310556_INSPECTIONS_20171231

NORTH CAROLINA �
Department of Environmental Qual

�^ Q Division of Water Quality
t Fkciiity Number , J O Division of Soil and Water Conservation
0 Other Agency
Type of Visit (3,C�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit KJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Arrival Time: Departure Time: County:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: T.
Onsite Representative:
Certified Operator: _
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o =' = Longitude: [—] o =' = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
0
0
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ 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 Current ... I
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: E
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 [ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
El"?
❑ NA
ElNE
El Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection r� o
Reid Records &Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ElNE
20: Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes No ❑ NA ❑ NE
the appropiate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
LI Yes
❑ No
❑ NA
❑ NE
❑ Waste Application El Weekly Freeboard ❑ Waste Analysis El Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall LJ 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
dNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
`;Wo
❑ 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
O No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
94A
❑ 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
E? o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
10
❑ 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
LJ 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
ICE No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Facility Number: — $ Date of Inspection o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
�r
El Yes
[�No [I NA El NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: L. &v,9M LA(W Al 2—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _j ` Ll 8
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
L!/ 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
ental threat, notify DWQ
envi7yes
7. Do any of the structures need maintenance or improvement?
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E4 ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
E] Yes
V No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ 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
ElNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
11;Xo
L3 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
VNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
UV CL, 6)906,19 iJZH X lkj 3 a CALL -zF Ph4 rowtS.
S o(_,K!06- A lr, n. A 6,f ,
►',) C4 r KE G X4 wrA I-F S G0 .
Reviiewer/inspector Name v; Phone:( `/6) 774 — 13 dd
Reviewer/Inspector Signature: Date: - :L 43 J
12128104 1 tonfinued

OR
P �� Division of Water Quality
hCility Number j l ss (� 0 Division of Soil and Water Conservation
- . 0 Other Agency �L
F
ype of Visit ,C,omm Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
eason for Visit C!'hzoutine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: QO Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: JASon/ A t-4-1°fi I" /,1Ar4 S 5 i4 oJO,_ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o = i 0 « Longitude: = o = 4 = !i
S.wi ie
❑ Wean to Finish
t' ❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
v
Design Current Design. Current.. Design .Curl
Capacity- Population Wet Poultry 'Capacity Population' Cattle Capacity "Popul
�: ❑ La er
❑ Non -Layer
68 �� Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Tur ey 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
4
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes L✓J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes O No ❑ NA ❑ NE
❑ Yes LJ No ❑ NA ❑ NE
12128104 Continued

Facility',Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E No ❑ NA ❑ NE
g P h' { P g P "Y q
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: L44 GGa 6V LA d W Lj
Spillway?:
Designed Freeboard (in): 3 (. j �q• r
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
EJ 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
ZNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions"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
fp 1vo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
el
9. Does any part of the waste management system other than the waste structures require [� Yes
LJ ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
tV ❑ NA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes
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) Oeet'rv%(1 DA 6u ) S"
13. Soil type(s) A Lrj—" Vj4,L,4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Li No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0<9
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[I NA'
❑ NE
17. Does the facility lack adequate acreage for land application?
El yes
-- //No
2 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[? o
❑ NA
❑ NE
Comments (refer; to question #I): Explain any YES`answers and/or any recommendations or any other;comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
(L6PLACC- UN(xoorJ � 6AVCx6 Fo .r.-Jorca7c 3r•S a STAoT Fume _.
A c.c4x,o.L,,A G- T6 D tc SzG W► '
Reviewer/Inspector Name J6�� t_, U, Phone. Ctl6 gd "7o ,S'
Reviewer/Inspector Signature: Date:

Facility Number: j S 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 CAWMP readily available? If yes, check
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
❑ Yes
Eb o
El NA
El NE
El Yes
No
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
7No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
UNNA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
ElR No
A
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ko
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
2"N'A
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E1 o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E3Go
❑ NA
El 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
B No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
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
r No
❑ NA
❑ NE
Additional Comments and/or Drawings: .
Page 3 of 3 12128104

Owner Name:
Mailing Address:
Physical Address:
Type of Visit Qf Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ,�� Routine 0 Complaint 0 Follow up 0 Referral
,0 Emergency 0 Other ram,-❑, Denied Access
/4�/f�
Date of visit: I U�(O'3 I Arrival Time: Departure Time: I County: WV Region:
Farm Name: _ ! &:;;:: / s¢9m Owner Email:
Phone:g T ll g,o
Facility Contact: Tit
Onsite Representative. 7 integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ 0 = S = Longitude: = o = , ❑
Design Current
Design Current
6—FROV urrent
Swine
Capacity Poplation
Wet11 Poultry Capacity Population
Cattle
Capacity Pop lation
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
n-La eT
❑ Dai Calf
❑ Feeder to Finish
❑ Daity Heifer
Farrow to Wean
0
Dry.Poultry
❑ Dry Cow
Farrow to Feeder
ElNon-Dairy
❑ Layers
El Farrow to Finish
El Stocker
❑ Gilts
El Non-Layers
ElBeef Feeder
El
❑ Boars
El Pullets
❑ Beef Brood Cowl
❑ Turkeys
Othe
El urkey Poults
Number of Structures: �-
❑ Other
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: , ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes V No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes '0 No ❑ NA ❑ NE
❑ Yes EdNo ❑ NA ❑ NE
12128104 Continued

s
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: C_�y41 '
Spillway?: A41 /Vd
Designed Freeboard (in):
Observed Freeboard (in): 2
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 VNo ❑ 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 A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PNo ❑ 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 SPAN > 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) >Jl ilrlR ( /M
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
VfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V1No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
O No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
X No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0No
❑ NA
❑ NE
�aAJ �5 •. _ c115
Reviewer/Inspector Name l Phone: 4Pl0 ~l/" IIuvIFA
Reviewer/Inspector Signature: Date:
12128104 Continued

f
Facility Number: — Date of Inspection
ReQuired_Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP ❑ Checklists ❑Design El Maps El Other
❑ Yes
o No
❑ NA
❑ NE
[]Yes
V No
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
0 Yes ❑ No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking Crop Yield V 120 Minute Inspections lj� Monthly and V Rain Inspections Z Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
Cl Yes 'VNo ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gNo ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes PNo ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 9No ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ONo ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No XNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Y� 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
XNo
❑ 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? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0No
❑ NA
❑ NE
Addthl Goinments. ir. andlo: Drag wins,
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�7 f
12128104

