310547_INSPECTIONS_20171231

NORTH CAROLINA �
Department of Environmental Qual

IL
Type of Visit: .0 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: rL� Departure Time: E Ll 'L_J County: Region:
Farm Name: r T a Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: C �� mL� I l I _r
Certified Operator:
Ili (3
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: 1 3`
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pep. Wet Poultry Capacity Pop. Cattie Capacity Pop.
Wean to Finish La er Dai Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
DairyHeifer
Design Current D Cow
D , P,oult , C•_a aci P,o Non -Da'
Layers Beef Stocker
Non -Layers Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0"No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
f o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: jDate of Ins ection: '1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J:3*'F4o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes LJ-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 �o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes J2'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 _E5"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes,,0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes _13'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 J2'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes',0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes _[D'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;2' qo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes jEfNo ❑ 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 E3'&o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes-.EyNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes . fNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faciii Number: I I - Date of 1nspe_ct_ion_.-%q 1,) 11-) j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes,,ETNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes,,O-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 ,ETNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No �A ❑ 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 ;3"'No ❑ NA ❑ NE
❑ Yes ,JNo ❑ NA ❑ NE
❑ Yes �E'Klo ❑ NA ❑ NE
❑ Yes _E]No ❑ NA ❑ NE
❑ Yes 121 No
❑ Yes [�No
❑ Yes ENo
❑ NA ❑ NE
❑NA ❑NE
❑ NA [] NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any.other comments".
Use drawings of facility to better explain situations (use additional paizes as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/)/20I

Type of Visit: 40 C�dmpliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
I
Reason Visit: [v"� Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Z Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:(.Jo lj ATd Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: \ 17,3q
Certification Number:
Longitude:
Design C*urrent
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle C«apacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,oultry
Layers
Non -La -Layers
Design
C_a aci
CEl
urrent
Pao
D Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Beef Brood Cow
Boars
Pullets
11111
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 �o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes �rNo ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: I - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
of a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ?j J
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5
dNo [] NA ❑ NE
❑No ❑NA ❑NE
Structure 6
�Yes No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
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
❑
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑Yes
�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes[�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
No
❑ NA
❑ NE
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
� o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
YNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ NA
❑ NE
Required _Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design [:]maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

IFacHity Number: - Date of Inspection: ol�j (p
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] No ❑ NA ❑ NE
(� the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ 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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer. to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).'
NEVJ CbC } 14Lf RE80LD,1rJC51 Povs ES
7) K C � C F PJD
VC- L E fib
Reviewer/inspector Name: CJO� j�A(z <,- LL-,
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C/ b
Date: V
2/4/201 S

Type of Visit: Q Cofiance Inspection V Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 11
Date of Visit: Arrival Time: i �,p ,Y Departure Time: Z 0 County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
1 -j _
Onsite Representative: d p dIntegrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
rS
Design C►urrent Design C•nrrent
ine C►apacity Pop. Wet Poultry Capacity ean to Finish La er
Dai Cow
Design C*urrent
ean to Feeder Non -La er
eder to Finish
Da' Calf
Dairy Heifer
Farrow to Wean Design Current
Farrow to Feeder D , UU-1 . Ca a_ci Plo ,
Farrow to Finish JLayers
Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars
Pullets
NJ
Other
Other I
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes ❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection: -t �
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 _ Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes IZNo ❑ NA ❑ NE
[:]Yes P/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes �o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes ro
❑ NA ❑ NE
❑ Yes
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes rwo
� ❑ NA ❑ NE
[—]Yes ❑ NA ❑ NE
❑ Yes � ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [jNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2 No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: jDate of Inspection:
24:,Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes I � 1Yo ❑ 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 2rNo, ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ErNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes /No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 ZNo
❑ Yes I A o
❑ Yes Zf No
❑ Yes
❑ Yes
❑ Yes
❑ NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
❑NA
❑NE
❑NA
❑NE
❑ NA
❑ NE

LTypeofAfisit: (QCo pliance InspectionQ Operation Review Q Structure Evaluation QTechnical Assistance
eason for Visit: Routine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: 0= Departure Time: U= County:y Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: J& MA 811.1ULLI& Integrator:
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Wean to Finish
I
M1
ILayer
Wean to Feeder
INon-L
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
IN 6
reNon-L
Gilts
Boars
Other I i Ii•I (Other
Latitude:
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Cy ow
Cy alf
Hy eifer
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ o ❑ NA ❑ NE
❑ YesVNo
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
�4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No
Structure
Identifier: ice^
Spillway?:
❑ NA ❑ NE
❑NA ❑NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Designed Freeboard (in): _
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EX
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N ❑ 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 > l 0% 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
V. o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesVNog
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ YesVNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
R_enuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
jNo
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
VNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfer
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspection ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ YesVNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
R
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesiZo❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [-]Yes yo [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA D NE
Other Issues
28. Did the facility fail to dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
properly
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
N
DNA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
❑ NA
❑ NE
33. Did the Reviewerfinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
D NA
D NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
No
[ ] NA
[] NE
Comments,(refer to question ft Explain any YES answers and/or any'additional'recommendations:or�any other comments. -
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phonecgl0 916 -
Date: �'I k? /)
14

(Type of Visit: Q) Co pliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: J I Arrival Time: Departure Time: County: CXPLT_� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: JUIJHT�fl� M5_1( r , Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 9 6 &-7
Certification Number:
Longitude:
Design Current
Swine Capacity Pop. Wet Poultry
Wean to Finish I ILayer
Design Current
Capacity LpAagp.
I
C►attle
Dairy Cow
Design
Capacity
C►urrent
Pop.
Wean to Feeder
I jNon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dr, P,o_ult .
Des ign Current
Ca aci P,o
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
I
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes io ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
❑ Yes rk<qq ❑ NA ❑ NE
❑ YesVj_No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facfljty Number: -07DDate of Inspection:
,Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo.
❑ NA
D 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
V1 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yesg'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[—]Yes
dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
n No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
C] 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[
DNA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
T<"o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Vo
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes No ❑ NA [] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
'124. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes
ICJ ° ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Wo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
-En"No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
5KNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
To ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
to ❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone(_ Jev ? 3
Date: 16 It -7 b3
2412

