `' : k "i
a
12128104

t
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (eoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: g 6 Arrival Time: Lll1.l� Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: / Title:
� y�
Onsite Representative: � ao;-r
Certified Operator:
Back-up Operator:
Phone No. -
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 =' = « Longitude: = ° ❑ ` = ,S
Swine
Design C*urrent
Capacity Fopulation
Wet Poultry
Design
Capacity
C►urrent Design Current
Population Cattle Capacity Population
❑ DairyCow
❑ Wean to Finish
❑ La er
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
'Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Dry Poultry
❑ Layers
1-1Non-La ers❑
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Cow
Number of Structures:
Gilts
Pullets
803 Boars
❑ Turkeys
❑ Turkey Poults
ther
Other
❑ Other
Discharges & Stream Impacts
/
1. Is any discharge observed from any part of the operation?
El Yes
�O
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[�,Ai+o
El NA
El NE
other than from a discharge?
i/
Page l of 3
12128104
Continued

tP acility Number: 'j — d Date of Inspection 2t 8
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Iructure 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? El Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes E4o ❑ 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 th at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA [IN E
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LI No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ffNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
3No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3�No
❑ NA
❑ NE
�No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
LrNo
❑ NA
❑ NE
Reviewer/Inspector Name I (� I Phone: /d 7 3
Reviewer/Inspector Signature: Date: __j
Pave 2 of 3 12128104 Continued

Facility Number: 3 — Date of Inspection U
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2N ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑Yes No ElNA ❑ NE
the approprrate box. ❑ WDP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Q o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and t"
Rain Inspection�No
Weather
Code
22.
Did the facility tail to install and maintain a rain gauge?
El Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
rNgo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;3-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
52No
❑ NA
❑ NE
Other Issues
Z
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes FNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 1Io
❑ NA
❑ NI:
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 ONo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Rcviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes O No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes 42rNo
❑ NA
❑ NE
Additional :Co►riipents;antllor-Drawin
Page 3 of 3 12128104
Page 3 of 3 12128104

i
Facility Number � $$
(J Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
V
lType of Visit Co fiance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance
ReasonforVisit Routine o Complaint 0 Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit.
Arrival Time:
Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: J N�1T XL
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = t Longitude:
Design Current." Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Polllts
❑ Other
Design Current
Cattle Capacity Population
❑
Dairy Cow
0_44iryCalf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ❑ NA
El NE
❑ Yes
El Yes
No ❑ NA
❑ NE
El Yes
No ❑ NA
❑ NE
12128104 Continued

7 Facility Number: — Date of Inspection q a
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: 1 A6-wp w1,0
Spillway?: Designed Freeboard (in): f/ /q
- .-
Observed Freeboard (in): In 4
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 environment;rNo
at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ N
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes C2 N ❑ NA ❑ N
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes 0 No El NA [I N
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ N
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes ✓U No ❑ NA ❑ N
❑ 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
E
E
E
E
E
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LJNo❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
�Zo❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Z No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
7_ � V ❑ 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 A&AAJAPhone: f 4' 35V
Reviewer/Inspector Signature: Date:
1 12128104 Continued

' Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes o
❑ Yes 2No
El NA El NE
❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Wee ly Freeboard El Waste Analysis El Soil Analysis ❑ Waste Transfers El Annual Certification
[I Rainfall ❑ Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 3 No ❑ NA ❑ NE
❑ Yes
LJ`No
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
❑ No
;<A
❑ NE
❑ Yes
9<o
❑ NA
❑ NE
❑ Yes
01 o
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes CTNo ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104

Ovivision of Water Quality
Facility Number y8 O Division of Soil and Water Conservation
- - -- -- _ Q Other Agency
Type of Visit 45-compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for VIsiVI!5Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: G
-� Arrival'I'ime: Departure Time: County: Region: _ �l
.�
Farm Name: ua n i ay - Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = Longitude: = o =' ❑
Design Current Design Current Design Current
Swine ° Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
10 Wean to Finish �I
❑ Wean to Feeder i
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder i
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other---
❑ Layer i
i
❑ Non -Layer
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Poults
❑
Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of.Structures;
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility -Number: Date Inspection
of
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
Struc re I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ 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
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
Yes
❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > l0% 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) (Z
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments..
Use drawings of facility to better explain situations. (use additional pages as necessary):
i
Reviewer/Inspector Name Oc.` I Phone:
ReviewerlInspector Signature: Date:
Page 2 of 3 12128104 ' Continued

