310565_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Qual

Type of Visit: 0 Compliance Inspection ' Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: - u rr1 Arrival Time: Departure Time: County: Region:
Farm Name: jD lT � 5-07 +�f T Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Jel 6}-rl i a.*,— Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Dairy Cow
Current
Pap.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Zap
Design Current
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
D . P,oul_ , Ca acit Pao ,
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
-
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ZfNo ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
N ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
noNo ❑ 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)
El Yes
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
g
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

I `[Facility Number: - 5-4 T1
Date of Inspection: a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freehoard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: Sb�►I F=i n -
Spillway?:
❑ Yes
❑ Yes
Structure 5
rN
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Designed Freeboard (in):
Observed Freeboard (in): 3-7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA
(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
waste management or closure plan?
[3 NE
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental reat, 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 Aaolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): [52 ►'ink eA rr+i tol r I e't
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NA
rNo
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
N ❑ NA
gNo
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records &Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑fNA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfe //❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspection Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ 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

fFacUity Number: A i - I Date of Inspection: / 1- 22
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes N NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes No 0 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA [:]NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes [:]No
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question.#): Explain any YES answers,andlor any, additional recommendations orany othercomthents:
Use drawings,of facility.to,better explain situations (use additional pages as necessary).
-1 / br4�4 0),
7
07 -(o-1 7
Reviewer/Inspector Name:
ReviewerAnspector Signature: [•� s 1 'Ic IQZ,� P (/
Page 3 of 3
Phone: ')
Date: '12- 2-2. —L7
274/2015

Fl�
Type of Visit: mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit. _0 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: p Departure Time: 0 County: �Region:
Farm Name: j �,t J� ice_ Owner Email: �
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: pm
Certification Number:
Certification Number:
Longitude:
esign
Swine Elipacity
Wean to Finish
Current
Pop.
Design C►urrent
Wet Poultry C*apacity Pop.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
lt , Ca acit P.o
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
ers
Beef Feeder
Boars
7fiae
Beef Brood Cow
Discharges
oults
Other
and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ' El 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 PNo ❑ NA ❑ NE
❑ Yes
[:]Yes
ffNo
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
[No
[—]Yes No
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
2/4/2015 Continued

I!
Facili Number: - Date of Ins ection:IS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
1 a. If yes, is waste level into the structural freeboard? ❑ Yes ff No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 'Z 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 ZNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J?fNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ONo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ff No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PTNo ❑ 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 F2rNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes PVNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes E�r No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA [] NE
❑NA ❑NE
Page 2 of 3
21412015 Continued

FaciliNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes -ONo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ZNo DNA ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ,?rNo ❑ NA ❑ NE
❑ Yes E'No ❑ NA ❑ NE
❑ Yes a'No ❑ NA ❑ NE
❑ Yes Z^No ❑ NA ❑ NE
❑ Yes ,a No ❑ NA ❑ NE
❑ Yes.EfNo ❑ NA ❑ NE
❑ Yes �,j�N0
❑ Yes No
❑ Yes C2,1Vo
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any, additional recommendations or any other comments..
Use drawings of facility to better explain situations (use addihonalpages as necessary).:a ,
,1; r,&, o�- re(_arc45' %ok j�Qo/.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 2
Date:
21412015

Date of Visit: Arrival Time: Departure Time: 0 County :14ILe-- Region:
Farm Name: Jp yl 14" YID' _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Integrator: m /C
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poul#ry Eapacity Pap. Cattle
Finish La er Dai Cow
Design Current
Capacity Pop.
Feeder
Non -La er
Da' Calf
o Finish
Da' Heifero
Wean
o Feeder
o Finish
V
Design Curren#
D . $oul Ca aci P,o ,
La ers
D Cow
Non -Dairy
Beef Stocker
Non-Laye
Beef Feeder
Boars
Pullets
Beef Brood Cow
keys
Qther Turkey Poults
Other Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes )2rNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ,6 No
[:]Yes ENo
❑ Yes P�No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: i
Spillway?:
Designed Freeboard (in):
_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[] No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ONO
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
4�:rNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the. waste management system other than the waste structures require
❑ Yes
ONO
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
kEn No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ 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
2/ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;2 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
PI/No
❑ NA
❑ NE
acres determination?
TT
17. Does the facility lack adequate acreage for land application?
❑ Yes
L21No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
1n nnac tho facility fail to have all components of the CAWMP readily available? if yes, check
box.
❑ Yes PtNo ❑ NA ❑ NE
❑ Yes Tk ��o ❑ NA ❑ NE
] WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
aping need improvement? If yes, check the appropriate box below. ❑ Yes [;; I o
ion ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
ocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
fail to install and maintain a rain gauge? ❑ Yes 1Z No
the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes ONO
DNA ❑NE
0 Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
21412015 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E3 No ❑ NA ❑ NE
25. Isrthe 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 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes JC3"No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ;ErNo ❑ 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 EfNo ❑ 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 Z No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes qNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other -comments.'. `
Use drawings of facility to better explain situations (use additional pages as necessary).
"J 73 e S to (4 1 rl 1 4of a'� f
ar ray n��.1.
�/ gook
Surds
S 13111Y
� y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9 1 o 4'323
Date: b ��
21412014