IType of Visit: Q Co Hance Inspection V Operation Review O Structure Evaluation C) Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: b Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: T Title:
OnsiteRepresentative: VdNRTj4ftj _on;�L,uea-- Integrator:
Phone:
Certified Operator: Certification Number: pS ( 071
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Design Current
C**opacity Pop.
Cow
Wean to Feeder
Nan -La er
Calf
Feeder to Finish
Heifer
Farrow to Wean Design Currentow
Farrow to Feeder Dr, 40ul Ca RE P,o ,
Farrow to Finish Layers
pNon-Dat!y
tocker
Gilts
Non -La ers
eeder
rood Cow
Boars
Pullets
OtherI
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes C21 No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes jpNo
❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection: d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes /NNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure )
Identifier: o "�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes E/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application , �/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I �(No ❑ NA ❑ NE
maintenance or improvement? T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes VNo ❑NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 ❑
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes QNoo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ®No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ]Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes f 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 EfNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard []Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes I yNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: f jDate of Inspection: -�/
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes En No ❑ NA ❑ NE
25..Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes To ❑ 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 E No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C3<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.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 Cj4o ❑ NA ❑ NE
❑ Yes Ell "o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes ICJ 1V NA NE
❑ Yes No ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments -
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�V
Phone I
Date: 1614
214110111

zl
(Type of Visit: 0 Co fiance Inspection Q Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: O Routine Q Complaint O Follow-up O Referral Q Emergency O Other Q Denied Access
Date of Visit: Ig Arrival Time: Departure Time: r2 County:[ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: jo�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: fj -7 1
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish I ILayer I
Cattle
Dairy Cow
Design
Capacity
Current
Pap.
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
I Di, Pioul Ca aci P,o ,
ILavers
Non -Layers
Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turke s
Turkey Poults
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
[]Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes oNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yeso
W��Nj
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: c'i cj 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑Yes
I
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmenta
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Vo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
O/No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[—]Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
��N
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Zc
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps [—]Lease Agreements ❑Othe
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No O NA ❑ NE
❑ Waste Application ❑ eekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [3Waste Transfers ❑ Weather Code
❑ Rainfall 0 Stocking op Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 27N(o ❑ NA ONE
Page 2 of 3 21412011 Continued

Facili Number: - 113ate of Inspection: L f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo
❑ NA ❑ NE
25. IS the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.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 RI/No ❑ NA ❑ NE
❑ Yes I_J l�o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes �: o ❑ NA ❑ NE
❑ Yes
040
❑ Yes
VNo
❑Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
ai)VP0AT(::2 Cr4P �TW
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �� 7ft ' 73, Q
Date:/'�_j )
2141201

5'M
Type of Visit Co liance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit ORoutine 0 Complaint O Foilow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /U 2 b Arrival Time: Departure Time: County: DY +! Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
J
Onsite Representative: t�d �� f rr�— Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= o [= 4 [= « Longitude: E--] o El' 0
Design Current Design Current Design
C►urrent
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity
Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder I
I
10 Non -Layer
I
❑ Dairy Calf
q
Feeder to Finish Y40
❑ Dairy Heifer
El Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
ElNon-Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts ❑Non-Laers
❑ Beef Feeder
❑ Boars ❑ Pullets
El Beef Brood Co
❑ Turkeys
Other ❑ Turkey Poults
❑ Other A ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L'I No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑Yes
[3 No [I NA
El NE
❑ NA
❑ NE
❑ Yes
El Yes
ONp ❑ NA
El NE
El Yes
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 31— Date of Inspection �b
te Collection & Treatment as
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure Structure 3 Structure 4
Identifier: LA�I�I LW_,o AjZ/
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3`2 33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 2 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 environmentaltheat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYesZNo
o El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes ❑ NA ❑ NE
(Not applicable to roofed pits, 'dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ✓O No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > t 0% 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
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Zo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 ❑ NA
[I NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�ZJ
9 No ❑ NA
❑ NE
Comments (refer to question #) Explain any YES. answers and/or any recommendations or any other comments �:, w
=Use`drawings"of°facility.to better explain situations. (use.additional pages as necessary.):
r6 eA60/0 ,
Reviewer/Inspector Name a L� °�� �� Phone: 0
Reviewer/Inspector Signature:
Date: 6 /
Page 2 of 3 12128104 ' Continued

Facility Number: — Date of Inspection 16
Required Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E?Ko ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 01<0 ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E7 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
WNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[j No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E2 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
ElLJ 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
E No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
4'o
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Zo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Q Compliance Inspection ()Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint Q Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: to r 1 o Arrival Time: Departure Time: County: -'bLA7l?0 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: cfam arl4M� iL Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 = . = 1{ Longitude: = 0 0 6 0
it
Design Current
Swine Capacity Popsulafion
Design Current Design Current
W,et Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean #o Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
2,39L
24ub
DaiEX Heifer
Dry Poultry ❑ Dry Cow
ElNon-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
Non -Layers
❑ Pullets
❑ Turkeys
❑ Farrow to Finish
❑ Gilts
❑ Beef Stocker
❑ Beef Feeder
ElBeef Brood Co
Number of Structures:
❑ Boars
Other
❑ Turkey Poults
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
[I No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
VN
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

