310525_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

Type of Visit:-tMompliance Inspection U Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: .7 Arrival Time: Departure Time: '3 County: Region:�0
Farm Name: TGt k q Mae—e k Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: %2��?t /Wlf��oz Title:
low
Onsite Representative: .r.--✓
Certified Operator:Gr��
Sack -up Operator:
Location of Farm:
6` e,l,v'e.-- Phone: !
Integrator: v�[
Certification Number: /1 `03
Certification Number:
Latitude: Longitude:
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Discharges and 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?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑.No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes JNo
❑ Yes 5No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3
21412015 Continued

Facili Number: - Date of Inspection:
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 l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
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.)
MNo ❑ NA
❑ No ❑ NA
Structure 6
❑ NE
❑ NE
❑ Yes n No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes gg-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 P!�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as'required by the permit? ❑ Yes J&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 _S No
❑ NA
❑ NE
maintenance or improvement?
Waste AV lication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 03�.No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo
❑ 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): Sv" 1®-41 z°l�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �2_`No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes fgLNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable D Yes Jallo ❑ 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?
❑ Yes � No ❑ NA ❑ NE
❑ Yes C -No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes C5—No ❑ 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes J5,No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Eil-Wo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes fK No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CS No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [j No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [3 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 [RNo . ❑ NA ❑ NE
❑ Yes I No ❑ NA ❑ NE
❑ Yes [g.No ❑ NA ❑ NE
❑ Yes 03 No ❑ NA ❑ NE
❑ Yes No
❑ Yes ® No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
DNA ONE
(.. ). p
Comments refer` to uestion # 3Ez';Iain any YCS answers andlor:any ad.itional€recommend�taians or,any ater,cotnnrRents 'x .
e:.¢liefitr€Ibu. E: Il,s�€, t, r� �<r,�. fr:,. v.tau�<< r ,. :t ...� r. ,1: ,.., .,,i 1. ' '�,; �rYa¢ PY��.
i.I$@;(jlAWjn S,O,faeillty„t0;ffetter�elC Ialn,&>iili8i8113(IISelt[ldlt1011al. 'de3`ASrnCCPSSACy):u'P=���€
Reviewer/Inspector Name:
Reviewer/inspector Signatut
Phone: 9;70 —?ZL�­O/s J
Date:
2/4,201 S
Page 3 of 3

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: r( Arrival Time: Departure Time: County:
Farm Name: �ji�„ r1'l,A r e �� T Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Region: C.J /
Onsite Representative: Integrator:
Integrator:
p �a 3 _
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design
Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity
Pop.
Wean to Finish
c��
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
j
Feeder to Finish
DairyHeifer
t
Farrow to Wean'
Design
Current
D Cow
Farrow to Feeder
Dr, Pnoultr,
Ca aciit
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and 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?
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 J2'No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes PNo [DNA ❑ NE
❑ Yes jFe'No
[] Yes 0, o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Face ity Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
F,�'No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
VNo
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure
5
Structure 6
Identifier: 1 �^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): p� y
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 El NE
through a waste management or closure plan?
/
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[�No
El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
/Z No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[:IfNo
❑ 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
FNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
jZrNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
2f No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
El NA ❑ NE
18. 1s there a lack of properly operating waste application equipment?
El Yes
VNo
❑ NA ❑ NE
Comments (refer,,to_question #) ,'Ezplain any'YES answers and/or any�recommendations or any other, comments �,,
Use drawings of facility to letterexplain situations: (use additional pages as necessary)i
t1 y
Y 3
V
Reviewer/inspector Name ��'��
m ��}*','� �`'°�
Phone: �Q 7�4c32>
.-
Reviewer/Inspector Signature:
Date: d
Page 2 of 3 12128104 - Continued

Type of Visit: 0,C'ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ZRoutine O Complaint O Follow-up 0 Referral O Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: ' . a Departure Time: County; Region: L
Farm Name: Owner Email:`
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Integrator: /71
Certification Number;
Certification Number:
Location of Farm: Latitude: Longitude:
Desrgn Current
Design
Current
Design
Current
Swine
Capacity Popp:
Wet Poultry
Capacityop
Cattle
Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
`
Dairy Heifer
Farrow to Wean
Design
Current
DEX Cow
Farrow to Feeder
Dr> Proultr,
Ca aci
Po P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Turkeys
Other
L U­y Poults
Other
Other
Discharges and Stream Imaacts
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 EjNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes [/]"No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: 3 IDate of Inspection:
Waste Collection & Tieatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes .❑ No ❑ NA [:j NE
a. If yes, is waste level into the structural freeboard? ❑ Yes El No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity yof 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 Z No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
0 Yes Zj 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 Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ;2 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 0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes allo
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes D No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
0 Yes 2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes 0 No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes [allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes E]^`No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes J2 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 ff No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facili Number: Date of Inspection: 431.2, 6
24. Did the €acility fail to calibrate waste application equipment as required by the permit. ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes g-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes,'contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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 ,45 No ❑ NA ❑ NE
❑ Yes �ffNo ❑ NA ❑ NE
❑ Yes J�:FNo ❑ NA ❑ NE
❑ Yes ,E)'No ❑ NA ❑ NE
❑ Yes _'�JNo ❑ NA ❑ NE
❑ Yes
,fNo
❑ NA
❑ NE
❑ Yes
J"No
❑ NA
[] NE
❑ Yes
;�j No
❑ NA
❑ NE
❑ Yes
❑'No
❑ NA
❑ NE
Camme.nts°.(referto question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use,draiAngs of.facllity to better explain situations (use additional pages as necessary).
C74- rPCCV'I l�orr�a
7/1c/ d
1-,2-7 l� l
Reviewer/Inspector Name:
ReviewerAnspector Signature:
Page 3 of 3
Phone:
Date:
14/20 1

