310548_INSPECTIONS_20171231

r
NORTH CAROLINA
Department of Environmental Qual

Date of Visit: Arrival Time: '--1y-I-- .j Departure Time: County: � {
Farm Name: (j�ll Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: C lD firy G wuw
Certified Operator: r & MQ'(
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Region: V0
Certification Number: I � S sK S-
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
EE
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) . l;oul
La ers
Design
Ca aci
urrent
P,o
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�'No
❑ NA
ONE
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
0 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
D NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of inspection:
I*aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes <0
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): SIS
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
❑ Yes O-N'o ❑ NA ❑ NE
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` 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_,E3<o❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XfNo ❑ 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 > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift , ❑ Application Outside of Approved Area
12. Crop Type(s): j �[J
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes _Ej No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ZroNo
D NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �No
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes Flo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
,[2No
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 2-r4o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes �o
❑ NA
❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes VNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection.,
. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ,2rNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes E3-<o
❑ 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 [30No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes �No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes J'No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
r
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 0 No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes _C3"'No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes,No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes VNo ❑ 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).
� 1 j � �
Reviewer/Inspector Name:t Phone: i� ` W—O%
Reviewer/Inspector Signature: Date: D
Page 3 of 3 2141201

Type of Visit: 0 Compliance Inspection O Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: �JT1A7-j A;J M ZLLcA, integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: �� Z
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
MI
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
C•att[e Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
t"'
J
Dairy Heifer
Farrow to Wean
Design Current
D . P,oult . Ca NO
Layers
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys_
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 [�J/No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA [] NE
[:]Yes �No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

] aicili Number: - Date of inspection:
Waste Collection & Treatment
4' Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Z"No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA W6�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes OlNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 2� No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ONE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes (ZI/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 CAW MP?
❑ Yes
o
Z
❑ 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
E; o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
I& Is there a lack of properly operating waste application equipment?
❑ Yes
[% "o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
ff No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes u ° ❑ 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

'yj
Fi+dli Number: ^ - Date of Inspection: ,1a
24! Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes d�No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZNo ❑ 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
o
❑ NA [3 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
I' I No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
WNo
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes dNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 61 o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question'#): Explain any YES answers'and/orany additional recommendations or any other comments.
Use drawings of facility,to_better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
M
Phone: ! b - b it
Date: ' q b w1b
Page 3 of 3 21412015

Type of Visit: Q Com ance Inspection U Operation Review U 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: C j� 11 Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: ,J W(4 T Integrator:
Certified Operator -
Back -up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
tapacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish 12 00
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,ouI
Ca aci_
P,o
Non -Dairy
Farrow to Finish
ILavers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey PouIts
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
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 eNgo
NA ❑ NE
❑Yes ❑ NA ❑ NE
[:]Yes r2eo ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili ^Number: -G jDate of Inspection: 11
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No [DNA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):'
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(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
2J/No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E(No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes EZ/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [;3/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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
l__I ❑ 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
"Ngo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�O-❑ 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 V 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 o ❑ 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 o
❑ 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
[DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes �zo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 0 No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes dNo
[DNA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C j No ❑ NA ONE
�N ❑NA ❑NE
No ❑ NA ❑ NE
Comments (refer:to question #): Explain any YES'answers and/or any additional recommendations or any=other comments:
Ilse drawing of facility to better explain situations (useadditionafpagea as necessary). -
Reviewer/Inspector Name:
A Z11)C_ b -
Me
Phone
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

Type of Visit: Q ConAliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other nQ Denied Access
Date of Visit: , Arrival Time: Departure Time: _L � County: l Ut' Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: U��� N �� Integrator:
Certified Operator: Certification Number: /
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pap.
ILayef
Nan -La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oul . , Ca aci P,o ,
La ers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
keys
Ot keyPoults
Other
Beef Brood Cow
t?ther
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes Zo
NA ❑ NE
Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: I- Date of Inspection:
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
I 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 environmenta
hreat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
N ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
El Yes
rNo ❑ 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
Vio ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 ❑ NA
❑ NE
maintenance or im rovement?
P
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
V
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes -VNo
[:3 NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes N
❑ 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
[DNA
❑ 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 CJ "' /
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes LS.�'1""
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

tacifity Number: jDate of Inspection: L
44. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes �WNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [—]Yes !Ko
❑ 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?
❑ YesO ❑ 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 to ❑ 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 � ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
.T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes WNog ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ 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
i
Phone:q jo .
Date: f
2/4/ZO 4

Type of Visit: O ZRoutine
pliance Inspection U Operation Review O Structure Evaluation O Technical Assistance
isit:Reason for V0 Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: L Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: `j vt)ATi "` Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Nan -La er I
De sign Current
Dr. P,oult , C•_a aci P,o ,
Layers
Non -Layers I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D Cow
Non -Dairy
Beef Stocker
113eef Feeder
Gilts
Boars
Pullets
Turkeys
Turkey Poults
I Other
El
lBeef Brood Cow
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
E
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E]
FN
❑ 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: -51 Date of Inspection: 6V17ta
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes
[:]No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LAej�d�
Spillway?:
Designed Freeboard (in):
j)
Observed Freeboard (in): �j b
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
ZNo
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ 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 hreat, notify DWQ
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 rNo ❑ 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 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes 2 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D401,
01 ❑ 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 rNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? D Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EKO ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes P'�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 Eleo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes E/No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes 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 LJ '' ❑ 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

FacflitX Number: jDate of Inspection:
2�4. 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 to provide documentation of an actively certified operator in charge? ❑ Yes VN:/
NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Ef No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [:]Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 121 0 ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes PNo
N ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ 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: 3
465& Date:
. /6 /tZ
21412011

Division of Water Quality
Facility Number � - SZ/ g � Division of Soil and Water Conservation
Q Qther Agency
Type of Visit: 0 Co pliance Inspection Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: y Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:-7�Nnjiuj rAzu— t,66'� , Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: Rci ,
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
esign
DCurrent
Wet Poultry Capacity Pop.
Layer I
Cattle
Dairy Cow
Design C*urrent
Capacity Pop.
Wean to Feeder
I I—Non:La-yer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Q
Design Current
Dt, P,ault , Ca pA ri P,o ..
Layers
Non -Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
I
Boars
Pullets
Turke s
'iurke Poults
Other
Beef Brood Cowd
Other
Other
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 [:3lNo ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes ❑ No ❑ NA ❑ NE
[:]Yes ZNo ❑ NA ❑ NE
❑ Yes ;244o ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Ins ection: b 7/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
.1
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: C
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):`
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ff 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 environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ 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
l0. 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
❑ 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 ;70
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes rNo
❑ NA
❑ NE
Required Records & Documents
l9. 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
❑ YesVNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [3�rNo Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: 404
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I__I 1V ❑ NA ❑ NE
250s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
N ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑Yes
No ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ o ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
vo ❑ 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
Ej 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
❑ Yes
❑ Yes
VNoE,]
NA ❑ NE
NA ❑ NE
NA FINE
Comments (refer to question 9): 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)..
5U,06.6
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone
Date: % 0 (�
214120 11