EPaility Number: 31 7 Date of Inspection o o
Waste Collection & Treatment
�4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L,A(7=ry l LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ` LA 3g
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
C6o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
[(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes
YNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
dNo
LI No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
Wwo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
VNo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�Vo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YN o ❑ NA
❑ NE
Com ents,(reler to gnestton'#) Explain any YES`-answers� and/or any'rgcommendattons or any otheracomments
s:
Use7dritwings of facility to better explain srtuattons{use additional>pages as necessary)
let.) U P OA'tlra, e.4 C W'IT t4 u 4L-'�E2,
LJ POATC C R-OP YSE LD (3(— SUS Td Ar'Dir Tj)"Ve,s dN i4PQ F4 rh
v`PR fwrc D.LC. Nob t t-r,jn r-a *_rr. -to Rya L 6—tC 4
Reviewer/Inspector Name �. a y _ Phone: / 771, QJW
Reviewer/Inspector Signature: Date: td
I2128104 Continued

Facility Number: 3t — Date of Inspection t a
riRepuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
6 Waste Application ❑ Wee y Freeboard ❑ Waste Analysis ❑ Soil Analysis
d Yes El No ❑ NA ❑ NE
❑ Yes lJ No ❑ NA ❑ NE
WYes ❑ No ❑ NA ❑ NE
❑ Waste Transfers ❑ Annual Certification
[:]Rainfall []Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[!fNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E�No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[TNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ENo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
[(Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KIN
[I NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 yes
h/I No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
(3 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
VNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
i.d No
❑ NA
❑ NE
12128104

0
kaeffity Number
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
Hance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
;Routine0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 1 Arrival Time: Departure Time: County: 30PL=O Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: J o Npj O iJ I r �/�I LL'm
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 = Longitude: = o = 6
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population .,,.
❑ Dairy Cow
❑ Daja Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ff No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ �No
❑ NA
❑ NE
El Yes
lU
❑ NA
❑ NE
12128104 Continued

Facility Number: — S Date of Inspection / e
Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElYes oeo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
StrtLQPye 1 Strucme ll2�� Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L10o04 L P —AS_lA -'j 1CY1CG„�1.CE�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VNo
El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ 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 t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ElNA ❑ NE
L.J No
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes L/I No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN 5 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes VN o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ZINLK ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes WNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
2j, j NEE 6 CROP Y.Z e v} to iff &AfC- , F_Z64ns ,lE 6-0 LZM � . Alf 0 UPoATE.9
SO PA10 4W rOR- t411/04-6 fad aN drR6. ATA LAC,-WAI,
Reviewer/Inspector Name Phone: (9m) m 7_7 P
Reviewer/Inspector Signature: Date: v
12128104 Continued

Facility Number: — ,� Date of Inspection
' Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo
"[I NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropirate box. ❑ WDP ❑ Checklists ❑ Desi ❑ Mn s ❑ Other
� P
0
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Applica ion ElWWeekly Freeboard ElWaste Analysis ❑ Soil Analysis El Waste Transfers
❑ Annual Certification
El Rainfall L✓� Stocking D46rop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections
❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ff No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L�JNo
[I NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElDNYes
"'
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
0/o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
E(NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EfNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
L" f 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
[ILJ 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?
[IJ Yes
�,�
LNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Q No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

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 ❑ Denied Access
Date of Visit: CJ� / Arrival Time: ' o_ Departure Time: County: Region:
Farm Name: ���/%s 1/%'S 11�s'L�cys�j_ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _4f fe a s�
Certified Operator:
Phone:
w,Phone No:
Integrator•
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = o = ' = Longitude: = o ❑ 6
Design
Swine Capacity
Current
Population
Wet Poultry
DesignIfff
Capacity
Current
Population
Design C*urrent
C►attle Capacity Population
❑ Wean to Finish
❑ Layer
1
❑ Dairy Cow.
❑ Wean to Feeder
❑ Non -Layer I
1
❑ Dairy Calf
Qf ceder to Finish
571
9 395K
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Layers
❑ Non-Layers
❑ Pullets
El Turkeys
10 Turkev Poults
I IE] Other
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
ElBeef Feeder
❑Beef Brood Co
Number of Structures:
❑ Farrow to Feeder
❑ Farrow to Finish
❑
Gilts
❑
Boars
Othe
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
[I No
El NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: j — Date of Inspection I—t7G
Waste Collection & Treatment y '
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environ ental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes
❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of 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
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
;Use drawings of facility to better explain situations. (use additional pages as necessary.):
cJo4 flee d �� �7'���e as C5,v6/p, Lla aG� /
ReviewerAnspector Name 1 /( I Phone:
Reviewer/inspector Signature: --`� Date: 8' b 6
Page 2 of .f IZI-MIU4 Lonnnuea

.:' -Facility Number: 31— Date of Inspection U
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑Checklists ❑ Design ❑ Maps
p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
7�y�6 43
31,1 6
z� L
Z, 2-
T
Page 3 of 3 12/2VO4

s
Type of Visit 0'Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Doutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f' E S Arrival Time: dd Departure Time. County: 00 LIt _ _ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative: GC�J 912i!DY
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0= I= Longitude: = o= 6 0 6f
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
1; 10 Non -La et_
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ,E3 0 ❑ NA El NE
El Yes L 4 ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection $ ar
Waste Collection & Treatment ,�/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes LJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: GA6OOtJ I M 6ovN 2.
Spillway?:
Designed Freeboard (in): f . F
Observed Freeboard (in): ; ay
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 3/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 WNo ❑ 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 Yo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZVNo
El NA [I NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, El Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
12. Croptype(s) (3cnv,^voR C�iJ 5190 C-5W �NNvWr.0
13. Soil type(s) A ue LA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑Ko ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 1 Yes [-I No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes L✓J No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes dNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [No ❑ NA ❑ NE
Conuneats C (r�,efe o question #/} Explain any Y,E5answers"and/or a .y recommendations oanoecommen
r y thr
se?rawuigstof facilsty to letter explainasituatibn' F(usevaiidittonal pages as necessary):
AAA4o✓E 0#'&Z S6&,0 APAD hlCW COr✓i"k
d1.) A160 TG Do (UJA)(AC(' A//A � TAIVC- rangy.
�� S die�G Ta Av C04f j li2iS. #l1 WTi'.LIJ
Reviewer/Inspector Name p ` Phone: gio �� far?
Reviewer/Inspector Signature: Date: s1 19 Q
12128104 Continued