Type of Visit: 0'Co lance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: (r !, Arrival Timer Departure Time: p r County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: MM Title: Phone:
Onsite Representative: lJ f // Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: I G SG r
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
,Afarrow
Fe er to Finish
Jnq0 ign Current
Dr. P,oult , Ca aci Pao ,
Layers
Dairy Heifer
to Wean
Farrow to Feeder
Farrow to Finish
I&k3
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Othe
Other
Turkeys
LLTurkey Pouets
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
O—No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E]-110
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes CfNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EjNo
❑ 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 ❑'go [DNA ❑ 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
Q Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[;1110
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
51 o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
J� 1"
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
To
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facih Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E N❑ NA
❑ NE
25 Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑No'am❑ 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
Z No ❑ NA
❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No Er5A.
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
�^
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
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
2o ❑ 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
L, ❑ 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 Reviewerllnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
F1 No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
LE 1"o ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facili to better ex tarn situations.(use additional a es as necessary).
�� (� (,•� 7"� E. � S ! a T-�, a r.} r� �l �O r' �
i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
:L V a., 4
Phone: (4If 6 737
Date: _ ( &_�7
21412015

Type of Visit: (DrCo iance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: aRoutine O Complaint Q Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time:.,!= Departure Time: County: ( Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: >k,5 [ tv�� Ae ('I, —
Certified Operator:
Back-up Operator:
Phone:
Integrator:
Certification Number: 9C117-2
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Design Current
Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
airy Cow
Wean to Feeder
airy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
j} 3
D ,ry Poultry
Layers
Design
Ca a_ ci_
Curren#
Pia
Dairy Heifer
Dry Cow
Non -Dairy
11
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
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 EZNo ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number; 31 - Date of inspection:
Waste Collection & Treatment
4t%ls storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA&=:�'+J .fib I.A&VOtJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J 1 J
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes C3 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 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 7No ❑ 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 M 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): Ye
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes o ❑ NA ❑ NE
❑ Yes Zo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes d�to
❑Yes No
❑ Yes o
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ YesrNo
❑ NA D NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N ' ❑ NA ❑ NE
A Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes YNoo ❑ 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes rN. ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 0 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes L No ❑ 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 ❑ ❑ 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 2 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 c ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 9 ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes VN ❑ 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 Signatui
Page 3 of 3
Phone_"I (3 7 1b
Date:
21412015

(Type of Visit: (!) CogLpliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ' Arrival Time: I Departure Time: ® County: U P1 —d Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: LMv
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: q 5
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultey C**specify Pop.
La er
Cattle
Dairy Cow
Design C*urrent
Capacity Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Farrow to Finish
D�;y P,oul_t_r C:a acity P,o
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes VNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes o
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
[:]Yes No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes VNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number; I - Date of Inspection: jp
Waste Collection & Treatment
4. lsstorage 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: (.A *V u U
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 'S q �J O
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 environmen 1 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
YN 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
dNo ❑ NA
❑ NE
maintenance or improvement?
Waste ARplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2fNo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
C?(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
Q No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
V No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
L.a No
❑ NA
❑ NE
acres determination?
IT
Does the facility lack adequate acreage for land application?
El
o
❑ NA
❑ NE
I &
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
o
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesJN
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 12f 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
No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

IFadlity Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2�40
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes tFNo
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: ,
❑ NA ❑ NE
❑NA ❑NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E4 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes E3/No ❑ NA ❑ NE
❑ Yes M/No ❑ NA ❑ NE
❑ Yes O/NNo ❑ NA ❑ NE
[:]Yes VNo ❑ NA ❑ NE
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
F14❑ NA ❑ NE
�lb❑ NA ❑ NE
o ❑ NA ❑ NE
Comments(refer to question #):-Explainany.YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional.naQes as necessarv).
Reviewer/Inspector Name:
J 0
Reviewer/Inspector Signature:
Date: IDI 119
Page 3 of 3 12/4a015

SSIa
Type of Visit: 0 pliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: Co(Routine O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: {o Arrival Time: ® Departure Time: County:,1 (�.� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 9-" M=_1Lt4EC t Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 6 `j b
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
I iLayer
Design
Capacity
Current
Pop.
Design
Cattle Capacity
jDairy Cow
Current
Pop.
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
cl 4 O
Non -La er I
07.9 PTu-Itr,
Layers
Design
Ca aci
Current
Rio
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers.
Pullets
Turkeys
Turkey Poults
Other
Beef Feeder
Boars
Other
Other
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes &No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) []Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �No
N❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ D
of the State other than from a discharge?
Page I of 3 21412011 C,

•
Facility Number: '� j - L>s (o I jDate of inspection: G c!
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: kA CA60oo 1So
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 25
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EZNo ❑ 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 0 Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes eNo ❑ 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 L3"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ "No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes ❑/ /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
E] 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
ETNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FT'N"o
❑ 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
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EIINZ
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Cj <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 2-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 0 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes _2-1�o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

V
IFacility Number: ,� I -"-->S(o jDate of Inspection: t
�24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes rNo ❑ 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Q o ❑ NA ❑ NE
❑ Yes Z"No ❑ NA O NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
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
gXN�,o [:] DNA ❑ NE
NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
c7,) 6PASS COVEn-MYa6- l�.u(-'— WIC— , ?LEASE CrUtAtJ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
91
Phone: Vq�b"
—�
Date: 1
/114
21412011