Type of Visit: (ZF Co Hance Inspection O Operation Review O Structure Evaluation p Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Zt Arrival Time: / D Departure Time: County:Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: joWATIVJ Ala_LLfrL_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: ^ Cj 1 :7 j ?-
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current Design C►urrent
Capacity Pop. Wet Paultry C►apacity Pop.
La er
Design
Cattle C►►specify
Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er
Daig Calf
Feeder to Finish
f /b
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Farrow to Finish
D , P,oult . C_a aci Pao ,
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turkeys
Turkey Poults
Other
Dischars+es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ ❑ NA ❑ NE
❑ Yes rl"No
Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: IDate of inspection: Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
5b
Structure 3 Structure 4 Structure 5 Structure 6
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
M/No
❑ NA
ONE
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
[2/No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[—]Yes
[D,'�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 [�Xo ❑ 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 2fNo [DNA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�]4o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;io
❑ NA
❑ NE
Re aired 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 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes n/No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faeffity Nu ber: - Date of Inspection: g
24. Did the facility fail to calibrate waste application equipment as required by the permit. Y No NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes 0 No NA 0 NE
the appropriate box(es) below.
Failure to complete annual sludge survey OFailure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon _ rWl l jJ
List structure(s) and date of first survey indicating non-compliance: ZQOV 50064 PA 6. S 9 V
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ff No NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes a/No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
[2No
NA
NE
and report mortality rates that were higher than normal?
No
29. At the time of the inspection did the facility pose an odor or air quality concern?
Yes
[✓7
NA
NE
If yes, contact a regional Air Quality representative immediately.
No
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Yes
[✓3
NA
ONE
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
dNo
NA
NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes WN'go
NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [] NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? Yes &/No NA ONE
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
Phone f
Date:
2141201

• =D[vislOn of Water Quality ''J-fc
acilit 'Number Obivtsioin of Soil�:i Water_Conservation­Z,;:,
wX #
•F
6=0ther :Agency,;,
Type of Visit Corn liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (9rRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: _ 1JAMI tL/ .CLL Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = c = 1 0 fl Longitude: = o
;n 'Curre
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
tier,
Other
77T—
in = :Wet Poultry C
Q.
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Cow
Calf
Heifer
U Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at:. ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 E21/No []NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
["No
❑ NA
❑ NE
❑ Yes
[�lo
❑ NA
❑ NE
12178104
Continued

Facility Number: 31 — Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure lI Structure 2 Structure 3 Structure 4
Identifier: LA&V-6N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes El /NoE3 NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre t, 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 Eq,<"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 9'<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 8No ❑ NA ❑ NE
maintenance/improvement?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
0 o
El NA
El NE
No
❑ NA
❑ NE
11:e�No
❑ NA
ElNE
q,T1.1W
El NA
El NE
El No
El NA
El NE
Comments(refer to question #). dE_xplain any YES answers:and/or any.recommendations or any other comments ` ""
,Use drawings of facilityto better explain situations (use addittonai pages as necessary) s S»
1 a%i Da�J� �e2 fEpr 2A�N
Reviewer/inspector Name J - d° $ Phone: 5 -
r
Reviewer/Inspector Signature: Date: a
Page 2 of 3 1 12/2A04 ` Continued

Facipty Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
` '" o
❑ NA
❑ NE
the appropriate box. ❑ W­Up ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
to
[] NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E5/No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M<o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ro
❑ 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
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,��
LJ 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 concem?
❑ 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
NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
NA
Fo
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
NA
❑ NE
Additional Comments and/or Drawings: ,
� N'
Page 3 of 3 12128104

Type of Visit Q Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit dRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: OLIPIL:W Region:
Farm Name:
Owner Name:. 0
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone No:
Onsite Representative: 'To NAT1lA'.) M xL_t__E aL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = . 0 Longitude: = ° = d =
i
Current
Design Current Design Current
0111111Design
Swine
Capacity Population
Wet Poultry
Capacity Population Cattle Capacity Population
❑ Dairy Cow
❑ Wean to Finish
❑ La er
❑ Wean to Feeder
❑ Dairy Calf
❑Nan -La er
© Feeder to Finish
t. loo
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder i
❑ La ers
❑ Non -Dairy
❑ Beef Stocker
ElBeef Feeder
El Farrow to Finish
Gilts
❑ Non -La ers
❑ Beef Brood Co
po Boars
El
Turke s
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
1 ❑ 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?
Page 1 of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
o
El Yes
WNo
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 3i Date of Inspection I W�Iog I
W ste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA [mss�j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): aq
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes FI No ❑ NA ❑ NE
❑ Yes ❑ No Cl NA ❑ NE
Structure 5 Structure 6
❑ Yes [� No ❑ NA ❑ NE
❑Yes 2jNo El NA [I NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes U(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes EjNo ❑ 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 [,TNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 21/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
[2(No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L/ I No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
In No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
El NA
[I NE
18. is there a lack of properly operating waste application equipment?
El Yes
WNo
❑ NA
❑ NE
a'.
+,Comments (refer3toqueshon:#} Ezplaen any,YES„answers�and/or�any recammendattonsvr anyother comments-
C�"+`+' I S -_
'Yy R®4
Use -drawings ofFfactltty #oybetter ezplatn sthtattons>(use�addrttorial pages asLneeessary).E�
��.-.cw.
i
Reviewer/Inspector Name
.sNt-!R{uE,� - - Phone:�9�� 75[ 73�6Y
Reviewer/Inspector Signature:
UL, Date: tbb L
12128104 Continued

Ffcility Number: 31 — Stf'� Date of Inspection 16
Re wired Records & Documents {J
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes CNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EJ No ❑ NA ❑ NE
the appropriate box. ❑ VAJp ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ETN/o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections' ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ErNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ErNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ElrNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑"N' o
❑ 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
allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
Q"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
CNo
❑ 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
BIN- o
❑ 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
LJ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
El No
❑ NA
❑ NE
12129104