❑ Yes LJ N ❑ NA [I NE
El Yes l,�'N0 ❑ NA ❑ NE
Facility Number: — Date of Inspection r 4S
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
L�J
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ SoillAA alysis El Waste Transfers
El Annual Certification
ZRainfall
El Stocking El Crop Yield El120 Minute Inspections L"I Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[-No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L'1 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
NNA
[3VA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El No
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
1VA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
�To El NA
El NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
To r] NA
❑ NE
❑ Yes
ZNo ❑ NA
❑ NE
❑ Yes
Rio , ❑ NA
❑ NE
❑ Yes Ejl Io ❑ NA ❑ NE
jAddidonal'C6mments and/or Drawings ti
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Q Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: / Z$� 6� Time: . 3 c
FQFacility Number �
Not O erational Below "Threshold
® Permitted 0 Certified [/ Coonnditionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: �il�4r�l6.:s1 / /Jtz _y>_'7y%lg kY(�r County: ea to �
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: -%O �Ce�� 1�Ci
or
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator: __— % (.1, l z
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' � OK Longitude ' 1 Du
Design
Swine Ca achy
Cubrent Design Current Design Current
Po ulat'on Pioultry Ga aci I'o ulaHon Cattle Ga achy P,o ulation
❑ Wean to Feeder
I
Layer
❑ Dai
Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
. x.
❑ Other
Total Design Capacity
Total SSLW
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons ©
Holding Ponds I Solid Traps Q
❑ Subsurface Drains Present ❑ La oon Area JC1 Spray Field Area
10 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/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i 2
Freeboard (inches):
05103101 t Continued
r

Facility Number: 31 —
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 proper]), addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered ves, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes ❑ No
❑ Yes ❑ No
® Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do anv sructures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
N aste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑p Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
I?. Crop rYPe t 2
J 13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAR'MP)? ❑ 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?
[I 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
1. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notifi? regional DWQ of emergency sinrations as required by General Permit?
(iel discharge. freeboard problems. over application)
❑ Yes
❑ No
23. Did Reviewer/Inspector fail to discuss review;inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
113 No violations or deficiencies were noted during this visit You will receive no fnriher correspondence about this visit.
_- 4 ... .'..n —... �� i , n =` •. ._ Y . ' .. _,� ..,.6 ke :.i✓ .a�'�.ir. F ^-+B"bf•'�,'
Comments,{refer io gnestton . Eiplauii.suy YES snsweis and/or,any recommencmtmns or anv ii er comments._
.�... ..,. —x
Use drawings of facility to better explain srinattons. (nse addt�onal pages s:s necessary) ❑Field Copv ❑ FinaI Notes
07 — 6 00,1 N I #' pva 4Pi j S el,00- l e "n At ire l 1e✓e% Trlmn )v i e �/� 4v7F`�tA/
ho�i know 9uAlle,/
" LAJ`114 42 lwals -1-ter5 d- cues -b Xe leowkw Or"r-o/Z'�re l
"11' fle "? _"� fi AIti - h i pYI %A
N1 2 7p i 1�G P t e
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Z G
O5103101 Continued

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
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. RVere 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 permanentitemporary cover? .
mments
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
O5103101

Q ion of water Quality
ouvision or Soil and Water Conservation
O Other Agency
Type of Visit O Compliance Inspection WOperation Review O Lagoon Evaluation
(1A
Reason for Visit outine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
t)ate. ut Visit: -=' i Tfine:
Facilityy' Number � / ��
0 Not Ouerational O Below• Threshold
O Permitted [] Certified 13 Conditionally Certified D Registered Date Last OperatedorAbove Threshold:
Farm Name: .............. c��!� � :.L�%,f�... e ��.y��{��—:............................................. County:.......... n (�. :�.-=........................................
OwnerName:................�� ................................... Phone No:........................._.............................................................
MailingAddress: .............................................................................................................................................................................................. ..........................
Facility' Contact: .. Title: ................................ Phone No: ...................................................
Onsite Representative:..�ri- .�`s:�...� ....r: � �:................. lnte ;r:�tor: ,.... , LUL ~. :..1 f......................................
*. .
Certified Operator:,,......,....... .. Operator Certification Number:..,....,....
Location of Farm:
[:)Swine []Poultry []Cattle ❑ Horse Latitude Longitude �• ��• �•°
Design Current
Swine Canacitv Ponulation
❑ Wean to Feeder
aFeeder to Finish
I,-) ^. O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I d 1[] Dairy
❑ Non -Layer I I❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon AreT ❑ Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Dischang,es & Stream Impactti
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made.1
h, If dischar•Lc is uhszrvec l_ did it reach Nkl;itcr ul'the Stater (11 y", n(xii'v DWQ)
c:. If discharge is observed, what is the estimated Ilo%v in iu''
d. Does discharge bypass a lagoon system'! 0i'ves, 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 storwc) less than adequate'? ❑ Spillway
StrUcaurC i Suucturc _' Structure SlrUClUre 4 Structure i
❑ Yes P No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
Structure b \
Idcntificr:............................................................................................
Confirmed

y 1
Facility Number: S�C<
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement'?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings`'
Waste Application
10. Are there any buffers that need maintenance/improvement?
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Croptype ! ~/��1 r �f �1' ✓. A //�✓� % i'��_c �=-: �'.�.i�1' 1
13, Do the receiving crops-8iffer with those designated in the Certified Animal Waste Management Plan (CAWM
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?
Re wired Records & Docunicnts
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24, Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes Q-No
i
❑ Yes P-}No
❑ Yes -0-No
❑ Yes —��No
❑ Yes --g No
❑ Yes f�I`No
❑ Yes -�TNo
❑ Yes -0No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes _�(No
❑ Yes 4 No
❑ Yes No
❑ Yes No
❑ Yes 1 No
❑ Yes �� No
❑ Yes lt' No
❑ Yes Q No
❑ Yes] No
❑ Yes 1] No
❑ Yes No
F0No violations or deficiencies were noted during this visit. You will receive no further correspondence 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): ❑ Field Copy ❑ Final Notes
y
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
Continued