(Type of Visit: Q 7Routine
pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: l )a 11.3 I Arrival Time: f® Departure Time:® County:__%>V1?6Zt3 Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: � � ,f1j=(_tj ,L Integrator:
Certified Operator:
Phone:
Certification Number: (0
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish I ILayer
Design Current
Cattie Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
I INon-LUer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
Dr. Poultry Ca aci Pao
Layers
2a Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes O/No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑Yes
N
N/❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
y
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: "' - Date of Inspection:�5tzla :J
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 r} Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I.rl(mvpa
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ 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 or7yres
nmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ElYes 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 2f No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 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 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
P!rYe❑
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes 4 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required_ Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 12<0
❑ 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 24 ❑ 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 Inspecti;_N_�ojFl
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 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number:
2.4: 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 ❑ YesJNo ❑ 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 VNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [3 Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes [ I+Io ❑ NA ❑ NE
[—]Yes [3/No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 2rNo ❑ NA ❑ NE
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
No ❑ NA ❑ NE
7 ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question ff): 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).
q i) 7kPaPj AcTP, A Rrol.l,D �Z o z l R-d Lk ADwG- To 17U DDLe�(r A rT M
iWA51-A oc . 9txAS6 ADDS,
1) 5G� oS iZ�r�oJC�.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: LR16 r 14 - J_3
Date: yj5p3
21412011

Type of Visit: 0 Co pliance Inspection U Operation Review 0 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: S Arrival Time: Departure Time: County: Z Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Title:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop. Cattle
Layer DairyCow
Design Current
C►apacity Pop.
Wean to Feeder
Dairy Calf
Feeder to Finish
Farrow to Wean d 3
Farrow to Feeder
Farrow to Finish
(a�
Dairy Heifer
Design Current Dry Cow
D I;oultr Ca aci F. Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Imuacts
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)
Z. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes I O ❑ NA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
�] Yes f- ❑ NA [3 NE
❑ Yes�P7 ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection: 1 v
WasteaCoRection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: W_'a6N .�i �Eoo
Spillway?:
Designed freeboard (in):
Observed Freeboard (in): 17 7 -2_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [2/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta hreat, notify DWQ
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �lo ❑ 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 Inspecti�/'/o
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes D NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes To ❑ NA ❑ NE
Page 2 of 3 214120II Continued
7. Do any of the structures need maintenance or improvement?
❑Yes No
❑ NA
❑ NE
$. Do any of the structures lack adequate markers as required by the permit?
❑Yes �10
❑ 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 ZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes WNo
❑ NA
❑ NE
maintenance or improvement?
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 ❑ FAN > 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 th the CAWMP?
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Vs
❑ 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 �
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes �Zo
❑ NA
❑ NE
Required Records &Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes �
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes �
❑ NA
❑ NE
the appropriate box.

Facility Number: - Date of Inspection: l�
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 to provide documentation of an actively certified operator in charge?
❑ Yes
o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
o
❑ 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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No
❑ Yes WN0
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
Yo ❑ NA ❑ NE
Ny DNA ❑NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes C;kf4o ❑ NA ❑ NE
Comments.(refer to,question #): Explain any YES answers and/or any additional recommendations or.any,,,other _comments.
Use drawings of facilitv to better explain situations (use additional napes as necessarv).
i!;) FELj Czechs NFEq (—ZN1E
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
L
Phone:
Date:
2141201

Type of Visit: Q.Co pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: S a r Arrival Time: Departure Time: County: �} P Region:
Farm Name:
Owner Name: -
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �_AY+n(�$ S-� R.0Jp
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
Design C►urrent
Wet Poultry Capacity Pop.
La er
C►attle
Dairy Cow
Design
Capacity
C►urrent
Pop.
Wean to Feeder
Non -La er
Daig Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean j
Farrow to Feeder
Design Current
Dr, P`oul C_a aci P,o
Dry Cow
Non -Dairy
113eef Stocker
Farrow to Finish
I
ILayers
I I
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Puults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes VNo
❑ NA ❑ NE
❑ Yes ❑ NA 0 NE
Page I of 3 21412011 Continued

Faeili Number: - — Date of Inspection: S-1 p J�
Waste Collection & Treatment
4. U storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ 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: j A&W6 �o Li4[s[Z7�,
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 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste ADplication
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 [�j 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 Lj No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [To
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 6(No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes Z
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes VNo
❑ 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 [3"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? ❑ YesWNo
o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: j - ,; Date of Inspection: 5
24 . Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesVNo
❑ NA ❑ NE
25.Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes to ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other;
[:]Yes [!(No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes /No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss reviewfinspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ENo ❑ NA ❑ NE
o NA ❑ NE
Y [:]NA
❑ 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 e'xplain'situations (use additional pages "as necessary)."
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Vd�
Phone:(gjb)—�6 _ bf
Date: S ] b !
21412011

Type of Visit Coi Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ql{1 d Arrival Time: O Departure Time: County: PulkXty Region:
I
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
OnsiteRepresentative: i✓l=L "a A., _ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 = 4 =61 Longitude: = o = 6 = «
Design Cuerent Design Current Design Current
Swine Lc.apacity Population Wet Poultty Capacity Population C«attle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
® Farrow to Wean
10
DrY Poultry ❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
I
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
El Gilts
ElNon-Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Turkeys ❑ Beef Brood Co
Other
❑ Turkey Poults
❑ Other
1 10 Other I 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 I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

'r
Facility Number: 3 r —SSG Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes dNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LU'1(rW?5),j I L444--mJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 o Ljky
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes El No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes I 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 [2/No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 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 L�J No ❑ NA ❑ NE
maintenance or improvement?
Waste Application /
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [Z No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E 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?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Zo ❑ NA
[-I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
/o El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
❑ NA
VNo
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
Comments (refer to question:#): Explain any YES,answers and/or any recommendations or any other comments° w
Use drawings of facility to better explain situations. (use.Additional pages"asnecessary):
Reviewer/Inspector Name
Phone: f
-- 7,3
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

1
Facility Number: Date of Inspection 6
r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ wup ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes [J No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
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
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspectionss D
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
F No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Cif o
❑ 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
ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
D No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes W No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[�]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
Ell
,�,�
.fiNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
NNo
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
El, Yes
E
ENo
❑ NA
❑ NE
Additional Comments and/or Drawings: M ,
Page 3 of 3 12128104
Page 3 of 3 12128104