Type of Visit ,CO pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ;O Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: la Z O Arrival Time: Departure Time: County: QIPLTh Region:
Farm Name: Owner Email:
Owner Name -
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: J�A�Qt_) M-X(.L&
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: o = Longitude: C
o=i ❑«
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
to Finish
❑ La er
❑ Dai Cow
Ean
an to Feeder
❑ Non -Layer
❑ DairyCalf
® Feeder to Finish
f (o
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
ElNon-Layers
❑Beef Feeder
PBoars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Ot]
❑ Other
urkey Poults
10 Other I
umber of Structures:
lI
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑No
ElNA
ElNE
2. Is there evidence of a past discharge from any part of the operation?
ElYes
O]No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
C3<o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued
r'A

Facility Number: 31 — Date of Inspection !o a
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: / A CM622
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 136
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
0 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
E2' o ❑ NA ❑ NE
through a waste management or closure plan?
at, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaRN�
7. Do any of the structures need maintenance or improvement? ❑ Yes
El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[I 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
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
C1 No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
V<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 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
[2/No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
dN0 ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1,2/* ❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments;(refer to question 0-Explain any4YES answers and/or, any recoiiiiriendatioas or' any other comments.
..
Use drawings.©f�facilitytogbetter,plam,sit tians. (usdditianallpages as necessary):
Reviewer/Inspector Name (u Phone:
Reviewer/Inspector Signature: Date: / 0 0
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
14. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [nNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
24. 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 O No ❑ NA ❑ NE
❑ Yes �o El NA [I NE
El Yes 7 ❑ NA ❑ NE
❑ Yes L No ❑ NA ❑ NE
❑ Yes [V`o ❑ NA ❑ NE
❑ Yes ❑VIVO ❑ NA ❑ NE
❑ Yes ' ❑ NA ❑ NE
❑ Yes L1 No ❑ NA ❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
I'J No ❑ NA
❑ NE
❑ Yes
El NA
[I NE
❑ Yes
ZNo❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number � j S ��
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit (7f,Copliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit lD Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: r ] o Arrival Time: /p Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
OnsiteRepresentative: _ JimlaTHo1 mz1'L'oL_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
�o
Latitude:
Phone No:
Operator Certification Number:
Back-up Certification Number:
E__1" Longitude: = ° = 6 = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish /d dl7
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity ,Population
r
❑ Dairy Cow
❑ Daia Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
i
Number of Structures: F
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 2rNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 2 No El NA El NE
El Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment �T
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes EXNo ElNA [I NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structu�,reI Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:LA- �
Spillway?:
Designed Freeboard (in): oZ
Observed Freeboard (in): -'Z'(I
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0<0 ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 2No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Q 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 Ld No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EJ No ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E_f 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 IJ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? E Yes ❑ ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
C'J No
❑ NA
❑ NE
9'No
❑ NA
❑ NE
g*o
❑ 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):
1 F.r fps �tIE6j tJE6,P (OW f 1U L , A'VAltIffN ?A- 6- kASJv1L r6vt,-Vr47tl 4&r o
OAITi41- OA Q — A Xp—,o;
-2d-) t1tA4TE (A& ooN hZ f'r& c1, C��N-t r.6 "rrH Stu (_
logg
A16& M� SG!/h�E / e�%,
Reviewer/Inspector Name 6 tG� Phone: 9 6 -- 73ff
Reviewer/Inspector Signature: Date: 4 v
/ 12128104 Continued

Facility'Number: Date of Inspection d
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 CA7",P,;
readily available? If yes, check
the appropirate box. ❑ �p ❑Checklists gn ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ 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
❑ Yes U?6 ❑ NA ❑ NE
Ud es ❑ No ❑ NA ❑ NE
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
o
❑ NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
WNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
d o
ElNA
ElNE
26. Did the facility fail to have an actively certified operator in charge?
ElYes
WNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
❑ NA
El
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El 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
El Yes
L� No
❑ NA
❑ NE
General Permit? (icl discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1.17 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E 2'INo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

6ivision of Water Quality
Facility Number 3 Division of Soil and Water.Conservation
- O Other Agency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (:;I -Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: a Departure Time: County: Region: �!
Farm Name: S Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: —
Back-up Operator: _
Location of Farm:
Title:
Phone:
Phone NO:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = d =61 Longitude: = ° 0 t = u
Design Current Design Current
Swine 'Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I I JE1 Layer
❑ Wean to Feeder ❑ Non -Layer
❑ Feeder to Finish T
❑ Farrow to Wean Dry:=Poultry
❑ Farrow to Feeder i
❑ Farrow to Finish i
❑ Gilts
❑ Boars
Other
❑ Other - - —
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Cu!
Cattle Capacity.. Popu
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures
J.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes
❑No
El NA
❑NE
El Yes
El No
❑NA
El NE
El NA
El NE
El Yes
El No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: `3 — Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 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
l8. 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 orany'other comments
Use drawings of faciility to better explain situations. (use additional pages as necessary.):
Reviewer/Inspector Name I « �oe / ( Phone: 9 Of
Reviewer/tnspector Signature: Date: 62
page Z oj,i ILIL51U4 uonrtnueu

Facility Number: — Date of Inspection f—
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 El Checklists El Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Nv 14�40e,6 o u`� a r ✓ �i h > `� � o SJ
Page 3 of 3 12128104

Type of Visit �C,00mpliance Inspection O Operation Review () Structure Evaluation O Technical Assistance
Reason for Visit C� Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: lq o Arrival Time: D 30 Departure Time: County: O t/ .. Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone No:
Onsite Representative: _ Gtj" keMwiI-.a q Integrator:
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
Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: [ o[ ❑ Longitude: [� o [� s 0
ds
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
l
❑ Beef Feeder
❑ Beef Brood Co
I
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 E/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
E/No
❑ NA
❑ NE
❑ Yes
D No
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — sy Date of Inspection �r`+
Waste Collection & Treatment '
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes OlNo ❑ 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: t4 600 A t
Spillway?:
Designed Freeboard (in): 5 t ;,4•q
Observed Freeboard (in): a -.L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Z 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 environmentalth
at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [INA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? El7 No
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[ fNo ❑ 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 I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence off Wind Drift [:]Application Outside of Area
dl..�
12. Crop type(s) 6(wjVyA 01) SGr
d "�sW Aw/an ca
13. Soil type(s) �uej `A���_�_ �_/
14. Do the receiving crops differ from those designated in the CAWMP? El Yes IQ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?2/Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
dNo
❑ NA
❑ NE
17. Does the.facility lack adequate acreage for land application? Yes
El—
<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
P4.
❑ NA
❑ NE
�.-
s,) r; (_, n s .r.� t3larD 51� 13Q1✓, ocs P ep m r b w E E� �1'� L.. 10EE P �s7Fp�1il°►�H
a �.} 6LA �nI Fri t,tr AuD . 1"(ZAWfi%A. W661DS ro 43C ,ram#J6 ,
" 60 onJ O6 Sxt� �t1 NR s f�.7 ��e� srH 7S" " ac yam. -��f u� 2 klR I ,� X- y
�immty N LE W"P-k ra �a�c�
2FQ✓.�- b FTZ'e650R r �rPDgTF OFs�G7'� fA6Al)ij� ti46��/
Reviewer/InspectorName a1 / -1-AaA"
Reviewer/Inspector Signature:
Phone:
Date:
I L/L6/V4
,D aicy
s,
Continued