Facility Number, Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
[I NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:AL
r5lazlz
lvtzo ,Scebm r�
//_
fier'4ffy' '�4 el—
��� al o,1474*-7 c<_�t
�f? Gc/
Page 3 of 3 12,128104

I H 4$'T
Type of Visit 0 compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (2 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0 S Arrival Time: Departure Time: (a Qb County: U�L^ Region:
Farm Name: _ JUA0A1A 181,660'W f ft•V+n Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: _ Gcoo )::�_Ntjw7.J integrator: Md(L?A_q
Certified Operator: WO 'EAT.6FE3 Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 c = t Longitude: = ° 0
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
0 Feeder to Finish Z two �
❑ Farrow to Wean j
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts M
❑ Boars
Other
❑ Other - - .._....._
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were'there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
1�No
❑ NA
❑ NE
❑ Yes C& ❑ NA ❑ NE
12128104 Continued

F
Facility Number: — g Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural Freeboard?
❑ Yes
No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: LA Goo J I
Spillway?:
Designed Freeboard (in): III
Observed Freeboard (in): ac�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2(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
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the penmit?
❑ yeso
wc
❑ 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
ElL9 Yes
,_,/
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) CW S
13. Soil type(s) NQ A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
El NE
15, Does the receiving crop and/or land application site need improvement?
El Yes
,6
LJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
ZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L' i No
❑ NA
❑ NE
19,) ICCE.P r_RV o(7 CC¢L1%C_: CXA'iE of
wy'rH K6C-0_0�
�fl6Znn (..00l�.S Cx�D�
Reviewer/inspector Name ? G� � ...•. k. .,:�. Phone: 910 L5= 3�oox
Reviewer/inspector Signature: Date:
12128104 Continued

z
Facility Number: Date or Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 2 Yes VNo
[I NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Cl Yes /No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections Weather Code
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes No ❑ A ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
❑ No
El NE
❑ Yes
❑ No
VA ❑ NE
❑
Yes
[�No
❑ A El NE
❑ Yes
❑ No
LJ NA ❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
LYNo
❑ NA
❑ NE
❑ Yes
14o
❑ NA
❑ NE
❑ Yes
VN
❑ NA
❑ NE
❑ Yes
Ld No
ElNA
❑ NE
El Yes
El NA
❑ NE
El Yes
�N/o
❑ NA
❑ NE
Add►tionaLCnmments and/or, Drawengs
z ant r .� Ak
12128104

Facility Number Late of Visit: / Z/ O Time: ��
15 Not O erational 0 Below Thresh Id
Permitted 0 certified 0 Conditionally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: J 6lxA 4 �t / m gene 6✓ _ County: AZI-1__ _ _
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator* —Zez- %Tii_-
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 04 « Longitude • 6 44
Design ,
Current
Design Current Design Current
Swine Capacity—
Population Poultry
CRI)Hcitv Population Cattle Capacitv Po vulation
❑ Wean to Feeder
10 Layer
I
❑ iry
❑ Feeder to Finish
❑ Non -Layer
JLJ Non-Dai
Ej Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SkW
Number,ofLag'c' a 10 Subsurface Drains Present ❑ La oon Area
"Holdin Pond's I.Sohd'Tra s �"
�, �-,0�,�, _ ❑ No Liquid Waste Management System
g' P em
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
WasteCollection -& Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier: /
Freeboard (inches):
05103101
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Structure 6
Continued