SSG
Type of Visit 0 C mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: f �d Departure Time: C� County: PbOLW Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: JAi Z65 SIn6dp Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = = =is Longitude: E_—] o E_-1 ' 0 «
DesiNil gn Current Design C►urrent Design Current
Swine
Capacity Population Wet Poultry COP ciit Population Cattle Capacity Population
Finish
❑ Layer
❑ Da Cow
o Feeder
❑Non -La er
❑Dai Calf
to Finish
❑Dai Heifer
to Wean
rBoars
❑ D Cow
Dty Poultry
6
to Feeder
❑ Non -Dairy
❑ La ers
El Beef Stocker
Non -La ers
Beef Feeder
to Finish
Pullets❑
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other Number of Structures:
Discharges & Stream Impacts
f
I. Is any discharge observed from any part of the operation?
❑ Yes
R No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
U N
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
7 Ne
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

cility Number: — Date of Inspection �! a
-Waste Collection & Treatment �,�
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E3No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure1I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA (Wed LA 6o6ll ZfO
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3Z -3$
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes LJ 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? El Yes CJ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes L� No El NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes [a No ❑ NA ❑ NE
maintenance or improvement?
Waste Application !!
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes 0 o ❑ NA ❑ NE
maintenance/improvement?
It. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L✓J No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ 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
E No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
PYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
ErNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
ElNE
18. 1s there a lack of properly operating waste application equipment?
ElYes
YNo
❑ NA
❑ NE
,Comments (refer tolquestion,#) Explain any�YES:answers andlpi anyrecommendadons�oroany other�comments..
Use drawings of fac►lity to better explain s�ituahons. (use additional pages asnecessary).,�
,.., _.,!
► S.) S 06E OS % 13E tiny 0 V160 fi A C" w i3 f&m4 [r04
Reviewer/Inspector Name ! C a i A RAJ EUL, Phone: p Jf
Reviewer/Inspector Signature: Date:
poop 2 of 1212RI04 C ndnued

❑ Yes 2No ❑ NA ❑ NE
❑ Yes 12/No ❑ NA ❑ NE
acility Number: — S Date of Inspection LifLi
Required Records & Documents
09. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the approprrate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
d
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
5No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
do
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
YNo
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
d
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
ElNA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
7No
❑ 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
dNo
❑ 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
LI N
❑ 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
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

I H Ss
Type of Visit -o liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Vlsit Routine ()Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: {1(5 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: r 'Title: Phone No:
Onsite Representative:JAM ES J rgfiyy Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = d = N Longitude: = ° 0 ` =
Design Current
Design Current
Design Current
Swine C►apacity Population
Wet Poultry C•apty Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
El Dairy
❑
Cow
Discharges & Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes VrlNo [INA ❑ NE
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made? ElYes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ElYes ❑ 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) ElYes ❑ No ❑ NA ElNE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes o El NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes No ElNA ElNE
other than from a discharge?
Page I of 3 12128104 Continued

�acility Number:3 Date of Inspection a o$
V aste Collection & Treatment
/Xo❑
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 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: 1A (1*6^- "N Z-00
Spillway?:
Designed Freeboard (in): 3 1 ��
Observed Freeboard (in): 3 qb
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes LQ ❑ 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 th at, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes N ❑ 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 6No ❑ 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Ye El"N'o ❑ NA ElNE
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 Cf No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes �WNo
o El NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ 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):
S) F a�OJ IJEE.9 t��'�.f AfflzED . 006JPT&lj dr1 96W -<04- ,i�lr►tPL!�S �KFf✓,
,Sso CA(,0,0d AMP SL 1'W ( 'f9)k VCP -tA/ J�/, Z#Zr.
Reviewer/inspector Name f Phone: f1lb) fib- /.KK
Reviewer/Inspector Signature: Date: Ia
12128104 Continued

Facility Number: — s(, Date of Inspection
Required Records & Documents ��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L�J No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�Vo
El NA
El NE
the appropirate box. ElWUP [I Checklists ❑ Design 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 1"
Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
CJ No
ElNA
[INE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
El Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NNo
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�[Q
La"
ElNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;INo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[3/NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EI/No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
Rio
❑ 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?
[IE Yes
�
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
7P4([INA
❑ NA
❑ NE
x - x
Additianal`Comtneuts an&or Dra rings `�:
w s
Page 3 of 3 12128104

(Type of Visit .0 Compliance Inspection O Operation Review O Lagoon Evaluation I
for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Permitted [3 Certified © Condi 'onally Certified 13 Registered
Farm Name:
Owner Name:.....W ..R�i1 ........ .... 6TROtl.
/I1 Time:
Not Operational O Below
Date Last Opera r/A�bave Threshold: _..... W. ..
County:... ........... _....
__. ....__ ._.
PhoneNo: ._..............._........ ..... ................ -............. ............ —
Mailing Address: W ........._ . — ...� - - - .. _._.. _.... _...... .... _ .. �. ............
Facilitv Contact: ........... __.------- Title:.._ ..... - — ......
Phone No:........ ........
Onsite Representative: �� ti Qi?E!`? T ._. ,_„ Integrator: IQGQ'I8V-11?1
Certified Operator:
Location of Farm:
Operator Certification Number:
2f5wine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude • 4 41
...F1,17"r a _ , _f,.
"zwtDesign t Cui rimt DeSig1I1 Culrrent c Design
Stiviiie r F z Ca a Po ulaihan Poultry` j` ci Poiiillation, Q_Cat#ie Caiiadcifv
Wean to Feeder
=
❑ Layer
Feeder to Finish
'_:.%:.
❑ Non -Layer
arrow to Wean
-
f<
Other
El Farrow to Feeder
-
Farrow to Finish
-
� TOE De5l�
=� I;
Gilts
,
Boars
`NuimberofI.agoons
ui _ -
VPd
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes )ZNo
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 ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes VNO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONO
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I ................... _.............. ........... ..... .......................
Freeboard (inches): �7
12112103 Continued