Facility Number: ! —��! Date of I�>spection �'7 - ;�1:�. Printed on: 5/4/2001
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? ❑ Yes ONO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes d-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 probiems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ElYes d-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'? ==:
Additional omments an orDrawings:
r15103101
r15103101

Type of Visit Q Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0• Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
E:
E
ility Number 31 547 Date of Visit: 4/18/2002 Time: 1pm
Q Not Operational Q Below Threshold
Permitted OCertified ❑ Conditionally Certified [„j Registered Date Last Operated or Above Threshold: .........................
Farm Name: Dioxnoid..T..Farm.A.Y.irginia.Tumer................................................. Coup
Owner Name: Ckria.......................................Tumr ........................................................ Phone No: 9.10-29,8 .60.QR....................
Mailing Address: 42..C.abin.Strept....................................... ............... .......... 1Pixik.kII LNC........................... ...... Z85.7Z .............
Facility Contact: .............................................................................. Title:......................... Phone No:
..........................................................................................
Onsite Representative: Gejtn..Kev=dy....................................................I....................... Integrator: C.arrnF.s.-Foods.l uc..............................................
Certified Operator: .Ch rislopher.A..................... birnelr.............................................. Operator Certification Number: 26.0.79 ..............................
Location of Farm:
North of Heulaville. On South side of SR 1703 approx. 0.4 mile West of SR 1732. AL
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude F-35--le F 00 ' 07 K Longitude 77 47 30 K'
❑ Wean to Feeder
® Feeder to Finish
2396
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gifts
❑ Boars
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)
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?
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:.................I..................................2................. .......
Freeboard (inches): ...............2.5..............................3.Q...................

Facility Number: 31-547
Date of Inspection 4/15/2002
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes No
❑ Yes No
❑ Yes Z No
❑ Yes N No
❑ Yes CK No
❑ Yes R No
© Yes U4 No
12. Crop type Coastal Bermuda (Hay) Corn, Soybeans, Wheat Fescue (Graze) Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application?] Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes © No
c) This facility is pended for a wettable acre detennination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Rewired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
N Yes ❑ No
❑ Yes 0 No
❑ Yes 0 No
❑ Yes No
{ Yes ❑ No
❑ Yes No
❑ Yes No
Cl Yes dl No
❑ Yes 0 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes N No
[3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
❑ Field Copy ❑ Final Notes
15 Winter wheat overseed needs to be cut and bailed to prevent damage to Bermuda.
19 The lagoon readings for last year are in a disarray. The owner died last year which was the cause of this. The 2002 lagoon records
look good.
Rest of Farm and Records look good.
Reviewer/Inspector Namea,StnUeg
Reviewer/Inspector Signature: Date:

..05,413101 Continued
Facility Number: 31-547 Date of Inspection 41i81200Z
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 0 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 CR No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes C? 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 0 No

Ir= -6 Ji
(Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: Time:
NNot Operational Q Below Threshold
Permitted C] Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold: _ . .. . .
4
Farm Name: \cam G Count
_� ...�. ... .:................................ .......I...................
y= ....... _..�............
OwnerName: ................................................... ........................................................................ Phone No:
FacilityContact: ....... .................... ................................................... Title:................................................................ Phone No: .................................. _...............
MailingAddress: .......................................................................................................................... ..........................
Onsite Representative: 5,...... v A.^L �Integrator:
T..... �..................................
Certified Operator:................................................................................................................ Operator Certification Number: ..... :............. .._.... ...... .........
Location of Farm:
❑ Swine ❑ Pouttry ❑ Cattle ❑ Horse Latitude • ' " Longitude • 6 64
Swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design : Current , .. Design ..Current Design Curt eat
Poultry. Cii aci ._•.Po uladon Cattle •.Ca -ace .Cmcity Population � � -Poouiation�
❑ Layer ❑ Dairy
Ca3 ❑ Non -Layer ❑ Non -Dairy
❑ Other -
Total Design -Capacity
- Total SSLW-
NdInWro[Lagoons .:: :• . ❑ Spray �. - ❑Subsurface Drains Present Lagoon Area S ra Field Area
Holding Pozds 1 Solid Traps ;, ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
J�(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 gaUmin?
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
N No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
A�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
[gNo
Structure 1 Structure 2 Structure 3- Structure 4 Structure 5
Structure 6
Identifier:.................................................................................... ........... .......
Freeboard (inches): 9 ! ',_X9
5/00
Continued
on b"k

Facility Number:? Date of inspection G
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below N'Yes ❑ No
liquid level of lagoon or storage pond with no agitation? , `
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes EYNo
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 gNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Q Yes RNo
.Additional Comments and/or rawings:
Ake �6� lnz--" "tee cvp "-�e5."& 'kilf �Vzl t -,-,QkT
��^ to. SL.►��tc �- C�� 2kCL--f-� ��-�2 s
5100