1,7
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit .eRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Z / Arrival Time: Departure Time: County: [i Gf Region: Wr/�
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
�
Onsite Representative: ,/�-� 07 ,�g'✓+r e-�h� _ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = e = i = Longitude: 0 ° = ' 0
Design Current
Swine Capacity Population
❑ Wean to Finish
Design Current
Wet Poultry Capacity Population
10 Layer
Design C►urrent
Cattle Capacity Population
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
El Dry Cow
❑ Non- Dairy
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Othe
❑ Other
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Humber of Structures:
rkey Poults
ther
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes �No
❑ Yes
eNo
El NA
[I NE
❑ Yes
9No
❑ NA
❑ NE
Page I of 3
12128104 Continued

Facility Number: — Date of Inspection z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. I f yes, is waste level into the structural freeboard? ❑ Yes WNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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 I;lIVo ❑ 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 ❑ N-o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes LI No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
0. 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 ErNo ❑ 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
�2`&o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
F!T No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑.Yes
PNo
❑ NA
❑ NE
4 11.'°::, gik�Xi 3`5
Comments {refer to qucstiou #} ` Explain any YI S answers and/or any recornthendatiods or any other;comments
Use�drawings,of facility to`better,explain situations: (use additional pages
Reviewer/inspector Name, � � � t; d `` '�` °= Phone:
f��
r
Reviewer/inspector Signature:
Date: 1'Z
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 [3No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes [,-INo
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ;TNo
❑ 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?
❑ YesZ'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes P1110
❑ NA
a
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes Q No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes ,U"No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes �3`&o
❑ 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 PMo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
;2fNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
2fNo
❑ NA
❑ NE
Ad�ditio.,ai, ginmenfs anclln Dra i gs
!o /' (/! 0
U 3
1� S
12128104

Div`isian of Water Quality
acility Number - S2 S ®Division of Soil and Water Conservation
n � Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: U Arrival Time: Departure Time: County: i Regio'
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
On site Representative: �g an ti «-e.4 .
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude.•
Phone:
Integrator: _ Yh z _
Certification Number: e la3 �
�L
Certification Number:
Longitude:
Design Current
Design
Current
Design
Current
Swine Capacity
Pop.
Wet Poultry
Capacity
1?0p.
Cattle
Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dt, P,ouItr.
Ca act
P,o P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
tkeyske Puuets
er
er
Discharees and Stream Imuacts
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
� o
❑ 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
10 C;37No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
7rNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
;D--No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: 73)
Waste Collection & Treatment
4:4ts stb'rage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Ej No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes -n 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 dNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes f2'No ❑ NA [] NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C 'No [DNA ❑ 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? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Z No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes U^o . ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes dNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes J�allo ❑ 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?
[] Yes FTNo ❑ NA ❑ NE
❑ Yes rNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes .2 j 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 J'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z No
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[DNA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: -2 Date of Inspection: 4d o
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25 [s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes LErNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes jErNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes oNo ❑ NA ❑ NE
❑ Yes oNo ❑ NA ❑ NE
❑ Yes to No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes .!fNo ❑ NA [] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ONo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ONo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/orany additional recommendations or,any other comments.
Use" drawings of facility to better explain situations (use additional pages as necessary). I .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
k Geel6dkC 56ocl
Phone: ! — 7 GY 7rS�
Date: eG to l
l/4/ 011

.0-Division of Water Quality'
Facility Number G.Division of Soil and Water Conservation
0.Other Agency.
Type of Visit (Compliance Inspection Q Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County.-4 ! Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: aLa
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Prone:
Phone No.•
Integrator: _ Operator Certification Certification Number:
Back-up Certification Number:
Latitude: = =' = Longitude: = ° =
' Design Current'' Design - Current t Des
Swine Capacity Population Wet Poultry Capacity Population Cattle TMCapa
❑Wean to Finish ❑ Layer
ElWean to Feeder ❑ Non -La er,
Feeder to Finish
ElFarrow to Wean Dry Poultry
❑ Farrow to Feeder
;'. ❑ Farrow to Finish
"❑ Gilts
❑ Boars
Otheri f
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
y.
',r C'i�rrent
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of.Structures;,:C
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ,ErNo ❑ NA ❑ NE
❑Yes
❑No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑"No
❑ NA
❑ NE
❑ Yes
[allo
❑ NA
❑ NE
12/2"4 Continued

Facilify Number: 2Y - Date of Inspection ;4�
�.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes A'No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
17
Identifier: Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 2 %
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [jNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes B-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 Q'No
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[I'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
Q-No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
B No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Q-No
❑ 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 D Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ✓JPJ'�/h/�/� CGS L/7 .� _ �G �lc%E_._
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0-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
allo
❑ NA ❑ NE
1$. Is there a lack of properly operating waste application equipment?
❑ Yes
9-No
❑ NA ❑ NE
Comments (refer to question #)i 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):
AL
Reviewer/Inspector Name I - Phone:
Reviewer/Inspector Signature: Date: v2 7 06
Page 2 of 3 12128104 Continued