Facility Number: Date of Inspection `/ n
Re aired Records & Documents
19. Did the facility fait to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAZes
W readily available? If yes, check
the appropriate box. ElWUP ElChecklistsi an El Maps ❑Other
❑ Yes No ❑ NA ❑ NE
ZYes ❑ No ❑ NA ❑ NE
21. Does record keeping neeZirovement? If yes, check the appropriate box below.
Yes
❑ No
LiNA
LiNE
ElWaste Application eekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
[3 Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 1J Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�40
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ENo
❑ 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
['J NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[�<o
❑l NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
ElNo
C NA
❑ NE
Other Issues
No
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑
[NA
❑ NE
29.
Did the facility fail to properly dispose of dead animal's within 24 hours and/or document
❑ Yes
dNo
❑ 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
6o
❑ 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
El Yes
LQ 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
ll1 N
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings
61
12128104

+ t 4
Date of Visit: Time:
Facility Number
Not Q erational 0 Below Threshold
IN Permitted ® Certified
// [3Conditionally Certified 0 Registered Date Last Operated or bo�ve Threshold:
Farm Name: il,tl�^/ L�r�i _aL _ �Iw1 _ County: 6e /`
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative:Q - _ Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑Horse Latitude 0 6 " Longitude a 6
Discharees & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Fieid ❑ Other
a. If discharge is observed, was the conveyance man-made?
b_ If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: %
Freeboard (inches): 123
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

w
Facility Dumber:
Date of Inspection L$
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?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
�;�aste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type(-
13. Do the receiving crops differ -,vith those designated in the Certified Animal Waste Management Plan (CAIANP)?
❑ Yes
❑ No
14. a) Does the faciiiry lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
=: 18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists. design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
® Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(icy' discharge. freeboard problems. over application) ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review•rinspection 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
t© No violations or deficiencies were noted during this visit., You will receive no further correspondence about this visit.
Comments'(irefe� to question . :any XES answeis nd/or any r eo endat otrs.or mw o*ei eo izRR
Use drawings of facility to better explatu sitnatwns.:(use additional pages as necessary} � 4� µ❑ Field Copv ❑Final Notes �
Ak-
Z 00 3 1� ��r�t iLi �P.� I�! p� �/r✓ �I r`�jif � �, � � T, 3 . M,&y Ye 14/ -Ad ANP-4 01
Ai,"41
�Q6T lT�n1
L�/ !ai P�D�
ff
_XY �"„'^�y`:'•':W..."NL. „.,"""'"y.
Reviewer/Inspector Name , " ± "€-
Reviewer/Inspector Signature: Date: Zaz
05103101 ✓
Continued

r . -
Facility Number: -,M Date of Inspection 1 x4'
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior below
liquid level of lagoon or storage pond with no agitation?
27. Are there anv dead animals not disposed of properly within 24 hours?
28. Is there any evidence of Wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. 'Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts. missing or
or broken fan blade(s). inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
and/or
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
O5103101

Q D' i on of Water Quality
iviislon of Soil and Water Conservation
ID Other Agency.,
Type of Visit O Com ance Inspection ' O'dperation Review O Lagoon Evaluation UeT
- - _ ��
84­
Reason . outine . O Complaint, O Follow up pEmergeney-Notification O Other :i" enied Access
Hale of Visit:- 5 •2 !!%= Tim,
Facility Number i4l.
Q Not O erational Q Below Threshold.
Y d g Date Last Operated or Above Threshold:
Q Permitted �'] Certified �//C Conditionally Certified Re tstered '
Faun Name�li..i.l county: .... 4.,t,..v........................... .......................
I
Owner Name i. . r.i^ ............ l�.f: .?.r................................. Phone Na:....................................................
.......................................................
MailingAddress: .......................................................................................................... ............................................................................................... ..........................
.
FacilitvContact: .............................................................................. Title:................................................................ Phone No/:...................................................
OnsiteYRepresentative: �'?• �S!',�....��C.i<.1.,t'1.�L:'"l. Integrator:`1:r.........
...............
.......................... ............I....... ,r. t..
Certified Operator: ................................................... ............................................................. Operator Certification Nun r:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude �• �� �•� Longitude �• ��"
Design Current Design' Current Design Current
Swine Capacity Population..Poultry Capacity- Po illation I Cattle- - Capacity - Population
❑ W 'an to Feeder
[2rf7eeder to Finish
; c 67.
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
❑ Layer•. ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
10 Subsurface Drains Present fj❑ Lagoon Area JLJ Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream ln�tti
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 convayancc man -matte? ❑Yes ❑ No
b. If dischar ,e is observed. did it reach Water of thc. State? ( II' yes, notify 1)WQ) El Yes ❑ No
c. If discharge is observed. what is the estimated flow in !_,alhzlin?
d. Does discharge bypass a lagoon system'? 0l' yes. notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation'? ❑ Yes M 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 Cl Yes No
Structure I SlruithlrC 2 Structure = Structure 4 Structure i Structure 6
Identificr:.................................................................... ..........
Frechoard (inchc>>: _
ncif) I t Continued

Facility Number: Date of Inspection '7/-'_ Ii
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
_-No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
ONo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
F_LNo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
�}islo
/
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
_0No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN Cl Hydraulic Overload
❑ Yes
_JE�No
12.
0 I /
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
0-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
0No
16.
Is there a lack of adequate waste application equipment'?
❑ Yes
No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available'?
❑ Yes]
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available'?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[D No
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
4 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
. r
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
j No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'
❑ Yes
No
/�`
24.
Does facility require a follow-up visit by same agency'?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
❑ No 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
Reviewer/lnspector Name
Reviewer/InspectorSignature: ;�/;r /_��/4-s.+'��if �—✓ Date:
010101 1" / Continued

Facility Number: —�4rz
I [)ate of luspection
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-�o
28. Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes —0--No
roads, building structure, and/or public property)
29. Is the lane! application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �RN0
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'—F-T�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes--;Eg.No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional Comments and/orDrawings:
05103101
05103101