type of visit: 4ar1rompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: e"toutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I q;14 Departure Time: County: a14 )—xV,, Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Integrator:
Phone:
Certified Operator: %Nl�z wu", Q pD41 "" Certification Number: I LIU
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
C►urrent Design
Pap. Wet Poultry Capacity
I ILayer I
enji
Pop.
Cattle
Dairy Cow
Dairy Calf
Capacity
t
Pop.
Wean to Feeder
I INon-Layer I
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
D . P.a_nitry Ca aci
La ers
e
P,o
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharaes 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 .2�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[]Yes [] No ❑ NA ❑ NE
[] Yes )n No ❑ NA ❑ NE
[—]Yes ENo ❑ NA ❑ NE
Page I of 3 21412011 Continued

lFacility Number: 3 ) - h b8 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0KNo ❑ 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: AL D
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.)
t'a
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes �No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes �no
[DNA
❑ 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 [X`No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes rNo
❑ NA
❑ NE
maintenance or improvement?
T
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 7 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes T No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No 0 NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes No
❑ Yes No
❑NA ONE
❑NA ❑NE
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
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
Ef No
[DNA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[r No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CJ No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

I�
1
•Facili j Number: Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RfNo
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Rn No
0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
no
0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ZNo
❑ NA 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
KNo
❑ 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
V'No
[DNA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
2'No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
.
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[XNo
[DNA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAVRVIP? ❑ Yes � No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes eNo ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:!'-
2/4/2014

Type of Visit: 4I) Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: )6Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ] Arrival Time: dl w Departure Time: County: & l Region:
Farm Name: _xb�� C. 'F�r�A� �Y• Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: OACertification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
I
Design
Wet Poultry Capacity
Layer
C•ur:rent
Pop.
Cattle
Dairy Cow
Design Current
C•+opacity Pop.
Wean to Feeder
Non -Layer
I
EE]
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
D Ploul ., C_a_ acit
La ers
C+orient
P,o
D Caw
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
1H
Pullets
Beef Brood Cow
Other
Other I
.—keys
Turkey Poults
10ther
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 7&o ❑ 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 j2�4o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 211Fl0 ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes eNo ❑ 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: 5 j 71r,17
Spillway?: G
Designed Freeboard (in): 7_
Observed Freeboard (in):__
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZTNo ❑ 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 eNo ❑ 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? 0 Yes ;2rl�o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 6 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 er!!jONo ❑ NA ❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes .no ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes X�lo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
7r�f 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?
TTTT
17. Does the facility lack adequate acreage for land application?
0 Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
TTKNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
zNo
❑ -1#A
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
rn
❑WUP El Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes eNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes,, /No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes E�,No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Zf No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ONo
❑ 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
ETNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
KNo
❑ 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
ONo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
/No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
r 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
PTNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VI No
DNA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
f:jNo
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations'or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date: Tbill
Page 3 of 3 21412011