Facility Number: 1 — Sf ( Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
?. Do any of the structures need maintenance/improvement? t,^ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ,R`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 evidenceof over application? [I Extls
lue Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes R'Tlo
'
12. Crop type N , 5ca C[ C.'64 . e
13. Do the receiving craps 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?
Reauired Records & Documents
❑ Yes N(No
❑ Yes ,K.No
❑ Yes kNo
❑ Yes ('No
JXYes ❑ No
❑ Yes [�klNo
17, Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes P(No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes VNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes JqNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 15No
21, Did the facility fail to have a actively certified operator in charge? ❑ Yes MNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑Yes ONo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes allo
24. Does facility require a follow-up visit by same agency? ❑ Yes PrNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes (R�No
�'�To yiQla iQtds;vl d fi:dj ndb$ •urge pQ€e4- dig tjUs'vlsit; • Y;oU 3<d1.te V'iye fie; futthoe -
6ri-es cedes: tt)auf: this visit.
Comments (refer to gaesfton #). ;Firplain any YFS answers aixVor any ,recoprmendations or_any ather rrim :'-
Use dra of factti to_better a lain srtuahons. use'addibonal _v es as n _.
.tY gP � . .. - ( . __.. 1��. ecessary) '.�
ReviewerMspector Name i}1
Reviewer/inspector Signature: Date: 5/00

Divrston of-Satl and Water Conservation Operation Review - s ,, .
' .-� Division of Son and Water Conservation Compliance Inspect�bn �r �
ji
Division of Water Quality 'Campiiance Inspection _ q=_yT=a ra 6�;
Other, Agency Operation Review -'' ' �„
Routine O Complaint Q Follow-up_of DWQ inspection Q Follow-up of DSWC review O Other
Facility Number .3
Date of Inspection 7 ! Z 40
Time of Inspection / : 4 24 hr. (hh:mm)
j3 Permitted 93 Certified 13 Conditionally Certified Q Registered Not O erational I Date Last Operated:
Farm Name: .� r .^,o wC� T Fe-, e- Y"A �j Vi'nl ! a -Fv, vt P✓` County:... [l ./..t..`'................................. .......................
Owner Name: ,. nn I Tv ,A Cv^ Phone No;
t.?. L?. �..................... .............................................................................................................................
Facility Contact:
Title:
Phone No:
MailingAddress: ................ .......................••.••.............. ....... ........................... �.......-.................4...........5... ..........................
Onsite Representative: �' �'. L�✓' %, GB d �>7E Integrator y ✓ ' `:..................................
7.. ............. ....... .
Certified Operator:.................................................:.............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude Longitude
Desi gn;Current Design -Current YDestgn4 Current. _.
Swine 'Capacity, Po�tilation Poultry Ca city Population,' - Cattle :Cap`a'city z,P,opulation
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish Z 2400 ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish I Total Desigm Capad y �-
` ❑ Gilts
❑ Boars Total`SSLW
Number of Lagoons 10 Subsurface Drains Present ❑Lagoon Area91 Spray Field Area
Holding Ponds / Solid Traps 10 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? ElYes f9 No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes Vf No
c. If discharge is observed, what is the estimated flow in gallmin? h 14
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes Ef No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JD No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 7j 9T2—
Freeboard (inches): ...........9 .... Z .................................................
.....................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0 No
seepage, etc.)
3/23/99 Continued on back

Facility Ntimber: Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11, is there evidence of over application? ❑ Excessive Ponding ❑ lPAN L
12. Crop type t3eY,mtJ4 �4y, Sri.a/I 6�,ec;_7, fe,n'�?UL�A 61,rizz, 6,orri,_Whc'`�1Z
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA
14. a) Does the facility Iack 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?
❑ Yes
0 No
❑ Yes
JZJNo
❑ Yes
® No
❑ Yes
O No
❑ Yes
ff No
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.)
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: Rd -yio-a0Qt>!s or• deli. eie diaeg were n4{ed• d0rtng �bis'vis. it' . ,Y,O.WWill -t&Oye lid f'ui-th&
;corres�ontdence'. about; this visit:
411 S /`1 *tf _ Am lull
❑ Yes
-[Z No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
W Yes ❑ No
❑ Yes 21 No
❑ Yes [XNo
❑ Yes [gNo
❑ Yes � No
❑ Yes V1 No
❑ Yes ® No
❑ Yes ® No
❑ Yes 16 No
❑ Yes S1 No
❑ Yes ® No
Comments (refer`to question #): ~Explain any YES answers and/or any'reconiinendations or.any other comments
Use drawings of facility to better explain situations � (nse additional;pages as:necessary)
., -,
H. Lva s4e rs Po1.4¢d �'4 -the and oil -r 61,74 Volk
_b P ,' e4 v .'es t✓e ee 4'q Lm . 41 S.d, � 4e, e 7=s
ctr¢ ,ryf �ct-1 soh eVgeVjjs 01
LirsP,rij1Az_j,-e
^a�v1c1rsn5r4r-b53 eXeeeCbV�drIT11
. , 1S,�4ae
hpi I7q�R'.,e,,i /7 aG 7
c a)1j1 cue, T^"rrayeritvdq ^az
6e,-,ltvi rned xis 3n�vt�� b elirhirta�� oft en 9�QS5Gs/w�eLCJ 0,-Cl q),l
;e1d 4Q �es61)e 9r4ze -t -ej �- 40n 6elrymvd�
014) 1W
7.
Reviewer/Inspector Name ` j .�e yt c i�! i1 j1/--i J� . _ -Y -
Reviewer/Inspector Signature: Date: 71/2 by(1

Faeility Number: 3a' — hate of laspection 12 A9
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 any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes [J No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
AAditional Coinxnehts: and/or Dirawtlip: u,y
a
� S. ,��jjc or�� � �� ss �s L�r..n. a 1 � �c ►� .M u d �. -�'; e ids -) "� /a 19� pv II s 1-� Z
!� G �' r"i tl d Gl H g 1,/ �Z �l v)e? �1 � Jr+12 ✓� V �'S GJi-Vt 4� �1 0 %1 /C72r r`1, V G{ i1 q''�A tS G I l� ,'� � -� .
I�-y,f�5q))�,o� �•,a� �,- gc,�P��es �n Ind wl4t� :✓�rj'yR�iah G%s;�y; ]
i7 W�S'?� �r�� wed.°��r ,alp "ro ►'�q-�C� ��r+,'C�J�.+nvl �iGs�grl "p
GI f"
3123/99