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
)Facility Number 31 548 bate of Visit: 4/18/2002 Time: 2:30pm
O Not Operational O Below Threshold
Permitted MCertified [3 Conditionally Certified O Registered Date Last Operated or Above Threshold: .........................
Farm Name: ...... County: 1?upl�ia ................................................ W..1]� Q.........
�ion�ald.:]<:tta'�ner.k:alrm ..........................................................................
OwnerName: Linda ....................................... Tuxa kx........................................................ Phone No: 9.I0-.Z9,A-6Q.Q8...........................................................
Mailing Address:7d.3..CAbAnj.Stxcet......................... )E'ua i ... C ...............................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
Onsite Representative: Cx jab..Kcwmdy..............................................
Certified Operator: Ch ristoph erA.................... TtarUcr.......
Location of Farm:
Integrator: CA rxoW.&,F9o.d n c.............................................
Operator Certification Number:26.079 .............................
North of Beulaville. On East side of Hwy 111 approx. 0.25 mile North of SR 1702. A
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 • F 59 13 - Longitude 77 • 48 23
­11-
❑ Wean to Feeder
® Feeder to Finish
1196
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes X 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 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 19 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier'..I.........................................................................................................................................................•.....................................
Freeboard(inches): ...............34............................................................................. .............

Facility Number: 31-548 Date of Inspection 4/18/2002
S. 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 maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Graze) Corn, Soybeans, Wheat Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit 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?
❑ Yes ® No
❑ Yes 0 No
0 Yes ❑ No
❑ Yes 0 No
❑ Yes 0 No
0 Yes 9 No
❑ Yes 19 No
❑ Yes R No
❑ Yes CK No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes i No
❑ Yes No
❑ Yes N No
9 Yes ❑ No
❑ Yes N-No
❑ Yes 19 No
0 Yes N No
❑ Yes 9 No
❑ Yes 0 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes X No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Field Copv L-1 Final Notes
1 Trash needs to be cleaned out of the lagoon waters. Note: Solids in lagoon are getting high. This lagoon will need work in the
future to reduce this amount of material.
19 The lagoon readings for the 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 Name
Reviewer/Inspector Signature: Date:

05103101 Continued
Facility Number: 31-548 Date of Inspection 4/18/2002
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below 0 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 ® 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 0 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, mussing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? Cj Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No

t1.
Facility Number
Date of Visit: U-O Time: a3 4
� \ ��
Not Operational Q Below Threshold
Permitted 13 Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold: ..................
Farm Name: .................: _..__
G................?..�'.�'^�2�.............................................................. County:.............................................:.............. _
OwnerName: ................................................... ........................................................................ Phone No:.................................................................... ».» ....»
FacilityContact: ....................................... ......................................... Title:................................................................ Phone No: ................................ .......... »..
Mailing Address:
Onsite Representative: � sir- � Integrator: + ```�`1"
.......---..
p . ....
Certified Operator: ................................................... ............................................................. Operator Certification Number: ........................... .._...........
Location of Farm:
a
«r
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �` �" Longitude �• �� ���
Design : Current =
e. CRDacity PoDulatioti
-
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
Gilts
❑ Boars
Number'of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area . ❑Spray Field Area
:!Holding Ponds/ Sohd Traps." ❑ No Liquid Waste Management System
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
❑ Yes
9No
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
O No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
Olo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ........................................................................................................... .................................... ....................................
....................................
Freeboard (inches): '36
5100
Continued
on back

I
i ti
Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
0 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
&No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
VNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
V No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
&No
j t
12.
Crop type Z< C 1 W l
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
D`No _
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
g.No
b) Does the facility need a wettable acre determination?
❑ Yes
qNo
c) This facility is pended for a wettable acre determination?
❑ Yes
VNo
15. Does the receiving crop need improvement?
❑ Yes
9No
16. Is there a lack of adequate waste application equipment?
❑ Yes
Pd No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
allo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
O No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
t No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
JR No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
fi�'No
yiul a iQiis :off ddiciendL-s ri�ere h0 e# during thisMsit; - Yotjk will tei*i*e 00futth . .
• Correspondence. milt this visit... - • - • ' . - • ... .
Comments (refer to question #) Expiatyi any YES answers an llor any'ort mendations or�any other comments. '
:.
Use dr wk4s of-faeibity to better explain situations. (use additional=pages as sary)
«�� > L_�5 ,
Reviewer/Inspector Name C-
Reviewer/Inspector Signature: Date: i �-� G-�t, g/po

Facility Number: — Date of Inspection G G
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below SYes ❑ 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 *0
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 r�^No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 'No
i Additional-C ornments andfor wings:_ _
V\P -4+
L,4( e g T
5100

ON
Q DIvtsi©n of Soi! and Water Conservation Operation Renew z ,
y ~ '0 Division of Soil and -Water Conservation -Compliance Irispectxon z��
Division of Wa r Quahty mpli Iaspe d©nto Co ante
,.. r g z
OAeratton=Rev�ew _ _ _ _ _., -._. _.. _• _. �_ _
11BRoutine O Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other -
Facility Number 3 r S S Date of Inspection ►$ 7,10
Time of Inspection : 15 124 hr. (hh:mm)
Permitted 13 Certified 0 Conditionally Certified 0 Registered 0 Not O erational Date Last Operated: A ..........................
Farm Name: 1 D +tea L TV ✓ "L r'r �c . '"'� County: � l/ta / �,,
Owner Name: /<0l1� Id -TV I-- eY"
............................................................................................
Facility Contact:
..... Title:
Phone No:.....
Phone No:
MailingAddress: ................................1l.......................................................................................................................................................................... ..........................
Onsite Representative: , I�,n riot !D[ TU --o e✓-, (�'g ►-.a ko nh a Integrator: !•� r
.................... f......................................... 7- g .....7.......................................................
..............
Certified Operator:.................................................:.............................................................. Operator Certification 1\T((umber:..........................................
Location of Farm:
Latitude ` 4 14 Longitude ' 4 44
Design _ Current Design .Current . ., Deli
gn �Cgrrent
Swine Capacity= Po ulation Poultry Capacity -.Po ulation Cattle,'.-Capacity``-�Pomulatiofi
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish j 3 ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean :W r
❑ Farrow to Feeder ❑Other
❑Farrow to Finish Total Design. Capacity
❑ Gilts
❑Boars °Total SSLW
Number of Lagoons1 Subsurface Drains Present ❑ Lagoon Area Spray Field Area
Holding Ponds/.Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes N No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the convevance man-made? ❑ Yes 19 No
b. If discharge is observed, did it reach Water of the State? (If ycs, notify DWQ) ❑ Yes ® No
c If discharge is observed, what is the estimated flow in gal/min? h %�
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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Freeboard(inches):........3.v................. .................................... ... ..................... .................... ........................... .................................... ................. I..................
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 -dumber: Date of Inspection 1 3 DU
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes EffNo
(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 R9 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes A No
Waste rinolication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ZfNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN [(Yes ❑ No
IP
12. Crop type y o(ht 6 ze��w1� 1 i Get � •-, C�� rni �e$ , `Sd'1�6 Z SV e� t+�� ✓ riri lJct r _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available? _
❑ Yes
No
l &
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
P(No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
PJ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ief discharge, freeboard problems, over application)
❑ Yes
ETNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
(5 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
✓ 9 No
0: Rio yiol;aiiiQris'or iiefi. ciendia5 Were ngted- di Wing ; his;visit: Y oi� will reed Rio #'ui-thgr ;
cor'respo>ndence about this :visit ::: :: : : :
Comments (refer to question #}s; Explain any, YES answers,and/or any recommendations or:any other comments -
,-.:
Use drawings of fa6itty_tcj better. explain situationsdtt .(use ad�onal pages as necessary)
11. TL,e�eh����ovCrlaad ;,I Pin Full
3- 7, ss Q��-� 0y92- acre, Do
nvc ] opt of Givrd v s e Cat 0vi Ojot_-f AGr eye
1� . Thr; Q �r'dh m �� olG�ea5e1 do ha4 rvla74-1 I rrC,^l Gll? %61� de.<i9 h
� t
lk"4 e S 1,7 h lnlc _4a let n,
15, ticr'� 4.4 e1;�:�p-}� 4a Aeon �1 ir, 6er-►"vda eisly ��3
Reviewer/Inspector NameD S r .
I-
Reviewer/Inspector Signature: Date: r7l/3 Aa