Facility Number: / — Date of Inspection l Z1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Aanlication
10. .Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13.
Do the receiving crops differ With those designated in the Certified Animal Waste Management Plan (CA ArMP)?
❑ Yes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
IT
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design. maps. etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DI Q of emergency situations as required by General Permit?
❑ Yes
❑ No
(iel discharge. freeboard problems. over application)
23.
Did Reviewer,'Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
113 No violations or deficiencies were. noted during this visit. You will receive no further correspondence about this visit.
Hs ...s-, �d�A'^f?.CPrk .,rPd',��"y.�'Tb.,."',F.Fw���'+'�'«....wGXk.7k4 _�5
Co;nttrtenis. (refer fo gnestiiin''Eiplana any YES atswersadlor,any recommeudatzone or sYty other rnmnients: >r it r,v
Uie drawings of facility to better explain situations ,(use addiittana)pages as necessary) a.c ❑ Field Copy ❑ Final Notes
k
t� r i• ' a +'� (�Y'td'= � �Tfi�' z_,..t.. N �� ��:.g� �.Siet�S4...R:�i. .w.--;S'�+}°_�'}�f�.'�! �.."�W�Si:A�xtast�d..w-.-,�r�.za...r...n��-�..:--r• �.
�1G'Lm/�la d' �►�ih b elf X O/
Hw
��
ReviewerAnspector Name " <� `' r' „ ag o "� ;e
Reviewer/Inspector Signature: Date:
05103101 Continued

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

Facility Number Date of Visit: 7 Dz Time: I &
0 Not Operational Q Below Threshold
13 Permitted 13 Certified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
le —
FarmName: ......!1 u.......4..... 1(................................................... County:----_,/_�-•--•--..........--•--•.................
OwnerName: •------------------------------------------------------------- Phone No: --------------------•--------------- - -----
MailingAddress: ........................................ ............................................................................. ...................................................................................... ...........................
FacilityContact:........................................................ .Title• ....................................... Phone No:......................................
Onsite Representative: DQt°,��±�Z°,[Integrator:
Certified Operator:....................................:........................................................................... Operator Certification Number:.....-----...............................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' " Longitude • 6 44
Swine ... ;i
❑ Wean to Feeder
® Feeder to Finish
/ZVd
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts ,
1. Is any discharge observed from any part of the operation? ❑ Yes ZFNo
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 nNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes '�QNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ._..- -- -- l ----................................... .......................... ........................... ........................... ...........................
Freeboard (inches): l/

u�iu�iul
c.unrrnueu
Facility Number: — Date of InspectionZ�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
®. No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑Yes
®No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need 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 Apolication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
1*4o
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
[Z No
12. Crop type �i7i'h `��e'094 5 — %/ b� !! G
-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
Kj No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Jj No
b) Does the facility need a wettable acre determination?
❑ Yes
® No
c) This facility is pended for a wettable acre determination?
❑ Yes
J.No
15. Does the receiving crop need improvement?
❑ Yes
W No
16. Is there a lack of adequate waste application equipment?
❑ Yes
ZNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
M No
I8. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
t No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
&No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
kNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
9No
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
-S.No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
(No
IM No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Prtw e3i �ti^-r
Comments (refer to question Explinran YES"answers'`a d or an recommenda lops oany;o! er comments. 1
g"s;ciffacility to.bette {explainsisitu tion(use:additronal.pages as'necessa )• -
{u ti _ ❑ Field Copy [:]Final Notes
d' 60,"101 ✓� i�t v� st 4
S�')
T
841011. '�' $9� P�n� e's, �$'n'. dF: 7 in n t.Z 4
Reviewer/Inspector Name t,z�s(�a�s ,1., 4�r-�t�s 5;- >?�
a....N 4h ir:V xYG•,.+ ..yfi 1 rL`" _r ..y. J�{W.._ai .i.....F. K+. N=. y. i _. Lam:: .aR '.
Reviewer/Inspector Signature: Date:

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

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: � Time:
10 Facility Number ��
Not Operational Q Below Threshold
Permitted 13 Certified 13 Conditionally Certified [3 Registered Date Last Opera d or Above Tbreshold: .........................
County: V. }.1-►..
Farm Name: ..3.�'.::�' . �. ^�a� "1.................. ........................... ......................................................
OwnerName:........................................................................................................................... Phone No:....................................................................................:.
FacilityContact: ............................................................................... Title:................................................................ Phone No:...................................................
MailingAddress:......................L....................... ..................... ............................
�►r t;� SInte rotor: ..................................................................................Onsite Representative: . 4-­--'1(':�;"**
.
Certified Operator:
Location of Farm:
Operator Certification Number: .....:....................................
a
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 66 Longitude • 4 if
Design„ . 1
•rent
..latioa
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
m ❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Current.Design'' �=,Cu
Po" ulatiion Cattle' Ca' aci .
❑ Dairy
171 Nan -Dairy
❑ Other
Total ` Design'' Capacity
Total SSLW:'
;, Number:of Lagoons [] Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area ,;a
F '
' �%Ioldirig Poatls I Solid..Tra Is ❑ No Liquid Waste Management System
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated (low in galhnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure S
❑ Yes �(No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
gNo
❑ Yes
[�No
❑ Yes A, No
Structure 6
Identifier: ...................................................................................................................................................................................
Freeboard (inches): 3�
5100
Continued on back

Facility Number: _IiiE Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type ��(..►1 sa--f /
13. Do the receiving crops differ with those designated in the Certified Animal Waste'Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pcnded for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes gNo
❑ Yes [kNo
❑ Yes Wo
❑ Yes KyNo
❑ Yes FNo
❑ Yes kfNo
❑ Yes 9No
❑ Yes 0 No .
❑ Yes RNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes gNo
❑ Yes R(No
❑ Yes k(No
❑ Yes KNo
❑ Yes No
❑ Yes No
❑ Yes ( No
❑ Yes �j No
❑ Yes KNo
❑ Yes qNo
❑ Yes A No
.... •!'�Q1� p�l5.a!' dgfsae��ie vv re Pie$
CorreS o deii& a1s VllSI'
Cotttttaetts'(refer to'guPstion #) ,Explain anypYES answers and/or any recommendations or,any
,other'icomments.`Fp
Use'drawings'af facility:to: beiter;explain situations{ttse addittanal pages ss necessary): °:,�,.r" r'n E�` r''�'e!� . t.iF.:�
o�IJ
Reviewer/Inspector Name€"E�iT'I3
Reviewer/Inspector Signature: Date: .-Q 5/00

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below es ❑ No
liquid level of lagoon or storage pond with no agitation? FdyC1
27. Are there any dead animals not disposed of properly within 24 hours? 0 Yes ;YN 0
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, 0 Yes [kNo
roads, building structure, and/or public property) IT
29. Is the land application spray system intake not located near the liquid surface of the lagoon? 0 Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) 0 Yes No
31. Do the animals feed storage bins fail to have appropriate: cover? 0 Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? El Yes 4No
Additionai'C,,omments'and(or,,rawings:,",
A� trqe5� �cs<tL-\
5/00