0 Division of Soil and Water Conservation Operation. Review
Cl Division of Soil and Water Conservation.- Compliance Inspection
; f Divisiomof Water Quality -,CoznAkiice. inspection ` .
[3 Qther Agency ' Qp6f;itiom evtew a =<
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review�-70 Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
0 Permitted Certified [3 Conditionally Certified 0 Registered [3 Not Operational Date Last Operated
Farm Name . ........ .............. .. ........................ iAgj N �r�Q.....�,.A.rr4j County ... /..)1-...-... U..........
OwnerName: ........ ................../../ ..(%4.�.........................-....................................... Phone No:...... . ..:2...... UaDP.........................
Facility Contact. .--. .a . .b......... 3+wS........ ............. Title: ...................................... ..-...... .......... Phone No: Z..'.. A.�..L`*. . .
r7l
Mailing Address: ��..4�.1�s�T ..............................h �.i'L.!G�... ...~.�..Y...� .... /....F� a...........:�$.�.2.2
rs
Onsite Representative:.........r�rk.rZ,............;kkr. kl. ........ I Glrtegrator:...ls'/................................................................
Certified Operator: ....................._ Operator Certification Number:...........
Location of Farm:
.................. ........................................ ............................................................................................................. ---•--.•---.........................---.
Latitude 0 ' Longitude • ' "
.Swine
- ^ Design Current
Capacity Population
❑ Wean to Feeder
XFeederto Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number of Lagoons ®: ❑Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
,,_
4oIdrng`Ponds'/ Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ElLagoon ❑ 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. Dues discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any"part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Struc re t Structure 2 Structure 3 Structure 4 Stnucture 5
Identifier: (C.
Freeboard(inches): ......... ........................... z . ................... .................................... .. ................................. ............................
5. Are there any immediate threats to the 'integ ity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes Of
❑ Yes XNo
1l/4
❑ Yes f [4No
❑ Yes [;(Nd
❑ Yes 0 No
❑ Yes No
Structure 6
❑ Yes No
Continued on ack
seepage, etc)
3/23/99

Facility Alumber: — jL/ Date of Inspection Z!
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 KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes o
11. Is there evidenceofover application? �+❑ Excessive Ponding ❑ PAN El YesTNo
12. Crop type ! bv< IRA/ , J Irn Ariti�r 2-37[y,a
13. Do the receiving crops di er with t ose designted in the Certified Animal Waste management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes gNo
15. Does the receiving crop need improvement? ❑ Yes �)&o
16. Is there a lack of adequate waste application equipment? ❑ Yes o
Renuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
[]Yes
[[No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
o
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
o
rNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
7No
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
aNO
24.
Does facility require a follow-up visit by same agency?
❑ Yes
1A No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
gNo
0: Rio •violations:or• deficiencies •were noted• during this:visit: Yoh wu •receive Rio further • ;
- correspondence: ab' f this .visit. . . . . . . .
Comments (refer to question #)..;Explain any YES answers and/or any recommendations or any other coinmemts-
UseArawin --.of facility to better explain situatfi ms (use additional pages as -necessary)
... ---
31 _ 347 3/-_6'44 A44e beck 40MA eid ,Mite a-K.t rcw4e p 4n iatra T77
Ti.s rn 8 ✓ �z 7�'/�� '
C1yn3 errs! it �1 S/ k
/ 47sc.`p /Ll3l ?%Ai Z+i-1i_f) Wild -Ap
)ZA14 e 1 � k-Fri
041- b-e a,e % ,
Re viewer/Inspector NameC.i'ra';P� /!G;
Reviewer/Inspector Signature: Alf Date: //-2—Y �jf
3/23/99

Facility Number �(L�7. Date of Inspection
Odor Issues 31 J S-ff
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes kNO
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes SIo
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 XNo
30. Were any -major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ;Wlo
32. Do the flush tanks lack a submerged fill pipe or a permanent/terrtporary cover? ❑ Yes No
,&I
I
3123/99
•:I
•''•.•r-.— "r.— .. r. . --... � - . ... - . . _ ... CT'•�.,'-1'^.T.'�..�.5"r„'.^.v+�'�^.""'+".�'T•:—� ^^9'r�..r.��`.•. _ _ . _ .. - ..'o.. . .. -.— . � � ... ........ . .

Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
1RPRoutine O Complaint O Follow-up of DVVQ inspection O Follow-up of DSWC review O Other 1
Date of Inspection /q➢
Facility Number 3 Time of Inspection Ui 36 24 hr. (hh:mm)
13 Registered 0 Certified 13 Applied for Permit 0 Permitted JE3 Not Operational Date Last Operated:.- ................_.....
bza-rnc�a Y
FarmName: ....................p�� �,.........zkr x:...................................... County: .... 4................................................................
'c's. 7 C.9ta)..g8','�
Owner Name: ..................:. vtntf.................................................. Phone No:.............. Z.....'.....$%........................................
Facility Contact:
Title:
Phone No:
MailingAddress: ..................................................................... ................................................ ..................................................................................... ..........................
Onsite Representative: .............._�.._Tv.`.?`� ....................................... ............... Integrator:..................................... ....
CertifiedOperator;............................................,......................................................a........... Operator Certification Number ..........................................
Location of Farm:
Latitude Longitude
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
2. Is any discharge observed from any pan of the operation?
❑ Yes
[0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
[0 No
c. If discharge is observed, what is the estimated Flow in aaUmin?
"1IT
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
[ZNo
'4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
09 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
® No
- - maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
1�1 No
7. Did the facility fail to have a certified operator in responsible charge?
❑Yes
P No
7/25/97
Continued on back