Facility`Number: 3Date 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 ,9 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 ,Z 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 M No
32. Do the flush tanks lack a submerged fill pipe or a pennanent/temporary cover? Yes ❑ No
3/23/99

0 Division of Soil and Water Conservation .Operation Review - A
- _
°Division.of$oil and_WaterConservahgn Inspection =
..Compliance
of Water Qyality _Compliance Inspecti[n F r
-
,I3ivision
-.: .. - -
0 O er Agency Operation Review
Ile'Routine 0 Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number 3 Date of Inspection
Time of Inspection 124 hr. (hh:mm)
Permitted (( Certified © Conditionally Certified [3Registered 1E3 Not Operational rlDate Last Operated:
Farm Name: . `. kvxL /1W.Ar r n.t-...t.!..... County: . .........................-.......zd '........
................ ..........
Owner Name:.......!/ .... -- . �YN-t'rY �I :..�1 ._...
Phone No:............
Facility Contact: .._.......! A........ t. .. ..... Title: Phone No:C1..L_
....................................................
Mailing Address:
Onsite Representative:.) tl.h�...@�F1....... �!�. .� ..1..jk.✓... ntegrator:....../�/fI.......................................................
.... ........ h .... ...Z .
Certified Operator: ................................................... ............. ............................................... Operator Certification Number:..........................................
Location of Farm:
t............................................................................................. ............i
Latitude • �' �" Longitude^ • �` �"
M - Design
Current ` : = Design Current.:: - - Design Current
Swine Capacity
Po ulation' ~Poultry— Capacity Population._i .Cattle " _ Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
eeder to Finish
/1,J
='%',
❑Non -Layer
-
❑ Non -Dairy
❑ arrow to Wean
s -
❑ Farrow to Feeder
f ❑ Other
❑ Farrow to Finishty
Total Desigif'Capad
❑ Gilts.
❑ Boars
T = Total SSLW
s Number of Lagoons
�: ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holdirig;Ponds / Solid Traps
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach.Water of the State? (11 yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d- Dees discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): .. .................................................................................................................. ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes � No
❑ Yes 9 No
[].Yes [ANo
❑ Yel NLNo
❑ Yes qNo
❑ Yes [�No
❑ Yes kNo
Structure 6
❑ Yes P No
Continued on back

Facility Number: — Date of Inspection
6.�Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ 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
(j No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
Cl Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[(No
11. Is there evidence of over application? ❑ E cessive Ponding ❑ PAN
❑ Yes
y No
12. Crop type
13. Do the receiving crops differ with those desi Hated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
�560
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
tXN0
b) Does the facility need a wettable acre determination?
❑ Yes
/�j No
c) This facility is pended for a wettable acre determination?
❑ Yes]
No
15. Does the receiving crop need improvement?
❑ Yes
�V0
16. Is there a lack of adequate waste application equipment?
❑ Yes
;No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
�No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19440
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
N60
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
ClYeso
/fN
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
`o
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
Po
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
U. �io.violations'er• defci6ntieg .*4t rb pates• during �his:visit; • Y:ou will -receive rid futtM
rorres�oridence: a'' f tK visit. : :: : :
Comments (refer'to:question#) ,-Ezplaiii any YES answers ind/or any�recominendations or any othercainmeiits
U- se,drawings of facilitv� to better explainsrtuations {Else additional'pages a§;necessary} -
Ale'#,We beelt dplertwke AAj 6va� 016zl At /144
Reviewer/Inspector Name
Reviewer/Impector Signature: C '� �� 4 �- —)-7' fn 1A'Date: /%
3/23/99

Facility Number: ?� — S[� Date of Inspection
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 ATNNo
roads, building structure, and/or public property) I
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes KNO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) [:]Yes A,No
31. Do the animals feed storage bins fail to have appropriate cover? [-]Yes XNO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes xNo
i
:: 3/23/99