Facility Number: 3 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 2No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. off] Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking © Crop Yield ❑ 120 Minute Inspections Z'Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[Q NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
�JNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[2No
RNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9No
❑NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
0 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;3'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
qNo
❑ 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
EFNo
❑ 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
13 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2Vo
❑ NA
❑ NE
Additional Comments and/or Drawings:
T�a�.s�ri- Clo /P�G�s � a ✓�l�P � �D��
Page 3 of 3 12128104

IYype of Visit )V Compliance Inspection O Operation Review O Lagoon Evaluation I
for Visit RrRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
13 Permitted [3 Certified 13 Conditionally Certified f© Registered
Farm Name:
OwnerName:... .....» ... _...._._._........... _...»..__------------- » ............................
MailingAddress:....._ ._._._....»....... _.................W_.» ».....»» ......_.... ...
FacilityContact: » », »...W W.__............... ». _. »..._... Title:... _..... ..... .,
Onsite Representative:
CertifiedOperator•..._.........................»._........._.........».».»..............W__..w...__
Location of Farm:
Time:
Date'Last Operated or Above Threshold:
County: �4 !� _ .__._ ..
PhoneNo:»................................»......».».»..........._........_........ .
....... ........ .»Phone No:
�5Integrator:./l._...» »..»....»..........._»..._»_..�......_._.
Operator Certification Number:.....__...._.._...........»..._._.
L'W
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude "
Disc eA-s 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? of yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RfNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ,KNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .._.... .... ».... _ ..... .. ....._.....___.. _ . » .. __ _ ._.__ ... _ »....... »......_ .....___......
Freeboard (inches):
12112103 �C" Continued

k acility Number: -- S- Date of Inspection F/'.,i/ 2MI F S;1'
5; Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [_-]Yes P�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes E(No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 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 ❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Q10
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground )❑ Copper and/or Zinc
12. Crop type liir Gr �Lll r .SLR �i/iPrl"��.�i/
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes J'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 .ONO
16. Is there a lack of adequate waste application equipment? ❑ Yes eNo
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes P140
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ZRo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes PNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ;]-Go
Air Quality representative immediately.
❑ Feld Copy ❑ Final Notes
-(Trlel,-all
Aea o rc--14P/�
ce Je-
C S
��CeS
C/o Ll ors
Reviewer/Inspector Name Z
Reviewer/Inspector Signature:
Date:
!1/1l/V3 C.ol anuea

Facility Number: Date of Inspection
l eauiredd Records & Documentq
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes dNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes Ea No
23. Does record keeping need improvement? If yes, check the appropriate box below. Oyes -WNo
❑ Waste Application ❑ Freeboard Z Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) [:]Yes eNo
27. Did Reviewer/Inspector fail to discuss reviewlmspection with on -site representative? ❑ Yes ,®"No
28. Does facility require a follow-up visit by same agency? ❑ Yes , O'No
29. Were any -additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ONO
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes ;a-00
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
[0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Ok� 0-F
e ven-� .
P1e�sz 4-ct k- lmarw— 1-e� ja lc w,z s an a.�Ys'� S .
12112103

M A "
Date of Visit: �� Time:
Facility Number
10 Not Operational 0 Below Threshold
P3 Permitted UtCertifled [3 Conditionally Certified © Registered
Farm Name:
Owner Name:
Mailing Address:
Date Last Operated or Above Threshold: _
County: Aje 2 (.-1
IV
Phone No:
Facility Contact: Title: I Phone No:
Onsite Representative: L j integrator: u_1 _wfl _
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Worse Latitude 0 �� �66 Longitude 0 6
Design Current Design Current Design Current
Swine Capacity Population Poultry CUE)acitv Po ulation Cattier. Capacitv Population
❑ Wean to Feeder 10 Layer I ❑ Dairy
® Feeder to Finish JEI Non -Layer 1 10 Non -Dairy
❑ Farrow to Wean
El Farrow to Feeder 10Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Soars Total'SSL.W
Number of Lago as ❑ Subsurface Drains Present ❑ La oon Area Spray
Field Ares
:Holdin s Ponds /`Solid TrapsLiquid
M. �. _ .. ❑ No Waste S stem .�=M
Discharges _& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 'RI No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b, if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collgction & 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 b
Identifier;
Freeboard (inches):
05103101 Continued

a 46
Facility Number: _3,1 — �, Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes &fNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 8INo
(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 ErNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes %�JNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes tNo
Waste An_nlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ( , No
11. Is there evidence of over application? ElExcessive Ponding ElPAN ❑ 1
Hydraulic Overload ❑ Yes tSNo
12. Crop type /it"/1&4A1r �ft1s s/J
i
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes KNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
VNo
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
JJWvo
16. Is there a lack of adequate waste application equipment?
❑ Yes
El No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Pi -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
RNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
KNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
fi� No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
EQNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
M No
(ie/ 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
[KNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
C0MiRins(reert=qai`YipESanswersaidlora;n"recommendatia so anyoticmmn
Use �lrawrngs"nf facility to better explain srtuations (use additional pagesMs>necessary)❑Field
Copv ❑Final Notes
Reviewer/Inspector Named < w ,W a n ew.;,,
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: _T/ -52 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
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?
C1 Yes tgNo
[--] Yes No
El Yes No
193t
El Yes Z3 No
[:3 Yes XNo
El Yes �lo
El Yes PSNo
Milditional C6mm6Ws)pnd/or Drawings -'.;�.
05103101
05103101