Facilit,v Number: 41
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoon..Iioldini Ponds, Flush Pits, eW.l
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft): .....
10- Is seepage observed from any of the structures'?
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
Structure 5
❑ Yes RNNO
❑ Yes [ONo
Structure 6
..................................................................................
0 Yes jR No
❑ Yes [2) o
12. _ Do any of the structures need maintenancelimprovement?
® Yes
❑ No
(If any of questions 9-I2 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste :application
14. Is there physical evidence of over application?
❑ Yes
[K No
(If in excess of WMP, ur runoff entering waters of the State, notifv DWQ)
15. Crop type.................r0.ir.Scr..n ........... ......... �.t4,.r.....
16. Do the receiving crops differ with those designated in the Animal Waste i`4anagement Plan (AW VIP)?
❑ Yes
R No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
N No
18. Does the receiving crop need improvement?
N Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
i] No
20. Does facility require a follow-up visit by same agency?
❑ Yes
No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative`?
f
❑ Yes
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?
❑ Yes
No
24. Were any additional problems noted which cause noncompliance of the Certified AW,UIP?
❑ Yes
( No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
No.violations or deficiencies. were mated during this, visit. You.will receive no further
correspondence alioitt this. visit.•'.' .: '
Comments (refer,'to gpestion #f): MEttplain any Y`I S=answers andlar any recommendations ar any tither comments �: ,
iisedrawings of,facthty to better eXplain situations :(use additional pages as necessary)
1.2, Caw{t��� e�{orti5 ta�bc:ti QX%L, w-Al.
17- Cc-4z%t u_tt tsr, s► lt<1 be- cen.�la lYrfir�eakla� � St�w s1,ov� i�� � � vcrordS.
WU� .`off his<� et, otee� acrea�G .
7/25197
Reviewer/Inspector Name
Reviewer/Inspector Signature: _ Date:

s�
t Z
i
❑ DSWC Animal Feedlot
OperatlonY Rev]<ew
..
�DWQAnimal Feedlot
4pe�rahon S><te Inspection k
JQk Routine O Complaint O Follow-up of DWQ inspection O Follow-uR of DSWC review O Other
Date of Inspection+ p�
Facility Number 3 j
Time of Inspection i O 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: Registered ❑ Applied for Permit (ex:1.25 for 1 hr .15 min)) Spent on Review
Certified ❑ Permitted I or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: ,....._..._. _ .... _............. ii
Farm Name:.. County: n... ......... W.... _ ..........._ .
ll4Yl�i?Y)r r fes.Y�!1�.. ...... _..... _.... _ .._ .. ......,
Land Owner Name: phone No: __.q I —
Facility Conctact:........... _...... _..... ........... .. Title: Phone No:
� I
Mailing Address:.113...'n ccll .?+.....
........_....... _.... .,,,,..... ........ ..._..... .......... .
� x. .] . _.... .Y ..ti�--- ._........... ..... ....._. Integrator:.
Onsite Representative: 3 !!4e-pl :...... .._.... ......... ...........
_...._._.
Certified Operator:1Ck,[.1.5`.,r.Operator Certification Number:
Location of Farm:
Latitude 35 ' oo ' 01 u Longitude �• ®�"
TVDe of ODeration and Desien CaDacity
+moo a-cI .
ne DeSign Current , Design Cu lent t R Design CurrenEh
Poultry ...Ca aciPo ulatton Cattte Ca aci Po Mahon
..: �v.Ca aci Po nlatian,n .,.
❑ Wean to Feeder ❑ La er ❑ D
® Feeder to Finish l i b 0 Non -Layer ❑ Non -Dairy
Farrow to Wean :° �� '` `f
RbARM
To al Destg pac ty Farrow to Feedert n Ca I ,
Farrow to Finish
L
❑ Other T .y
Tota! SSL _
u
Number ofLagvons_ 1 Haldtng Porids� ❑ Subsurface Drains Present
x zh' ❑ Lagoon Area aP ❑ Spray Field Area
�d'neraj
1. Are there any buffers that need maintenance/improvement?
2. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
® Yes ❑ No
❑ Yes ® No
❑ Yes
® No
❑ Yes
No
. iJYPs_
❑ Yes
M,.No
❑ Yes
® No
❑ Yes
® No
® Yes
❑ No
Continued on hack

Facility Number:-2,..... ..—.SL_t.7..-
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 9 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes BNo
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ®No
structures (Lau
Dons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
10. Is seepage observed from any of the structures? ❑ Yes &No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes D9 No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
I4. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type -.................. _.... W... -- -....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Ce-r-thfied Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
® Yes ❑ No
® Yes ❑ No
❑ Yes 2�No
❑ Yes RNo
❑ Yes RNo
❑ Yes KNo
❑ Yes 91 No
Q Yes ❑ No
❑ Yes 14 No
❑ Yes 9LNo
❑ Yes 9L No
®. Yes ❑ No .
Comn ents (r'efer to g testlon #l) Explakn any YES answers and/or'any`recommendations or any other comments
Use draunngs of facility to better explain situations {use adcigtional-pages•as necessary)
� _
...�-.N
� ., - .{�
I . - - i n. � l e.u. $ � a w. .�fi.. � c i L v f �o--�.`�w��-a•� c�.�-A S � Y-a`-y -�--eL
1c�-�+L
Q
ml. E-c_ kA-C• A-1 y a c- c d dL i. off w t o tL I+
5 • b i cnr�.'E 4 +� � s i +,•. � rro csu S a { �..,a�v , � ti i r•,.P.�r ti wS 'ta � � i +,. 1 o�-q a o �•-.
0 4 o-.v ,R -j
+; e", c„-,r- l �L c o %1+ r
A r e ",- V t S w 4 I 0 C C V T P! Tw 17*�- 1 v`�Oti v� 1 , S C 0 ✓`^
t
`f
t_-ar t t 0 a; rt
Reviewer/Inspector amen xx.. r w °:o Yz .�as.?.gsz .au.✓ m d�+2.
Reviewer/Inspector Signature: Date: 7 10
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit
4/30/97

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