❑ Division of Soil and Water Conservation ❑ Other Agency
jADivision of Water Quality ��� �.�
lftKoutine O Complaint Q Follow-up of MV0 inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number $[
Time of Inspection 7=ZQ 24 hr. (hh:mm)
D Registered PICertified Qii 11Applied for Permit Q Permitted U Not O erational `Date Last Operated :
Farm Name �'+A�JrI. 1 Countv:....... 1.;A..............................................................
Owner Name ............................. 3 1..si.................................. Phone No:....��l .i..�9....................................
Facility Contact:
Title: ................
Mailing Address: ............ t S......C-Alq1.k...-Sk............................ ............................ .......
Onsite Representative: ............. Lr-,.A+.7..... Tuft,.., ._.__..............................................
Certified Operator;
Location of Farm:
.......... Phone No:
.............................. .�`" ....
Integrator %,......�1�.tf r�l4lrli....................:........I....................
Operator Certification Number, ........................... ...... ......
Latitude a 04 Off Longitude ' & 44
Designs Current;Design
Current Designs Current
Slz�lwine 9 Capac><ty'sPapulataoti F Pouf#iy Capacity. Population Ca#tle� r � Capacity Population i,,
ean to Feeder
µ ❑ Layer ; ❑ Dairy
Rciw
Feeder to Finish `
Y ❑ Non -Laver ❑ Non-Dairyl
❑ Farrow to Wean,
:� .F._ ,RE g :
❑Other
El Farrow to Feeder
3 O"
❑ Farrow to Finish
Total Design Capacity:=y
❑ Gilts
Bart r ei Y�,
� Boars
`� � r T 1 SSLW
y
N
119 Subsurface Drains Present O Lagoon Area I&Sprat Field Ares
❑ No Liquid Waste Management System � �?�
General
1. Are there any buffers that need maintenance/improvemenI?
❑ Yes
tZ No
2. Is any discharge observed from any part of the operation?
❑ Yes
ERNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made?
❑ Yes
IX No
b. If discharge is observed, did it reach Surface Water? (If yes, notiN DWQ)
❑ Yes
R No
c. If discharge is observed. what is the estimated flow in szaUmin?
d_ Does discharge bypass a lagoon system'? (If yes. notify DWQ)
❑Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons holding ponds) require
ElYes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97 Continued on back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ;allo
Structures (Lagoons.111olding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes M No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft): Z............................... _...................................... ....................................
........... I........................
10. Is seepage observed from any of the structures?
❑ Yes
allo
IL Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
_J2 No
12. Do any of the structures need maintenance/improvement?
1B Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. 'Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Anplication
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or entering waters of the State, notify DWQ)
runoff
1
15. Crop type .......... Y.YhSI.f!4' ............5 t ...r si................ cIyr. V......fa. ....... .................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
,� No
18. Does the receiving crop need improvement?
❑ Yes
®.No
19. Is there a lack of available waste application equipment?
❑ Yes
[,No
20. Does facility require a follow-up visit by same agency?
❑ Yes
Ca No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
PNo
22. Does record keeping need improvement?
Yes
P3 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
PNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
® No
0-No.violatio'ns-or. deficientries'rvere-noted-during this.visit.- You:will recei've-no-f&tlier
correspondence about-this:visit:.
(Z-. art,*-, -jiwwlj Le__ mvaAf f. -d,
E 1Av&W
Z:r.c " 7Zlo o
fit, - ? S 140
7/25197
Reviewer/inspector Name�}
K F[\�i16�
{4� 3 �Y
.[� b,x.,�� ,..tea. ww
Reviewer/Inspector Signature:
�jr,��l
4
Date: 7/11147

110 Routine O Complaint O Follow-up of DWQ inspection O Follow-ue of DSWC review O Other
Date of Inspection - � o - 1
Facility Number 3 l
Time of Inspection I I j : _gE] 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ($Registered ❑ Applied for Permit (ex:1.25 for 1 hr IS min)) Spent on Review
❑ Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated; ..... ....
Farm Name:-15aW—Ad...
Land Owner Name: o'� i .... _. id Y..�..... ..._.... ..._.... _— .............
County:
Phone No: �U) 2qf µS 0
Facility Conctact:......................._......................_.... Title: _.. Phone No:
Mailing Address: A. V......C", Ifs.. ................................. .............. ._.........1.! h ...... .: i�..... ...... .... r� �.�
OnsiteRepresentative: .._ij. ...1Y�.. ....... .. _ Integrator:
Certified Operator. is .,.., ......._ .,...._ LuC . _...,._ .... _..... _ .. Operator Certification Number:
Location of Farm:
I.. A - ... ...eLeas.__..ka c..r.. ... ul.
Latitude ®• 4 /� " Longitude ©• 6 23
Type of Operation and Design Capacity
Desgnrrent De`segn v ;Current ' Des�gtruent
Swine�Cattte�
p Ga ace Po" ulation 'Paultryr to aci <Pa ulation; ? Ca acr FrPo "uliitron
Wean to Feeder Layer _ ❑ D
Feeder to Finish Non La er " ❑Non Daia
Farrow to Wean
Farrow to Feeder ��Total Design{Capacity
Farrow to Finish. 0 sh. t
other
„ _, .. Y ❑ Lagoon Spray
Present . F W
Number�of L oons-/ Holdrn Poddssurface
Field Area
General
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?
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/9 7 maintenance/improvement?
®Yes ❑No
❑ Yes ® No
❑ Yes N No
❑ Yes ® No
❑ Yes
Qj No
❑ Yes
No
❑ Yes
No
, Yes
❑ Na
Continued
on back

Facility Number:.:,... �... 9
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes E' No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding PooAg
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (tl): Structure 1 Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes IR No
❑ Yes allo
❑ Yes RNo
Structure 5 Structure 6
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type b.4N s!a........... ..-- .. 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?
1
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certlfied 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
Ed Yes ❑ No
-Yes ❑ No
❑ Yes allo
❑ Yes ($-I`fo
❑ Yes ;KNo
❑ Yes RNo
9 Yes ❑ No
❑ Yes IgNo
❑ Yes E5No
❑ Yes ff No
❑ Yes ®.,No
❑ Yes K No
RYes ❑ No
Comments (refer to question Ezplam any YES answers and/or any recommendat►ans or any other comments
iJse'drawings of faci qy t' better explain situations. useaddihonat pages as necessary)
w, :.o- .. V
'S
i . M a V_t. v . £. �o kR2 4rw e�, q t 7 lb k-� v ` Q -K3 a Q-.n o - v e-v,-
o. dl c�- •�, of c In e-1 . !dr 1 s o , LA-ZT a .,.� a
S
0 f 1 �q n o
tC_.j
V- env E.,L fie. 6 a-r t e-&
t- 1 a u t- L t 1. Ca b e a v a o o M o
w Q. o r ,.-) a c a ,.
2LJ "A l ix L-Z4, -
r`j
.1 1 �^
Reviewer/Inspector Name = f< ... gh
Reviewer/Inspector Signature: dn Date: -7 J 6 q
cc: Division of Water Quality, Water 4uality Section. Facilitv Assessment Unit 4/30/97

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
Ronald Turner
Ronald Turner Farm
713 Cabin St
Pink Hill NC 28572
SUBJECT: Operator In Charge Designation
Facility: Ronald Turner Farm
Facility ID#: 31-548
Duplin County
Dear Mr. Turner:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919/733-0026.
Sincere ,
A. Preston Howard, Jr., P.E., Director
Division of Water Quality
Enclosure
cc: Wilmington Regional Office
Water Quality Files
P.O. Box 27687, 14
Raleigh, North Carolina 27611- 7687 NvfCAn Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 50% recycled/ 10% post -consumer paper