Type of Visit la'Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification Other ❑ Denied Access
Facility Number Date of Visit:
0 Permitted 0 Certifi1ed 0 Conditionally Certified 0 Registered
Farm Name: — 94 h_d n -_ M yA� ee a -d i
Owner Name:{�f�let��
Mailing Address:
Facility Contact: Title:
Onsite Representative: C ,0 J., m a reakll_ti
Certified Operator:
Location of Farm:
% 'rime: / 0
rO Not Operational 0 Below Threshold
Date Last Operated or Above Threshold:
County: D L to i ;.'N --
Phone No:
Phone No:
Integrator: �22 elk't
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 « Longitude 0• 6 «
Design Current Design Current Design Current
Swine Ca 'ace `° Population Poultry Ca aci Po Matson Cattle ` Ca aciPo`ulation. ..
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
ElFarrow to Feeder ❑Other
❑ Farrow to FinishTotal Design Capacity „
❑ Gilts W
❑ Boars Total SSLW.
❑ No Li aid Waste Management
Lagoon Area �U Spray Field Area
y Number of Lagoons' Subsurface Drams Presentw
Holdiug:,P;onds/ Soltd Traps _.. ement S stem
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?
M Collection _& Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[:)Yes ❑ No
Structure 6
Continued

Facility Number: -$"2.S Date of Inspection Z !3
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 Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management flan (CAWMP)? ❑ Yes ❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/lnspector 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
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
@omments'(refer to question#) Explain any�YES answers and/or:any recommendations or. any other comments.
Use drawings of facility to better explarn situattons: (use additional pageessoary). ❑ Field Copy ❑ Final Notes
wAs 6e4ween 17?e, m���qd��'s-��r�c+ 4AJ46S
r'Ofresen-�Q�r'✓�s f /4v/'ph7_ I��awn ,�t�o,�eseh�a��..e�GnGt �L✓Q
rt►tCnR-ri"¢S 44 d�'SGVSS --/he 4 s,'v��z'a� GnrtG2rri��J
e sk -nAao-ds AA+ ipWly -lU -14e �.►�OOj'11 ghGj �� pe.-m;+4
u e s &.f' 4kte ��G 1 �
Hw�y
Reviewer/Inspector Name * ,. ,. 4`
AW.,
Reviewer/Inspector Signature: Date: 17 Z CZ.
05103101 Continued

Type of Visit 0 Compliance Inspection' O Operation Review p Lagoon Evaluation
Reason for Visit 0 Routine Q Complaint O Fonow up O Emergency
Facility Number Date of Visit:
Permitted [3;pCrttifiedd 0 Conditioonally Certiified0 Registered
Farm Name:..l�"�Ll..f.!-l.,lr4...
Owner Name: ........ ..1.1�i�.1..�..........I/...1UC
❑ Denied Access
cow— r00
Time
Q Not Operational Q Below Threshold
Date Last Operated or Above
�Threshold: .........................
County:.... y�..�iC.�.rr:••.............................................
PhoneNo: ................................................................................. . ....
FacilityContact: ................................,............................................. Title:........,................,...................................... Phone No:...................................................
Mailing Address:...............
....... ............................. ........ ........................... ..................... ..... .
Onsite Representative:.....fl-�,1f✓ !/r.... ...... Intcgrator:...�! �r�.`...,T...........................................
CertifiedOperator : ................................................... ............................................................. Operator Certification Number: ..........................................
Location of Farm:
Swine' ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �' �"
` Design Current rDesign Current Design Carrent
S!c CCCaaciPoeatoa a n
❑ Wean to Feeder ❑ Layer ❑ Dairy
T eeder to Finish ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
ra` ❑ r; Gilts ❑
Boars Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
s Holdtng�Pohd§ / SohdTraps ;. ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes) No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. 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/ruin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes a
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes INO
tructure I S uct rc 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................... .............. .................................................................................................................................... .
Freeboard (inches):
5100 Continued on back

rpumDate of InspectionEL
the any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion;
seepage, etc.)
b_ .pre there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. 'Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence ofover application? ❑
❑ PAN ❑ Hydraulic Overload
12. Crop type � JjF&ZlyV14 4- / V 1114 !/! l/►/ E
❑ Yes ONo
❑ Yes PNo
❑ Yes PfNo
❑ Yes P�No
❑ Yes 0 No
❑ Yes VNo '
❑ Yes O(No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
O No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
PfNo
b) Does the facility need a wettable acre determination?
❑ Yes
�^o
c) This facility is pended for a wettable acre determination?
❑ Yes
to No
15. Does the receiving crop need improvement?
❑ Yes
16. Is there a lack of adequate waste application equipment?
❑ Yes
JVNo
9No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes )2fNo
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'
*o
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
/� No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail tv discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[�No
/
Q•Vi01.hji0ijs•or- dgecien�li.s re ed S� ing �s:� s t� Yoh w�i ee iye o; #`u4t#�or :
6 resaoriciei & abauf this visft:................................... .
!Q rLer ✓L/ /' Lim'
�J r .. i �7 3 . &� �1 s"Ji T� Y {Mksi4� 9
Reviewer/Inspector Named � a �47r ";� 1 . Y3 . r oeu.! L
1
Reviewer/Inspector Signature: Date: 5/00 :I
II