1,
acim,.Number: j — jam Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
PNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
[rNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
;dNo
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
❑ Yes
PYNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
P'No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
RrNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
,0 No
❑ Excessive Ponding ❑ PAN Hy ulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type )64gAa,0 } fj' J 4&44'��
13. Do the receiving crops differ with those designated in the Certified Animal W6ste Management Plan (CAWMP)?
❑ Yes
0 No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
RfNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
ONO
16, Is there a lack of adequate waste application equipment?
❑ Yes
,TNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below [:]Yes ONO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes RKNo
I9. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes );3"No
Air Quality representative immediately.
Comments (refer W queshoa #) YFxi liii"JWAYES ans�w amd/ ray recornmendattons oraayother co Bents.
iTse drawengs offaciLty to better �n sltuat.o (useiadditzonalj.pages as necessaryi�) 1❑Field Copy ❑ Final Note^s
,'t '� � ��'a�"Pn^': s IM ry—"STr�'+L�: �g_,«.sc "Z ^t"."•a�' G.a � i� v'�,r"Sr t .L':='.?e.. ��..««r��� ". ,-.»L'��'$".`�'i.', �=�'a�'s
723 4e©2 T tjfl Z.-1 5 O 101e Z OX /h,E cdit/F ,e
•
72OWS
// �iQO/✓1
73J 4 / jD�1/s L/ �v IQ �� 2 i� �� �v J 'r /�r14 �7 �r lO /
/Z
% %!i �p'� NO
�F ��sz�✓B�� C-%9�eo
T
Reviewer/Inspector Name�,�.`''
Reviewer/Inspector Signature: Date: i!
12112103 1 Continued

Facility Number: Date of Inspection i/
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes O'No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
[]Yes
040
23, Does record keeping need improvement? If yes, check the appropriate box below.
Rryes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
j2rNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
f/ No
26. FaiI to notify regional DWQ of emergency situations as required by General Permit?
Yes
(iel discharge, freeboard problems, over application)
❑
("No
27. Did Reviewer/Inspector fail to discuss reviewrinspection with on -site representative?
❑ Yes
P(No
28. Does facility require a follow-up visit by same agency?
❑ Yes
0,No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
XNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 3I-35)
❑ Yes
P�No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

r T
Type of Visit A Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit o Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
[Facility Number Date 4f Visit:
Permitted OCertifled D Conndiitiioonally Certified 13Registered
Farm Name: �� ✓ <' /VM
Owner Name: - ;;1/ ,m�'S S 11
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
Time:
Date Last Operated or Above Threshold- _
County: �[te�ya_z_,6/
Phone No -
Phone No:
Integrator: 6�( Seo Qo
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 �' 0" Longitude 0 °
Wean to Feeder ' U La t
Feeder to Finish ❑ Non
Farrow to Feeder U Other
Farrow to Finish
No Liquid Waste
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
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: _ _ Nd �5 L
Freeboard (inches):
05103101
❑ Yes R�No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
ZU
VNo
❑ Yes
L,QNo
Structure 6
Continued

Facility Number: 3T_&3T11 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
[�N0
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
Dyes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
ElYes
No
X
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Wastg Application
/
10. Are there any buffers that need maintenance/improvement?
❑ Yes
11. Is there evidence of over application? ❑ Excessive Ponding El PAN ❑ Hydraulic Overload
❑ Yes
,,/No
`L!!/J No
12. Crop type S
13. Do the receiving crops differ with those desi aced in the Certified Animal Waste Management Plan (CAWMP)?
ElYes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
o
b) Does the facility need a wettable acre determination?
❑ Yeso
jNo
c) This facility is pended for a wettable acre determination?
El Yes
15. Does the receiving crop need improvement?
❑ Yes
X No
16. Is there a lack of adequate waste application equipment?
❑ Yes
VINO
Regu_ired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
0No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
ElYes
0No
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?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
a 0
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.
is .� "�. �. ,�-:;.,.�
Comments,,(refer�#o.question.#) Paplain anyYES'snswek and/ r n ammendarions or any-;o er comments_ .» .
Use drawrngsafafacility to better explain sitpahons addibonaLpages as necessary}
,(use
Field C Final Notes
17 J 2,001 SD2L, ESQ EPDR7
�
�Ij Zsa Pic
e
1 o A,ESA- 7 rZ r+r �zS,
ReviewertInspector Name
Reviewer/Inspector Signature:
Date:
0510310I
cI
Continued
4YO

k,
Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes �No
❑ Yes No
ElYes gNo
❑ Yes [JNo
❑ Yes '[ o
❑ Yes 7o
❑ Yes ❑ No
Additional.,Comnients.and/or Drawings .:
AL
1q) _QJ p,5—Frc 2,(o
9WA:F6 k 25 y3voa�-1'q o abi 1pw
P)RP�7E as F IT�zc
FR9/�
T+e�-
bF-9mU1OA,
APPL-ZCAT�od5'
R�Ic
AA-5
A
5a UP
N01
05103101

*� w G a s k K �V%Slfln f► WatCix� �'":s $`
1 �" _Mx visivin oi5oil artdvWater Coxtservatton� s.
.'.+ (./{�.e
e �
Type of Visit Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit 66noutine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility NumberEZP_=�
Date of Visil:
Permitted [3Certified E] Con 'tionally Certified © Registered
FarmName: ..... .............. ......................................................
Owner Name:.. .................
El Time:
Not Oaerational O Below Threshold
Date Last Operated.gr, Above Threshold:
County:......... ,l(-- - . -- � 1
.............
PhoneNo: .......................................................................................
FacilityContact: .. Title: ................................................................ Phone No:...................................................
MailingAddress :............................................ ............ I....... ................................... ....... "------------ ..... ..............
0
Onsite Representative: �� � ...... 1(F�y4 ..............YL. I f�•� ! Integrator:.........- L111 _....._1,
Certified Operator:............................................................................................................... Operator Certification Number: ..........................................
Location of Farm:
U(Swlne ❑ Poultry ❑ Cattle ❑ Horse Latitude • �d 64 Longitude �• �� �64
Design Current
'Design Current- .
Swine Capacitv Population
Poultry
Capacity. population Cattle
❑ Wean to Feeder
10 Layer
❑ Dairy
. ❑ Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
- Farrow to Wean t7
❑ Farrow to Feeder
❑Other
❑Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
r
Total'SSLW-' .L
Number of Lagoons :. ❑ Subsurface Drains Present ❑Lagoon Area
Holding<Ponds / Solid Traps I0 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/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?
yeug� = vurren4 -
aipacity.L Pe ulation z
❑ Spray Field Area
❑ Yes *�No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
❑ Yes
❑ No
—A)4—
❑ Yes
❑ No
❑ Yes
No
❑ Yes
o
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Mo
Stru •ture 1 Structtu c 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........... ............... ..............3:-.-.-........... ................................... .................................... .................................... ................................
....
Freeboard (inches): �C�� Sow
5100 Continued on back