0 Division of Soil and Water, Conservation Operation Review '
ivision of Soil'and Water Conservaaort Compliance Ir3pectioiii
ivisi n of Water Quality ` C01A li nce Itaspectroe
Other Agency •`OperattoniAev>Isw (' ! „k E+ a r.�, �, - , ki .�.•. a-t 4,: .. .IF. ,t. d. .
IQ Routine Q Complaint 0 Follow-u of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection 9 v�7
Time of inspection ip 24 hr. (hh:mm)
ermittedCertified ©Conditionally Certified ©Registered Not O crational Date Last Operated:
Farm Name* ............ f1lLh.:1.:.............. ...1W)!/A.'r0e* .....................................(aunty ........... yl.1.�................ ......
.
Owner Name:
:...................................... ....�.tom............................. Phone No:...................................................................,..................,
Facility Contact. .... ....... Title:....:J...:.....'31
!1V�1...�. Phone No :...................................................
,Mailing Address:.................................................................................................................................................................. ..........................
Onsite Representativea,/�G•� . ......... . ............................................ Integrator:.................... .......... r�!�......................................
CertifiedOperator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm: -�
..................................................................................................................................................................................................................................................................... I
r^........................................................................... ..... ....................... .. ..................................................... —1
Latitude �� �° �" Longitude • ' 0"
Design Current ° „ Design Current Design. Current
Capacity Population' E . Foultry _ Ca 'acit , Po "ulattan Cattle. Capacit Po ' ulatian i'
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish r,2cf ; ❑Non -Layer ❑Non -Dairy 'f
❑ Farrow to Wean r
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish i Total.Desigri Capacity
❑ Gilts,
Boars - Total SSLW
Holdi�n Ponds Salid ns ❑ No LSu ip uad Waste Managnt ement �SLagoon Area ❑Spray Field Area
i E
um or of
f
3 E i ry
' E � E ;f
g Traps q. g y tem
,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes L 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 ycs, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/ruin? -
d. Does discharge bypass a lagoon system? (Il'yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes f5k�o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �10
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes VIo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
/ r�
Freeboard(inches): ....�/./— ........... ..................................................................................................................... I ..................... .....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes VNo
seepage, etc.)
3123/99 Continued on back

Facility Number: — Date of Inspection
6. Are there —structures on -site which are not properly addressed and/or managed through a waste management or �
closure plan? El*T
Yes 0- _o
(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 o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes /O�N_o
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 ( o
i_
11. Is there evidence o ' ap ation? ❑ Excessive Ponding ❑ PAN ElYes�o�
12, Crop type l/J/V�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes �?(_No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes �Io
t6. Is there a lack of adequate waste application equipment? ❑ Yes / No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes 7WYo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Vo�yioiatid is:or clefciencies mere -ja' dttrift,tl,is:visit: Yoil >�eceiye Rio further
• corresO 6Tidence. about. this visit.: ...................
• .... ' ' ........ •
❑ Yes
❑ Yes -N:�Wo
❑ Yes_
❑ Yes ZM
❑ Yes No
❑ Yes 'm'No
❑ Yes UNO
/,
❑ Yes No
AL
1P
„i�g;
Reviewer/Insp or Name g'9 €? I d r iti g a 377��
i.,.,.H_ES .:.�
Reviewer/Inspector Signatur Date: 191,041
(� / 3/23/99

Facility Number: ?� — Date of Inspection—�j��7�C./
4, . . =- I
Odor Issues xy"s
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atfor below ❑ 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 1&tNo
28, is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �'Np
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 o
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 �Io
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes E40
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? VYes No
Additional Comments and/or ;
rawin&5:' .'
.,,
�. 3' :;. d ,
i. > .
h.... .z: .. ,. ,. f
L
t
...'/.
/
3/23/99

1 Q Division of Soil and Water Conservation Operation Rev�ewt, `'
j
1
�{W.{�
"1;r i'�' Division of Soil fid Water Conse anon- Compliance Flnspection � q,� ��•�E �-, ; �� ;, �, g ? ,° EPEE r
a
'
r
Division Water
t
of Quality 4 Compliance Inspection
E.Other A enc
i}I_< . .- U er.�r...at.tae.."n.r.+R, ei .i»eE..-x....i�
, 1., , .
:i;l.EA
Routine OComplaint 0 Follow-u p of DWQ inspection 0 Follow-u of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection G 24 hr. (hh:mm)
❑ Permitted P Certified
© Conditionally Certified © Registered JMNqt Operational \ Date Last Operated:
Farnt Name: �.11A3!l.T�. . �t�l�f►-- ................... County:........illr.\.................................... .......................
OwnerName:. ................ ... ........................ i� +-- .. ..........I....., Phone No:....�.S.�Q9�. ...? ?.7.g.......................................
................
FacilityContact: ..............................................................................Title:................................................................ Phone No: ...................................................
Mailing Address: 1.JK..... .... ..... ..... W VX'Att..14L...................................... 'n...........
Onsite Representative: ......�"} �.........� p4Y.`................:4a...X�a.k�Y.11kl.,....., Integrator: ....... C ................ ..........................................
Certified Operator: ................................................... .............................................................. Operator Certification Number:..........................................
Locatio of F m:
On ... .......-�:r.-8�5 ......y. �1....,.....0.1 ..vn—. - .s.pv ......:...ok....... �....................................................................................................................
i
....................................... .. .............................................................................. ....................... T
Latitude Longitude 0
Design Current Design Current,,'- Design , Current
iSw�ne Roultr El Cattle' `
+r k. Ca acity Population , „Y ;Ca 'acit Po Matron. , Capacity Po ulation
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish 12A6OQ ❑ Non -Layer ❑ Non -Dairy
`+ El Farrow to Wean
❑ Farrow to Feeder ❑ Other I
❑ Farrow to Finish E Total Design Capacity (7
I ❑ Gilts, r " r"3i
❑ Boars ;Total SSLW
Dischart*es & Stream Impact
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 RNo
c. If discharge is observed, what is the estimated flow in gal/min? LA
d. Docs discharge bypass a lagoon system'? (If ycs, notify DWQ) ❑ Yes V No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes aTNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 1pNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): .......... `3.1................ .............................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