Facility Number. l Date of IaLspeciion p
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes dNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes PNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �Ko
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ,4!fNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes A: No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Yes rNo
'Additional'Comments an or, rnb� '
.. ... :,:.,. , :... e...-,.. ..,, . ..<. ....... ,.a . .. ,.:,.b", r i ;a
�'5100r-fit
T

IType of Visit J6 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit
Routine 0 Complaint 0 Fonow up 0 Emergency
Facility Number Date of Visit:
13 Permitted 0 C rtified D Conditionally Certified [3 Registered
Farm Name: . .. . ....... .......................
Owner Name:........... n6-W- ............ AkiT.W.-I ............. I .............................
1 [3 Denied Access
Time: �Q
rO Not Operational 0 BelowThreshold
Date Last Operated or Above Threshold: .........................
County:...401W. .............................................
Phone No:
FacilityContact: ..................... L ......................................................... Title: ................................................................ Phone No:...................................................
Mailing Address . ................
tegrator: ...
Onsite Representative: n, Z'/
....... ............
Certified Operator:....................................................................................................... ........ Operator Certification Number: ..........................................
Location of Farm:
Swine [3 Poultry ❑ Cattle [] Horse Latitude
Longitude
Design
Design
rren
Current
Swine Capa ��i iy" p6owaticiri
!"try,
P0 Capa&y,,
Population C 'Ittl ace
-e- ''Xii Niiiillation..,:';
0 Wean to Feeder
13 Layer
❑ Dairy
yi
�eeder Wto Finish
JE1 Non -Layer
I
I❑
Non -Dairy
I
0 Farrow to Wean
__j
[3 Farrow to Feeder
10 Other
I
0 Farrow to Finish
TotalMSIMI
❑ Gilts
Boars
Toted SLW
N 6i'of Uio6ns 77 ❑ Subsurface Drains Pres!jtj�goon Area Spray Field Am
PM
d Waste Management System -Holding Ponds Solil&Ti 10 No Liquid
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? 0 Yes No
Discharge originated at: [] Lagoon 0 Spray Field [I Other
a. If discharge is observed, was the conveyance man-made? 0 Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) 0 Yes 0 No
c. li'discharge. is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? 0 Spillway
tructure I Sjucturc 2 Structure 3 Structure 4 Structure 5
Identifier: .........................................PZ/
Freeboard (inches):
5100
0 Yes 0 No
0 Yes No
0 Yes 0
0 Yes INO
Structure 6
Continued on back

IF'I
Facility Number: — 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
ld. Are there any buffers that need maintenance/improvement?
11. Is there
❑ PAN ❑ Hydraulic Overload
12. Crop type �0,6 liYYJ/1A- ,_*y A a Z1 X9625�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(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?
0..i Q YiQl �ipljs'o�- agfjcjencii§ •rv�re )i0' ed• 00iog ibjs v' Wit; • ;Yoh wii� ye �o
cori esb6tideiki abiod this visit: ................................... .
❑ Yes ONo
❑ Yes WNo
❑ Yes PrNo
❑ Yes Po
❑ Yes 0 No
❑ Yes PNo
❑ Yes O(No
❑ Yes JD No
❑ Yes P.No
❑ Yes �?No
❑ Yes YJ No
❑ Yes gNo
❑ Yes j No
❑ Yes ONO
❑ Yes PfNo
❑ Yes No
❑ Yes No
❑ Yes /� No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes �No
9
0 7�14 T � Gc�i9 SSE Ate. �u1NE
C.!% �GL� - Q� Tf'l e✓ A,.0j* r
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: / 5/00

T . .
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 ❑ Yes �No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ON()
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 00
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 FJ'No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes A!fNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes gfNo
Additional, Comments an or: rawings
.. ... .. ..
5/Da

#:
Type of Visit O Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 525 Date of Visit: 7-11-2001 Time: 10:30
Q Not Operational O Below Threshold
Permitted © Certified [3 Conditionally Certified ('] Registered Date Last Operated or Above Threshold: _ _........_ ..
Farm Name: FAbQtw.Ma KFtdx.Farm.......................................................... County:.Auplin►.................................... 3'.4JKQ......
Owner Name: Qn------------------ Marealiy- - --------------------- Phone No: 1JQ24S:A045.aUZ28=4412jM_---------
MailingAddress: F.O.Rox.3.7.1............................................................................................. Rewo-Olie...l! Kc ........................................................ AsA ..............
FacilityContact............................................................Title Phone No: ......................................................................................
Onsite Representative:>�bdy_----------------------------------- Integrator:
Certified Operator:&bnaj.................................... Marcady .......................................... Operator Certification Number: JA1.0.3 .............................
Location of Farm:
South of Beulaville. On South side of SR 1804 approx. 0.5 mile West of SR 1802. A
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ,F 34 0 Longitude 33
-.,- � I III'
rl Design (!Current Design Cu'irentl Design Current
Swore Ca act Po ulation I'Poultry II II Ca acit Fo ulahon + ICattte Capac�ty..l'opulatIon:
❑ Wean to Feeder
® Feeder to Finish
1180
1120
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer
❑ Non -Layer
Total fM9
r
I ll „i'I II :
umber of Lagoons, .. '. 2 ❑ Subsurface Drains Present
Holding Panels l;SoIid`Traps'`�:° ° ❑ No Liquid Waste Managen
Discharges & Stream Impacts
❑ Dairy
❑ Non-D
Ij I!
4'
;n Capaci
1
otal IS5L`
111 159.300 1
J Lagoon Area ILI Spray Field Area
t System
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is,observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) F. ❑ Yes ❑ No
yrf� . •
2. Is there evidence of past discharge from any part of the operation.7 ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the;State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillwayl•r,.­❑ Yes ® No
Structure l Structure 2 Structure 3 Stirs are , ; ' Structure 5 Structure 6
Identifier:...-----•--•--........................................ .......................... -- -----•--•--•-... ..............•--•--•--•._.....
Freeboard (inches): 46 60
I
II
i. ;
I
❑Other
�ti,