Facility Number: — Date of Inspection 7 Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures obsery ? (ie/ trees, severe erosion, ❑yesNo
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 maintenancelimprovement? ❑ Yes too
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ElYes
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 bfBo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes (No
12. Crop type
13. Do the receiving crops diff4 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 o
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 YNo
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 `2�No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes &o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 4,o
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ffl�o
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes Q , Vo
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
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
ol.ec .9f'e5 were id du i4g �his:visAi You wDeceive do finer
corres o deizce: abaul; this visit
Comments (refer to questifla #} Expl!un any, E5 answers and/or any recoi amentlakions or';atty other ca f
ilse di a�vnngs of fact itklt bette rvexplain sitnations (tyse aclditior al -pages as jie• _
p s, Ito �aG�— La.Qctti.� r c Ab
�' t � 3; TWW1
A-07 I. R.- A - A,- . Z_ INA 11 6
Reviewer/Inspector Name Y P
Reviewer/Inspector Signature: JAI n n 44 Ca Date: S/qp

LFacility Number: h, — 15SU Date of Inspection Printed on: 1/9/2001
Odor Issues
264 Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property) ,' ,
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes d�o
:,�
Additional Comments .an or rawiagsZJ
yVv� V41 vU I
5100

)S(Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit OkCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: ime: 1 9': m I Printed on: 7/21/2000
0 Not Operational 0 Below Threshold
Apermitted [3 Certified E3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: .........iJ.. J............�.............. Countv:...........................................:...........
........... _ CA
OwnerName: ....-T !!I .r........................................................... Phone No:.......................................................................................
lJ��.......... ....... G...'1� .. .......Facility Contact: Title: Phone No.
MailingAddress: ........................................................................ ............................................ ...................................ay.*
OnsiteRepresentative:................?...._.._.._............�Jr°/�nte rator:..........(?f'!....1...'..`.�f.!s.............
(ttOtlt 1'C��'�
Certified Operator:...�...............Jf'J j�:yf��t;tl._.��. �'.D�,�,�.... Operator Certification dumber:...........
Location of Farm: ! (/
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �° ��° Longitude �• �' �"
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Po ulation
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer I I JE1 Non -Dairy
Marrow to Wean 1 O 3
[I Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagmm Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Dischare_s & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes J(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other \\
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
h. If discharge is ohserved. 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
,nature I StZ-S . 2 Structure 3 Structure 4 Structure 5
r�
IdentiFier: ................3............. .......... ..... 34.1.... . _.._..................................................................................................................
Freeboard (inches):
5/00
❑ Yes ❑ No
—^/0- -
❑ Yes ❑ No
❑ Yes KNo
❑ Yes Iro
❑ Yes [XNo
Structure 6
Continued on back

Facility Dumber: Date of Inspection — —DD Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed`? Oe/ trees, severe erosion, El Yes kNo
4seepage, 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 VNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ,KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes fk No
Waste Application \
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes KNo
12. Crop type s�J
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 ,j�No
b) Does the facility need a wettable acre determination? ❑ Yes allo
c) This facility is pended'for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes No
l6. Is there a lack of adequate waste application equipment? ❑ Yes k"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 XNo
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes '�;&o .
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes PFo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes _XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes �No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes I-KNo
24. Does facility require a follow-up visit by same agency'? ❑ Yes Wo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes )J No
N,0 •violati66s;oi- deficiencies •were ngted- diming 4bis:visit; • Y;oif will receive titi further •. - ;
icorres onden ' . a'baut. 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)-
S -A.
o f G�d7 4a� t�v /)60 i�•-.a IAJ1
11
�l 1MA4
IF
Reviewer/Inspector Name /'!G!/''" %' 'V
Reviewer/Inspector Signature: <f e--�/� Date: �� jr'-

[;IcilityNumber: I)ate of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes jIo
liquid level of lagoon or storage pond with no agitation? / \
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �lo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes VNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 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 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Ko
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes )No
_ ttonal
omments an or rrawutgs: =2`
A.t
3/23/99

' [ Division 'of Soil and Water -Conservation =Operation Review
` R:Div^isioh of.Soil and. Water Conservation - Compliance Inspection
Division of Water Quality. -Compliance Inspection ' o-
e
0 Other Agency - Operation. Review w
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DS«=C review 0 Other
Facility Number I)ate of lns1 icclion
Time of inspection '3 G 24 hr. (hh:mm)
Permitted ❑ Certified [3 Conditionally Certified © Registered 113 Not Operational Date Last Operated:
Farm Name: .......`-�„ :S GW � County:....... �1
....................................................................................... ............. .......................-.-..........................
Owner Nante:...J.....G Phone No:.. .......................
FacilityContact:.............................................................................. Title:................................................................ Phone No:............-........-.............................
MailingAddress: .............� Wt-.2.�......................................................................................3u..........................................
Onsite Representative:...........................................................................................................
lntcrrator:...t�r1.........................................-.....
Certified Operator:, ... Operator Certification Number:
............................................................................................................
Location of Farm:
a
............................................:.....................................................................................................................................................................I..........................
Latitude Longitude �• �� �"
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer I I ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer I JE] Non -Dairy
Farrow to Wean 160
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps JEJ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (if yes, notify DWQ)? ❑ Yes kNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'! ❑ Yes ❑ No
h. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in aalhnin?
d. Does discharge bypass a lagoon system? ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Pq No
3. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes b�'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes VNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: c��Vttw j Sb
Freeboard (inches): .........-d.`..1.........-..51.............. .................................................... ..........
1/6/99 Continued on back

li acility Number:31 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, El Yes tgNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes fv'(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 pact of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �S[No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes b(No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11- Is the evident of over application? ElPonding ❑ Nitrogen El Yes No
12. Crop type ......5.................................................................................................................................................................................................................
c 5
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes jXNo
14. Does the facility lack wettable acreage for land application? (footprint) El Yes NfNo
15. Does the receiving crop need improvement'? El Yes 0 No
16. Is there a lack of adequate waste application equipment? ❑ Yes KNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ElYes Z 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 eNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) �'es �l�o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes WrNo
21. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ONo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes WNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes IMNo
24. Does facility require a follow-up visit by same agency? ❑ Yes (�No
0. N.o.vWa*tion,s:ot: detciencies.were. noted duu-ing fh' is.visit:. Y u' wvill receive nd Mrihe'r .:.
cofresiD(Hidehice; about: this ;visit.; :: ;
Comments (refer to question #): Explain any YES answers and/or any-recommendations-or.any,otlter comments.. =_ 3
Llse drawings of facility.to better explain situations. (use additional pages as. necessary)
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 11/6/99