Facility, umber: 3� — Date of Inspvctlon
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
WYes
❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
j TNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
P No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
t. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
fiB No
12. Crop type
13. Do the receiving crops differ with those designated 'n the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
&PNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
XNo
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 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
�]G] No
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[� No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
J No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
/�
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
3/23/99

F3cilitj Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below '�g Yes ❑ No
liquid level of lagoon or storage pond with no agita(ion?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �3No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes r'�lNo
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 EVO
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 P No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes [UNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
Additional Commen& and/or Drawings —"'
'k�v Ise aP (aloe., C)t4. `i G S r""C- S64 6a 1"\'VS-kS<W (6- rsibLL
Q, ass-�sNa,,ce, �,,j
-7• gaz t3rr os c3 s\ o� O V-, W J) ok ! O.QoQ S kJ toe. TrweT nti rz3Sior, aM&S
Of-\ WaA� sl\OV6
2!a riusk
;ass
i AO
1C�000,
SWLA 3
04 0' be loo
(agaor SCA4ce -
32.us4��
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Date of Inspectionjjwr p
Facility Number Il
Time of Inspection=n 24 he
0 Registered 0 Certified E3 Applied for Permit E3 Permitted 10 Not Operational Date Last Operated:
go
FarmName: .........................�...... g > t.......a.U.en1L. i�. JCA.,................. County: ........ ��.)sk..................................... .......................
Owner Name: ............................�ia�r .... Jr-- 4i�.5. _......�it�ani. ....thlAk� Phone No:....g1��. Z9.g-..i%��...........................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address:...... QI.........t^.asf......
.NsJ.... ki?.N.... M ............................................l3Cs :�F..v �... t..... f s.................................... ..n'�A.........
Onsite Representative: ............. ................................................. Integrator: .............. CAY.(Vil.t...................................................
Certified Operator................................................................................................................ Operator Certification Number;
Location of Farm:
Latitude =• =' =" Longitude =• 0' ="
Swme ,
" ❑ Wean to Feeder
Feeder to Finish
❑Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
Current
'Pouutation Poultry .
❑ Other
= Total Design'Capacity`
Total SSLW
Area
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
N No
2. Is any discharge observed from any part of the operation?
❑ Yes
IN 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 gal/min?
,tf J/t
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
q No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
[N No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
I No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
M No
7/25/97

{
JAX
lFacility Number: —+J+-1 t{ at
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lag9onsjjo1dine Ponds lush Pits tc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4
❑ Yes 0 No
❑ Yes M No
Structure 5 • Structure G
• Identifier:
Freeboard(ft): ..............AA.................................................................................................................................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type G�;:n......1.s? "........�!1f�ItAw...
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lick of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities. -Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
13-No.vitiiationsor. deficiencies.were-no'ted'during this:visit. You,vdfl receive•nti•ftirthei-:
correspondepce about tbis'visit:•' :-:: : .. . :: :. . ;
U.
Hib.coA_ 16j� S� 0"_W 61 {Olk6m.
O
❑ Yes P No
❑ Yes P No
❑ Yes .On No
❑ Yes [P No
❑ Yes 0 No
❑ Yes No
❑ Yes No
❑ Yes] No
❑ Yes 1P No
❑ Yes Ep No
❑ Yes fo No
0 Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes 1h No
7/25/97
Reviewer/Inspector Name #.���
Reviewer/Inspector Signature: % ^���� 1 Date: p /yg 14 p
-r--r -Y---- -----