uJi vXvr
Facility Number: 31-525
Date of Inspection
7-11-2001 r
t,unttnueu
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?
❑ Yes ® No
❑ 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
$ t.
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 Anplication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN E] Hydraulic Overload
❑ Yes
® No
12. Crop type Coastal Bermuda (Hay) - Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Wastc'Management Plan (CAWMP)?
❑ Yes
®No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
® No
b) Does the facility need a wettable acre determination? __.
❑Yes
El 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. Nail 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,'ete.) ❑ Yes ®No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ® No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ® No
22. Fail to notify regional DWQ of emergency situations as required by General'Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
® No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?, :'
❑Yes
No
24. Does facility require a follow-up visit by same agency? �: �,; 't , _
❑ Yes
® No
25. Were any additional problems noted which cause noncompliance of the Cer4ified'AWMP?
rr .
❑ Yes
® No
® No violations or deficiencies were noted during this visit. You will receive nofurther correspondence about this visit.
:=ik=¢I#1'Ja'J1ja.'t:fUlA'tit;`!f?Jt�tf°'e¢;..;,,.,,billr''t{},lSi°P?J$$fall'a�o-erer„klpFi3"of$.7„L?3Fbe$`1FiSI•?t,"rEY1eitaNdd.H�ti91i7#;!?{$iJf!gJs[eett"eft3':'lE£hx-:'i`idNdFlid�^Jf#(ftfk""#diJ#Jal;E HitIH..'uH;t?t.. l:i.tl,zit'�
;Gomrnents /refer'to: uestion€# :'Ex lain an. YESanswers`andlortanrecornmendations�or an other;comments'r °:t�`3a'11{arrl4,,rk=t lal=tr
..a-.t:a.ssttss< Bra 4g -1. '�& t a p ^Ya.�t1fJ6' °r'edilEif�w € a : i:�ai;P=^t jtii i3"r�?j. #.Ji. w'z $r°:'i:at<t'9 d' la -. x, t ll���¢�8]Va , .fit<f{:,:,:
i i t. ar u; �"" ai � ti 3
UKr� x#f 7. :1F.r<3i'ifhr 3§.. #%$,.$lei 6��. ,trilidi(17d � Mr3�alFiiiW.i-.ALi"�''•ia�..'°�lii.��kJ.iiitFsM1iir.::F:0.gW:idw. 1 {',
1
Useidrawin s.of facfltt to!`better ex Isin situations. use:addittonal a es asineccssan ::{ € ¢''
g Y P ( P g y)$ Field Co Final Notes
aa,; 1 a j r{f'J v yry{��rsa� '{ ,{„3,. �¢ { d1{ :f{ t'{ ❑ py ® p1
�i
��ryJ }
i�ei�i§f.$.�i9I$id,?e� . e7?;otti�H}#YaftJ$�#,'1��"?�" a%fmJf°"sid�rrlr°if¢.,7iJ!%i%i.'fi i.?i!3i7?td7J,'Pd?!P°°,f$C#i<'iJCn,r,?Y'r?Pi77i7i`77.'0fdiP.aEE"E$9(F#�d6a:7�',Fna
NOTE: * Both lagoons have been retrofitted and desludged. Looks great.
+
**. Grower has not had to irrigate on his 2001 Bermuda crop.
*** District has sent DWQ permitting/pennit application.
r
Reviewer/Inspector Name IjOHN,C0LLECE :� 9ette,:9ose `�
�entered'by
Reviewer/Inspector Signature: t ': ' -. Date:

O5103101 Continued
Facility Number: 31-525 Date of Inspection 7-11-2Ut)1
Odor issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? Yes ® No
28. is there an evidence of wind drift during land application? i.e. residue on neighboring•`ve vegetation, asphalt, Y g pp (•' g p ❑Yes ®No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ®No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken Fan belts, missing or
or broken fan blade(s); inoperable shutters, etc.) ❑ Yes ®No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ®No
32. Do the flush tanks lack a submerged, fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
P r itsona ' 'omments=au or raw n s P7��r
.,. _� .. .. ,�. � � n . �,,_. ; � r .,- �,.. ,,g,�.�,lrliE.l .� in�e,i�l
- 1� Jibe .. � Edry
A,
1 �!
T
�J1r
•-1 -1