❑ Division of Soil and Water Conservation ❑ Other Agency
'
Division of Water Quality
y n:
r
.. . .
10[Routine O Com laint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
L- Facility Number
Time of Inspection G : 24 hr. (hh:mm)
©Registered ©Certified Applied for Permit ©Permitted 13Not O erational Date Last Operated:
Farm Name: ..............................C!.....5" "'^ _ • .....................
.......��.....1l.......-........................................... Il...................t....................................-..
Owner Name:..... ......................... ...........5...... �:.1 ... Phone No: f�'S$-....?.�g$..-..........................
FacilityContact: ..................--...-.. .... Title: ... .-........................................................... Phone No:...................................................
Mailing Address: vo �<K �� �
...............................................................................i........................................................................................
........................................................
.....
Onsite Representative: 6.... ��....... Integrator:...... ............................................
.....................................
Certified Operator: ..................................................
Location of Farm:
Operator Certification Number-, ........................
..4-44.N..... y ... .....' d4. ..�.q�. ...... D ..... .... .. .....,�. .,--- :�..... ,..�........ .....�i�si3..... {�y ......... A
.. .. .. ............................... .........
Latitude =# 4 " Longitude • 6 "
DesignerCurrent � F Design Current . x Design Current
k
Capacity -Population Poultry Capacity Popuiati Ca..ttleLL j I.Capacity wPopu&tid1
❑ Wean to Feeder ❑ Layer ❑ Dairy
[I Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Z Farrow to Wean. Q
❑ Farrow to Feeder ❑ Other r F
[I Farrow to Finish Total Design Capacity
a ❑ Gilts
i, ❑ Boars r ;Total fSSLW =
z Number of Lagoons / HolcLng Ponds :®r ❑Subsurface Drains Present ©Lagoon Area ❑Spray Field Area
No Liquid Waste Management System es
Me
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
N No
2.
Is any discharge observed from any part of the operation?
❑ Yes
N No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
4 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gallmin?
kA
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
allo
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
�9 No
mainten ancelimprovement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
tg No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
ifNo
7/25/97
u

facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures fLaeoans,Hvlding Ponds, Flush Pits, ,etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1
Structure 2 Structure 3 Structure 4
Identifier:..���r!r. ......._�'�..
1�.....
Freeboard (ft): . �
a,?
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
B. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes
'Wo
❑ Yes
IP"(No
Structure 5 Structure 6
❑ Yes
OfNo
❑ Yes
IZNo
Cq�yes
❑ No
15. Crop type... ..........................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a Iack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Onl
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0• Noxiolations-or deficiencieswe're-iltited-dwitig this, visit"- You; 411 ireceive no ftirtlier
: • correspQadehce about this:visit::: -, : : • . : • : . -.:: : : : . • • ., :.:... - :.::.::
ACV o,--- �S AM 's ue cd.,d2w--,
C� JQ�
❑ Yes n No
❑ Yes (9No
❑ Yes �Io
❑ Yes IONo
❑ Yes 1XNo
❑ Yes ONo
❑ Yes V(No
❑ Yes PQ'No
`Yes ❑ No
❑ Yes 0 No
❑ Yes qNo
❑ Yes E!(No
7/25/97

❑DSWC Animal Feedlot Operation Review
�z
DWQ Antmal Feedlot Operation Slte inspection
o
,:
Routine 0 Complaint 0 Follow-up of DWQ ins action 0 Follow-u of DS%VC review 0 Other
Date of Inspection
Facility `umber 3 �
Time of Inspection 24 hr. (hh:mm)
© Registered OCertified [3 Applied for Permit E3Permitted ©Not.O erational I Date Last Operated:...
FarmName: A,f[,rr+- .............. C;ounty:.....DL�}�l.,R............................................................... ...-. l............................................................:..
OwnerName: ....... d4-ly.m...... ........................................................................ Phone No:... `��a. .irr .�l�s%...............................................
Facility Contact V s S . Title :........ Qwq:jj r.................. Phone No: ........
Mailing Address: ..... P.P..0j(...... iL. ....f............
Onsite Representative. ...... 111 ........ ...........................
CertifiedOperator:...................................................................
Location of Farm:
Jul. sdAI........................................................... Aam8.......
Intet;rator(o%dto..................................................
...... Operator Certification Number.........., ,b,.
�4.........44....1I1....n Q.... ;n....... .. a...�..a�rs�......�.5...... �tYx......x ... tni. nax°k to,...n........5........La�.....
l�r...-..... V L .............. s7xa.!n' -(U. t`L.................................... .
Latitude �•����� Longitude �• ��
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
W Farrow to Wean
7j
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design,. Current
y Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Nan -Dairy
❑ Other
Total Design Capacity to 8-3
Total SSLW
Number of Lagoons / Holding Ponds ` ❑ Subsurface Drains Present ❑ Lagcwn Area ❑Spray Field Area "
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes JO No
2. Is any discharge observed from any part of the operation? ❑ Yes ($ No
Discharti-e originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance mein -made? ❑ Yes 0 No
b. If discharge is observed, did it reach Surface Water' (If yes. notify DWQ) ❑ Yes §9 No
c. If discharge is observed, what is the estimated Flory in Oal/min? M ZA
cl. 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 WO
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes �j No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
4. maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes �d5dp No
7. Did the facility fail to have a certified operator in responsible charge? El Yes LiNo
7/25/97 Continued on back