Site Requires Immediate Attention:
Facility No..31-
DIVISION OF ENVIRON-,'/MNTAL MANAGEME�-T '
A-N,L FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE. T . 31 ..1996
Time: 1Z•` Z d
Fain Name/Owne
Mailing Address:
Counny: 4 +'�
inteaTator. Phone: I14V 311 '745Y
On Site Representative: i3a f Phone: e.( ly� !r
Phvsical Address/Location: Pwg III /1" dl ma; je.< Aja o�
& t7oz. _
Type of Operation: Swine Poultry Cattle
Desi--n Capacity: IIq!ne _ �� Number of Animals on Site: e earl.rt eraj
DEN'-, Cer �fication Number: ACE DEM Cerdncaron Number: ACNEW
Ladnide: 3q" 5?' 0 2 " Lorso-im7de: -71_ qV ' Z/ " Elevataion: Fee:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient f eeboard of 1 Foot _ 25 year 2^-. hoe; storm evert
(ann`oxim?tely 1 Foot 7 inches)(0or No Actual Freeboard: �_Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or(D Was any erosion observed? Cis or No
Is aceouate land available for sprav? 4e or No Is the cover cmo adequate? Yes or I o
Crot;(s) being utilized:
Does the facilit;a meet SCS minimum setbac"K, criteria? 200 Feet frory Dwe:linos? 0or No
100 Feet from Wells? or NO
Is the animal waste stock -oiled within 100 Feet oL USGS Blue Line Su -tam? Yes o<fv
Is ai.=' al waste land applied or spray ir-ngated 25 Feet or a USGS IMLn Blue Line? Yes or No
Is `n=mal waste discharged into waters of the state by man-made diich, flus'ning system, or other
s�mEar man-made devices? Yes o N` 'If Yes, Please Explain.
Does the facility maintain adequate waste manag gent records (volurnes of manure. land applied
spray irrigated bn specific acreage NN-Ub cover crop)? Yes or No
Additional Cornments: 4. c le
( C �'lp�i`S � _�t SU.✓ .� /`Ci_�_ _ter �.-�... J � S-/v v N'r�•,,,,,,.,o �- i'L►�.. �/ ./ �s y
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In ector Name Signature
cc: F iciliiv Assessment Unit
Use Auachmenis if N`eded.

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N. C. DIVISION OF ENVIRONMENTAL MANAGEMENT
COMPLAINT/EMERGENCY REPORT FORM
W-TIKINGTON RBGIONAL OFFICE Date/Time: �(,e
Emergency: Complaint: 7t County: up) i .1
Report Received From: AyA 0 Yl ,
Agency: Phone No.
Compla i nan t : — -_A yj o-YL
Address: Phone No.
Complaint or Incident:/,�
Time and Date Occur —red: >✓ - // c7 �o
Location of Area Affected: Q�+,[.� U�2t'l%2 �A2�., 146/�
e r_V I A A.4-(-, s 11
Surface Waters Involved: Ill o Groundwater Involved: 6
Other Agencies/Sections Notified: __A/DAlf'
Investigation Details: S5wkVtA- rgew -- myq !Lt, (�p�i �►-� 1 -
so
Investigator:—&7/5 1k1 S L,,-� - Date:
SPA Region IV [phone] Pesticides 733-3556
Emergency Management 733-3867 Wildlife Resources 733-7291
Solid and Hazardous Waste 733-2178 Marine Fisheries 726-702I
Water Supply Branch 733-2321 U.S. Coast Guard MSO 343-4881
127 Cardinal Drive Extension, Wilmington, N.C. 28405-3845 • Telephone [phone] • Fax [phone]
An Equal Opportunity Affirmative Action Employer

N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
COMPLAINT/EMERGENCY REPORT FORM
WILMINGTON REGIONAL OFFICE Da. to/Time :
Emergency: Complaint: County: UP.) i.-ti
Report Received From: A Vl o ►'1
Agency: -- Phone No.
Complainant:
Address: Phone No.
Complaint or Incident:
Q ✓r? y, v,-c �c3v-2� C�
Time and Date Occurred: % - // -,i La
Location of Area Affected: J
2c7YLct�d -I U�rtl�iL_ _ r-Ae-VW 11-4osI,�j
0- 17 do + 170-3
Surface Waters Involved: /1y Groundwater Involved: 6dll
Other Agencies/Sections Notified: gfDAA
Investigation Details:_ I'V oy- L4,-
�.2�v�
Investigator: &/5 i/15 L.i _ Date:
SPA Region IV [phone] Pesticides 733-3556
Emergency Management 733-3867 Wildlife Resources 733-7291
Solid and Hazardous Waste 733-2179 Marine Fisheries 726-7021
Water Supply Branch 733 --2321 U.S. Coast Guard MSO 343 -4881
127 Cardinal Dive Extension, Wilmington, N.C. 28405-3845 • Telephone [phone] • Fax [phone]
An Equal Opportunity Affirmative Action Employer

ppWMTing Answer table with form F: Record 67 of 89 Main 6
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Answer #
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FACILITY #:
31-615
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OWNER:
CARROLLS FOODS
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FARM NAME:
FARM #2103
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COUNTY:
DUPLIN
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•
LOCATION:
1/4 MI E OF SAMPSON/DUPLIN CO. LINE ON SR 1335
xx
NRCS PRIORITY:
YES
•
DEM PRIORITY:
YES
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•
LETTER SENT:
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•
INTERGRATOR:
CARROLLS
•
PHONE NUMBER:
592-3131
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•
INSPECTORS NAME:
<WILITA°MS ^ 1
•
INSPECTION DATE:
7/24/95 [fl
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PROBLEM:
FREEBOARD
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RESPONSE FROM LETTER:
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LQS:
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1 Site Requires Immediate Attention:
Facility No.,7/- 41
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner: ,�°� ..:,9 % 7ru�•.z� .en t /
Mailing Address:
County: , b,.o 0 ti
Integrator:,p �( Phone:
C.
On Site Representative:4 Phone:! o a 5J� `I3 �5
Physical Address/Location: a t /e f
A, CS 1�- %00dl� U� .P� !7� f : /_ �n`�'tiGr, v+,• NC S�2 �7av
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: /124 Number of Animals on Site: // 9
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ' ( -" Longitude: 1 11 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
• (approximately 1 Foot + 7 inches) Ye or No A l Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes Was any erosion observedC9P or No
Is adequate land available for spray? Vor No Is the cover crop adequate? Yes o S q A
Crop(s) being utilized: r-U0-S1w-/ _ _11rxx urlile�t
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state -by man-made ditch, flushing system, or other
similar man-made devices? Yes oa If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with. cover crop)? Yes or(p
Additional Comments: Le
3 in,
Inspector Name
Sig ture
cc: Facility Assessment Unit
Use Attachments if Needed.