' 1
�- Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
{Type of Visit gCompliance Inspection O Operation Review O Lagoon Evaluation
(Reason for Visit oRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number I
Dale or visit:
O Permitted © Certified [:]Conditionally Certified 1WRegistered
Farm Name: iG '
OwnerName: ........... ! 41.4!' n...........I..........................1........................I.................
FacilityContact:...............................................................................Title:........................
6=0 Tillie: Printed un: 7/21/2000
—771
Not Operational 0 Below Threshold .
Date Last Operated or Above Threshold: .........................
County:..tJ� "'1
Phone No:
.............................................................
........................... Phone No: ...................................................
MailingAddress:.........................................................:....................................................... .......... ......... .............................. I......................... ..........................
Y7,4 �' /
Onsite Representative........~a.b.P...h..........�.. .... .�.�.......................... ... >(nkei;rlkor:...:....!..V1......a.�.m..................................
Certified Operator:................................................................................................................ Operator Certification Number:...................... ....................
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 Longitude 0 4 61
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gifts
❑ Boars LEE Total SSLW
Number of Lagoons JE1 Subsurface Drains Present 111771 Lap -an Area ❑ Spray Fic d Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Irnpacts
1. Is any discharge observed from any part of the operation?
Discharge originatcd :it: ❑ Lagoon ❑ Spray Field ❑ Other
a. 11'discharge is observed, was the conveyance Evan -made?
h. If discharge is observed, did it reach Water of the State? (if yes, nolify DWQ)
c. I1' dischargc is observed. what is the estimated flow in gal/min'.'
d. Does discharge bypass a lagoon system'? (If yes, n()tify 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 tic. 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway
Sn-ueafure I Structure 2 Structure 3 Structure 4 Structure 5
Identiricr:.................{.............................. �............... .............3.......................... ................... ................... ....................
Freeboard (inches): 24
3 Z
5100
❑ Yes XNo
❑ Yes No
❑ Yes No
n 1A
❑ Yes Uf No
❑ Yes XNo
❑ Yes XNo
❑ Yes DrNo
Structure 6
Continued on back

FacilityyNumber: Date of Inspection Z) Printed on: 7/21/2000
5' Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KI 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 ONo
(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
Z No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
)TNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
110 No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
ONo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
;9 No
12. Crop type
13. Do the receiving crops differ with those designated in t e Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
JgNo
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?
OYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
J9 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?
Yes
No
(ie/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
gNo
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. Pail to notify regional DWQ of emergency situations as required by General Permit'?
(iel discharge, freeboard problems, over application) ❑ Yes t4No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 'g No
24, Does facility require a follow-up visit by same agency'? []Yes ONo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 6 No
viola it?ns;or• deficiencies •Were Jhofpd• d(tring 4)iis;visit' • Yoi} :will tk.,kive iio; furth .. . .
' corres oric�ence: about: this visit . :: ...... .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
J5. con4;nve' e-f•G1'15 4o � P,^ava-�es-�k�l;s�-, ber�,v A.
w. 0&4/%m )qcoaeh e(es)yh/voll.me rlherJ� Ikeer wt`4�
me,a rail,
1W
nspector Name
nspector Signature:
maA;-S
Date: q] Z 1 MP 5100

Facility Number: j —52 Date of Iuspection Printed on: 7/21/2000
{idor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or hPlow
❑ Yes
X` 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
KNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
2TNo
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
�9 No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan biade(s), inoperable shutters, etc.)
❑ Yes
10 No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
XNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
XNo
Additional Comments and/orDrawings:
5/00

© Division of Soil andrWater Conservation ''Operation Reveew r
13 Division of Soil and WaterConservation.Compliance Inspection ' fr
�DiviSion of water Qupllty 'Compliance Inspection § • €t c T r �, ;
the Agency;-; . ,
Oep I•$ti0'n REVIeW - F� ,4
W Routine Q Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
[3 Permitted 0 Certified © Conditionally Certified registered 10 Not Operational I Date Last Operated:
Farm Name: yy...................................I.......I.........
'-� lv�+�C�-d� C.ounty:........... G`.r'1
...`..............................................................................I........................
OwnerName..................................................................... Phone No:.......................................................................................
Facility Contact:..............................................................................Title: .... Phone No:
Mailing Address: ........
..................................................... ....................................................... I. ... ....... ............... ...................... ......................... I—......... ................ I.........
Onsite Representative: `!!!!':.................................... .... .. Integrator: ..... !„',ti !.Y.. .....................................................
Certified Operator:................................................................................................................ Operator Certification Number:......,...................................
Location of Farm:
A,
.................................................................................................. ..................... ........
Latitude �'�� �•� Longitude �• �' ��+ __..
Design Current.' , , Design Current Design Current
'Ca achy Population °Pouttry Ca acit Po )station Cattle Capact
achy ;Po `ulation
❑ Wean to Feeder ❑ Layer ❑ Dairy
eeder to Finish (� ❑ Nan -Layer ❑ Non -Dairy .
Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish To' +-'
tal Design Capacity.
;❑
Gilts,
❑Boars Tota1SSLW
Dumber of Lagoons
g ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
-Holdin ,Ponds / Solid Traps ;,':; ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/rnin?
d. Doses discharge bypass a lagoon system? (If ycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l true re 2 Structure 3 Structure 4 Structure 5
Identifier: s(�✓�
.Freeboard (inches): 3 3 Xintegrity
......................................
5. Are there any immediate threat to the of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23199
❑ Yes xNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes M No
❑ Yes XNo
❑ Yes N No
Structure 6
...............................
❑ Yes V4 No
Continued on back