Facitity Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Holding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2
Identifier:
Freeboard {ft}: ........... :rl................. .......
10_ Is seepage observed from any of the structures?
Structure 3 Structure 4
❑ Yes CQ No
❑ Yes allo
Structure 5 Structure 6
............................................................................................................
❑ Yes 21 No
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?
Waste Application
14. Is there physical evidence of over application?
(1f in excess of WMP. orrunoff entering
C. waters of the State, notify DWQ)
15. Crop type ..............aSw.....�C.n+u�a.._..._......................................................................._...........---..---..-.._......---..........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did ReviewerAnspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Pennitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
® No.violations or de"riciencies.were-no-ted during this:visit.- You.will receive no further
correspondence shout this'. visit'.
Gimments'(refer. to question #): Explain any YES answers and/di- anyrecommendattons or any i
Usegdrawings o€ faetltty to better explain srtuahons. (use additional pages as necessary) k
IZ.
tozyc�,
Sko�j fie, rcfa v—ed. &vr- spA on (c, wCli
��. &rmok crop
.3601)
foe_
Ifi peottefj,
❑ Yes JQ No
RYes ❑ No
❑ Yes [KNo
❑ Yes g No
......................................
❑ Yes C.No
❑ Yes 10 No
&LYes ❑ No
❑ Yes id No
❑ Yes ® No
❑ Yes No
❑ Yes [ No
❑ Yes 5j No
❑ Yes 91 No
❑ Yes A&No
7/25/97
Reviewer/Inspector Name -
Reviewer/Inspector Signature: , ,,, f Am Date: -7

k= : 'NumbeC' 3 Date :'ofi fnspecttari Time --"of; lnspeciron x"
.h .-7t UseA 24 hrtime.;:
Farm Status: _ . .._-- —_. _ _ _ Routine ❑ Co—mplaint ❑ Follow-u
Farm Name: �Y s_ ... �..�' _ ._. County: iitJ w. _
Owner Name: Phone No: �.
Mailing Address: � 2 A I-9 Q45 Drl yY��
Onsite representative: Integrator:
Certified Operator Name:
Location of Farm:
■
Latitude
©•®° r70 '�
Longitude '
� '� [+j Wn (I)
S, F— Z
3 S' J `S 5 7
17 SL
5-z-
1 Not Opera
Date Last
Operated:
of Operation and ❑est
Feeder to Finish
Other Type of Livestock
Namher�of Lagoons{ Hotciing �PondsX „-� � ❑Subsurface Drarns Presen#
-'„� 4> ��. ,. r�� , ���, 4 -x�� ❑Lagoon Area.. , ❑Spray.. Freld Area
General
1. Are there any buffers that need mai ntenancefim prove m ent?
2, is any discharge observed from any part of the operation?
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. Was there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
❑ Yes [3-fib
❑ Yes m No
❑ Yes ® No
❑ Yes ® No
❑ Yes
E2 No
❑ Yes
® No
❑ Yes
[9 No
❑ Yes
® No
Continued on back

6. Is facility not in compliance with any applicable setback criteria? ❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/1/97)? ❑ Yes No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (Lagoons and/or Holding Ponds}
9.
Is structural freeboard less than adequate?
❑ Yes
❑ No
Freeboard (ft): LaTT 1 La oon 2 Lagoon 3 Lagoon 4
10.
Is seepage observed from any of the structures?
❑ Yes
-0 No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12.
Do any of the structures need maintenance/Improvement?
❑ Yes
RNo
(It any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWO)
13.
Do any of the structures lack adquate markers to identify start and stop pumping levels?
&Yes
❑ No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type A a d2 e"
16.
Do the active crops differ with those designated in the Animal Waste Management Plan?
❑ Yes
® No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the cover crop need improvement?
❑ Yes
No
19.
Is there a lack of available irrigation equipment?
❑ Yes
® Na
For
Certified Facilities Only
20.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® Na
21.
Does the facility fail to comply with the Animal Waste Management Plan in any way?
❑ Yes
® No
22.
Does record keeping need improvement?
❑ Yes
© No
23.
Does facility require a follow-up visit by same agency?
❑ Yes
© No
24.
Did Reviewer/Inspector fall to discuss reviewfinspection with owner or operator in charge?
❑ Yes
® No
2.
.g✓ +�`e� 5g0'''p�' S "°6 -' � ''r' 3°,�"�` �� ar _ y - �-s } �i. 4 � �tr✓
i i X `s) - F h¢ H � : „�� � 4 �- x+ob'1^ i � '�'-a�.V".ar`➢vr k...
ift
x {
a
"",
Reviewer/Inspector Name � z:3*r'Y �. �. �tp,�� �Ys� :��°'� '�^. '��„ `s�` � �t,�, x • �w �.r ,x'v � ; �,£aa7 � S-•y
Reviverltnspectcr Signature :�f w x Date
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 11/14/96

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
James Stroud
J&S Hog Farm
PO Box 125
Albertson NC 28508
SUBJECT: Operator In Charge Designation
Facility: J&S Hog Farm
Facility ID#: 31-556
Duplin County
Dear Mr. Stroud:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate.a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919/733-0026.
Sincerely,
A. Preston Howard, Jr., P.E., Director
Division of Water Quality
Enclosure
cc: Wilmington Regional Office
Water Quality Files
P.O. Box 27687. 4,
Raleigh, North Carolina 27611-7687 NVf C An Equal Opportunity/Affirmotive Action Employer
Voice 919-715-4100 - 50% recycled/10% post -consumer paper

Site Requires Immediate Attention.
Facility No.3 L SS
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPER"e:,',/"
VISITATION RECORD
DATE:, 1995
Ti
Farm Name/Owner:I n��
Mailing Address: P4 60K 1Z
County: ff�/ .
Integrator
On Site Representative:
Physical Address/L- ocation:
Type of
Design Capacity:
I bic rk-or
Phone:
Poultry Cattle
Number of Animals on Site:
r 7L
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: _° ©f ' �" Longitude: '77 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) or No Actual Freeboard: Yo Ft. Inches
Was any seepage observed from the lagoon(s)? Yes orfec)over
Was any erosion observed? Yes or)
Is adequate land available for spray? Yes or No Is cr p adequate? Yes or No
Crop(s) being utilized: /
Does the facility meet SCS minimum setback criteria? 200 Feet from DWelling ? e or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oru
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes orlo
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or� If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on speci creage with over crop)? )e or No
Additional Comments: O -,,
JIm�__
Inspector Name S gn e
cc: Facility Assessment Unit
Use Attachments if Needed.