USIA XR(:S t 1)().1�
U7..'2U•' 95 13 ; 45 1291U.962122
�, • L� a
� j ui;�=n ry
:
�• ......... - - - ........_.._ ._.---..
•_
r
SI'l.E ISIT.A.TSCN:
•., ..
DATE:' • .�G.'s.
sSitetegviresedia�e
Atter�ttori `
—•: _ : FacUity.
Number:-:_
EC4RD.
1995
Owner: _ Ta# Mrde:
County: —�P� u►
Agent Visiting Site: Phone: 9IO. - 86- A i 426 _
Operator:
Phone:
On Site Representative: Phone:
Physical Address: 3/1 f ' o - ./ / 7
Mailing Address:
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site: _r/ / L
Latitude: " Longitude: Q "
Type of Inspection: Ground ooe' Aerial
0
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) Yes or No Actual Freeboard:,- Feet (a Inches
For facilities with more than one lagoon, please address,the other lagoons' freeboard under the
comments section.
W8 any seepage observed from the lagoon(s)? Yes o4gN Was there erosion of the dam?: Yes o dNo
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments:
•
Fax to [phone]
e
ignature of Agent

•
x^Yia '+n 5--a,w a b.t�it '�� «,,,r-° y....:....p , < ,..�` ,,.'D❑�. ;v.,ykr. , ,,i,11 "Via,,, ia�
n of Soil and WaterConservation� Other Agency � � � �t
❑Dlvlslo .�
<�
Division of Water Quality
A 12outine 0 Corti laint 0 Foil ow- u of DWO inspection 0 I' ollow-u of t)SWC review 0 Other
Date of Inspection p 30
Facility.Number 3
Time of InspeTtion Q? 24 hr. (hh:mm)
0 Registered 13 Certified 0 Applied for Permit R] Permitted 10 Not Opera Date Last Operated: ........
Farm Name Jai I ............ `•�........... —IFrx................... County: ......
buo.{.h.......................................... .......................
Owner Name: ...,...�.V.crt``s.-k.......... !�yp�?Cln........................ ............................................ Phone No:. .......,......................................
Facility Contact: ...... YV.Akp.� .............11r`s��.£Ita.................. Title Phone No: (Il'.��7$........
MailingAddress: .... .Q��.... .... .G.,.f .....`T............ A ................................... ...... LEI.G�?,!.LDS........j.N.................................... .r� .........
Onsite Representative: ....�ni>>�frrb...... 'NN .k-.................................................... Integrator:......,.:rtnRV`5.........................................................
Certified Operator; ......(t-I�.w.4...... ......... tt\Qirs-............................... ................. Operator Certification Number:..,OI.�..�.T. ...........
Location of Farm:
....... �!? :....evy... ........?F-A......... r...... %?..V, k....... :?'wm--.. e .f..--ok.....,s.....t �ts.,...i✓R.rx .....m.... .....m., ......ax......k�s......s� .er....
.01A+) . ....................... .
Latitude • =' =" Longitude =• =' "
� Design Current
�.
�� Design Current v f �a . Uesgn �dl:' CurrenE k
Swine, "Gapacity Population
_.
Poultry
Capacity ;Pupulat)on� Cattle„Capacity Population '
r'
Wean to Feeder
❑ Layer
,<,
❑ Dairy
Feeder to Finish
JL40
❑ Non -Layer
i^'
❑ Non -Dairy
El Farrow to Wean
Farrow to Feeder
❑ Other
:x
❑ Farrow to Finish
5Y
Total Design Coy acttyA:
l?
❑ Giltsz7
❑Boars
e
"�` .Totat SSLW
z
ri--, -
Lagoon Aa Spray d Area
Number of Lagoons Molding Ponds J ❑ Subsurface Drains Present ❑re❑Feld
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes M No
2. Is any discharge observed from any part of the operation? ❑ Yes K No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance mast -made? ❑ Yes 59 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 gal/min?
.d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes 1p No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 09 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes E�No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ' ❑ Yes Ej No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes itNo
1 ,�/
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 5R No
7/25/97 Continued on back