Facility Number: 1 Date of Inspection
0
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? `
❑ Yes
9No
(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?
k'`Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenatce/improvement?
❑ Yes
k'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
XNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
H. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
RNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
X"No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
9Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
XNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Require(] Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
WNo
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
ONo
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
�Po
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
UNo
22. Faii to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application) ❑ Yes •EfNo
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
0: �'Vo yiolatiQtis o delicienc�es 4vere hoed• O&irtg Ojs:visic • :Y:oo will •teeeiye iio: #'uob.
ictirres' oridence: a'b' ' f this visit
j 8k R E E4 'i 1 CI !
Com_ merits' -(refer taquesiion #) ,Explain any YES,ansrers anidlor any re'comnie�dations or.anyrotli0 comments f`
Use dt•awings of facili t6bettee'ex la1 situatio' use additional: a es as ne t�
ap .ea, .. �,.. .,( <t.,E. „l,.. .p.g. Cessary) t �E� 1_IttQ'� r(,t.
ZZ7
G'cr� , O�c�vS
li.tz V� t,ers�� s«r... IdL
wv-e-,h.s t �d`,�:: t;�e. w> . �; 4� % As'� 1-� s��, ► .� `Y'�
Reviewer/Inspector Name
d .,,
Reviewer/Inspector Signature: [� (1 Date: DL - Ty
3/23/99

.r,;Facgity Number: 7 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes KNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Ix No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes W No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes O'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [KNo
Additional omments and/or rawtngs ;
�-
'. ��`� .��, e_,F�, �-s�. 3t1w .lrfr,�r
{ \ k 19R
cr Jr1\
3/23/99

13 Division of Soil and Water Conservation ❑ Other Agency
15 Division of Water Quality
Routine O Corn laint. O Follow-u gof DAV ins ection O Follow-up of DSWC review O Other
31 Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
Registered Certified © Applied for Permit © Permitted [3 Not Operational Date Last Operated:......,
FarmName: .. 1frx>`.............. .......................................................... County:..........9. .........................................................
nn i kk ,
Owner Name: ........................ i�,��.......... ..... >':. �p m..J. Phone No: .1.4.� ��.'444�,..........................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress:............ a.........,. 1...................:..............�JI1�,!.�.�t . f.. �1k............... .....`R.f ........
� ................. .......... .... ...........
P Ce �.........C.'.ld�Y.�fiL:f;�I
............................................. Integrator: ......................................... �[
nsite E rese.ntatrve'...... ...............
Certified Operator-, ............................................................................................................... Operator Certification Number:.........................................
Location of Farm:
b... 4................... g...... aq..... - :..-SE-TEZ......................................................................................
.................... ........ .....
Latitude �',� �" Longitude �• �� �"
<Desin
..;..Current
Design, Current Design Current
Swme' ;` , y Capacity ;Population
Poultry
Capacity ,Population Cattle , Capac4-, pulafion
❑ Wean to Feeder
❑Layer
❑Dairy
(� Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity
,
.R
❑ Gilts
❑soars
Total SSLW:
Number of Lagoons 1 Holdin
Ponds
❑ Subsurface Drains Present
❑ Lagoon Area
10 Spray Field Area
AZ
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
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 gaUmin?
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
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any.part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
18 No
maintenance/improvement?
b. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
T No
7. Did the facility fail to have a certifiedoperator in responsible charge? '
❑ Yes
99 No
7/25/97
Continued on back

Facility Dumber:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (Lauoons.11oldinff Ponds flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ( No
Structure I Structure. 2 Structure 3 Structure 4 Structure .5
Structure G
Identifier: i�r..............................I.......................................................................................
...................................
Freeboard(fl): ......... 't: -••• ..........., x ..........................:3........,.....................,...........,...,..,....,.,.........,.........................................,,..........
.
�..�.
10.
Is seepage observed from any of the structures?
❑ Yes
09 No
11.
Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes
O No
12.
Do any of the structures need maintenance/improvement?
]] Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
M No
Waste Application
14.
Is there physical evidence of over application'?
© Yes
19 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ............... `.,........................... .......... ............ .................. ......................................
!r l7. A►...................�TVN .�......!f�' . ....
...............
......................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
(M No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
% No
18, Does the receiving crop need improvement?
Yes
❑ No
19. Is there a tack of available waste application equipment?
❑ Yes
IM No
20. Does facility require a follow-up visit by same agency?
Yes
F No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site: representative,
❑ Yes
99 No
22. Does record keeping need improvement?
Yes
❑ No
For Certified or -Permitted Facilities Only.
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
Cl Yes
T No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�J No
25. Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
No
❑ No. violations or deficiencie's.were-noted-during this.visit. You.W'ill receive no further
correspondence �i4otit this visit'. :
Comments (cefei to question #): Explain any;YlAS answers and/or any recom�nendattons;or any otlter commen
Use drawings of facility to better explain `srtuation5. (use additional pales as necc5sury) r .
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r'tCt�lt�s. 7/25/97
Reviewer/Inspector Name
Reviewerfinspector Signature: %�j,�` J �. ��=`� Date: S