- Facility Number: 31 —
J
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons, Hold in Ponds Flush Pits etc.
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes q No
❑ Yes [( No
Structure 5 Structure 6
Identifier:
Freeboard (fty ............3..................................I........".....
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 maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
l5. Crop type ..........(:Q!Y ......................... J a t...............................Aa.16k.%..............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
2l. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy.of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
®' No.violatiohs-or deficiencies were noted-duritig this', visit. You:wift receive noltirther
;•:•cbrrespQitdehce.ab"outahis:visit:•.�..�.�..�.�:�,�..•.�.�:�...�.:�.�:�.•.•..-�..:�:�:�..•;'.�.�. -.�. � .-
Ef Yes ❑ No
❑ Yes 0 No
❑ Yes 19 No
❑ Yes 19 No
❑ Yes V No
❑ Yes 1A No
❑ Yes 19 No
❑ Yes No
❑ Yes No
(A Yes ❑ No
❑ Yes rR No
❑ Yes [( No
❑ Yes 19 No
Iz. Trees sttie�i� lk n�.� %orti (moon. CA��'{Ync�' 1J;s�4+ric�- Sa; I and f►)tk•�cr fG1r �s5tsfar+c�- $arc.
=�ui.S o h of tw- wkil .hovid fps rc6"d ed i
zz. TA&cco .slr�auld be- IcsW v(•;{izA'c'. Pkv" Spro,
.�t1 a..v�J •�`tl� �U�.ba�s, tr•cga�•;on t�to�� sno�`r� b¢ ��. �(e„�.
7/25/97
Reviewer/Inspector Name !
g- x t
A 16
ti8n
-���rt�tnh?» .n;_.�.rt
.,'_,.
Reviewer/Inspector Signature:___
*t,== �'�, a, ��.
Dale: MI&/:z

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr„ Governor
Jonathan B. Howes, Secretary
November 13, 1996
Juanita Thigpen
Juanita Thigpen
4019ENC24
Beulaville NC 28518
SUBJECT: Operator In Charge Designation
Facility: Juanita Thigpen
Facility ID#: 31-488
Duplin County
Dear Ms. Thigpen:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919/733-0026.
Sincerely,
A. Preston Howard, Jr., P.E., Director
Division of Water Quality
Enclosure
cc: Wilmington Regional Office
Water Quality Files
4
P.O. Box 27687, N#f
Raleigh, North Carolina 27611-7h87 An Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 50% recycled/1096 post -consumer paper

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: _ , 1995
Time:
Farm Name/Owner:{
Mailing A
County: '
Integrator:
On Site Representative: —
Physical Address/Location:
Type of Operation: Swine
Phone:
Phone: / }_ :1 ? �f� 7F—
f C'L�_,_ 17 ri lon r eo _ 4
Cattle
Design Capacity: ,� _ _ _ Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longi,tudej- _2 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches 9or No Actual Freeboard: a Ft. 6 Inches
Was any seepage observed from the lagoon(s)? Yes or towas any erosion observed? Yes 00�03
Is adequate Iand available or spray? or No Is the cover crop adequate?or No
Crop(s) being utilized: 0,:g� •- 12 ] k.. 92
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?(Sor No
100 Feet from Wells?& or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o<15
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or(fo
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes 0(5 If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No f�i L��kep,L
Aldditional Comments: N
Inspector Name
IZ,e�
Signature
cc: Facility Assessment Unit . Use Attachments if Needed.