Type of Visit: N Compliance Inspection U Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0Dfenied Access
Date of Visit: Arrival Time: Departure Time: County: h1f Region:
Farm Name: \)C*N STj rH S(L SOt,I ( AAA Owner Email:
Owner Name: Lahw ' /1MI T# Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 1 Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop. Cattle
ILayer Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I jNon-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Design Current D Cow
D , P,oult . Ca aei_ P,o , Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other Turkey Poults
Other Other
Discharges and Stream_ I_mpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes P,
No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Fagility Number: ' jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes X No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �u - (-1 H
Spillway?:
Designed Freeboard (in): 1
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.) T�
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 0
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, et .)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 1') SC L�_-V r,^(_L f I
13. Soil Type(s): A Lk_A-t QLLLA__
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?
Yes
[] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes -E .No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
OWUP ❑Checklists QDesign Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No DNA ❑ NE
Q Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ W/te T s ers Q Weather Code
❑ Rainfall ❑ Stocking E] Crop Yield Q 120 Minute Inspections Q Monthly and V Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 21412011 Continued

Facility Number: --K 1 - S Z. S I 113ate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o ❑ NA ❑NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
CNo❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
Yes
❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�] No ❑ NA ❑ NE
7�
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
CkNo ❑ 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 4 No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWIvfP?
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
0 NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommenda(ions or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
C"p(_' gQA-T'/as/ b'C
�[D c�� � O 1 G �� �1�°�"�S -- c,�Iu Ctc 43 I Ms
r�41c.F to-e- (,-)I c vqc71oc-
V A, , S F
1� A9
Jn 5 aOfAr
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3l0 --�/ a3 1
Date: S113VID_
2/4/2011

Type of Visit: A Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 6LRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: f Arrival Time: Departure Time: FT_15S__1 County: Region:
Farm Name: _)Q4A1 SM 1 TH)ZSaw Q(Z rA-& Owner Email:
Owner Name: _ cCHP{ m ITN Phone: p. is «— 5CoR — `,Lj-
Mailing Address: P • cD. CA q � � � i %1 �� �"� 11—L- / V C_ 00 a S oa
Physical Address:
Facility Contact:
Title:
Onsite Representative: tt [ A )4
l
Certified Operator: am] 1 m
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
1 [.9 ri, (9 -S- - --
Design Current Design Current
Wet Poultry Capacity Pop.
Swine Capacity Pop.jfalL
Wean to Finish a er
PWean
Design Current
Cattle Capacity Pap.
Da' Cow
to Feeder
Feeder to Finish
on -La Non -Layer
Da' Calf
IV
Dairy Heifer
Farrow to Wean
/ QCa
Design C*urrent
Dr P,oultr, Ca aci P,o
D Cow
Farrow to Feeder
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
I
Turke s
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes []No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [—]Yes [] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: 3 1 jDate of Inspection: toS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: eg�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S pC
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.) T
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? N
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 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �kNo ❑ 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 CropWindow❑{Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �j��-�y �, \ �pqL- iL.LG7 T
13. Soil Type(s): FRA TuRcA ) I C4--L / Void _OC_1�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ 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
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
X No
❑ NA
❑ NE
the appropriate box.
❑WUP OChecklists ❑Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No
C] Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ �4ste Transfers
0 Rainfall 0 Stocking F1 Crop Yield [] 120 Minute Inspections Q Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9No
❑NA ❑NE
CD Weather Code
0 Sludge Survey
DNA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: j - Date of Inspection: $
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C4 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes KNo
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 rNo
o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
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 X No
❑ Yes No
❑ Yes �No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA 0 NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or an
other `comments.
Use drawings of facility.to better explain situations (use additional pages as necessary).
Ljepp-Tr c(j L�'6(_s'3
c�� a�.as► bN ��� �o�a
r J J t 15 FOB. 'i o - 5— j (_C ONE
g1,40 6XI
o a s ace ��v�
jq&�D 76 Wc�_)(_C ! 6AGLCSC
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 90 ` 1.96
Date: ' S 1 1
21412011

Type of Visit V Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )d Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i0 d [Arrival Time: ® Departure Time: County: {-1 Region:
Farm Name: ,�JY 1 SMI TN . SQ-QS ( ACzm Owner Email:
Owner Name: _µN �f1i11TN _ Phone:
Mailing Address: V.P. ox L ! l "'4 ' 1' IA11L H 1 LL dC ofVSiQ
Physical Address:
Facility Contact: \ a Title:
Onsite Representative: LAml Eiz_
Certified Operator: C • S Nt I -r4
Phone No:
Integrator:
D6i0
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [—] V = ' a « Longitude: = ° =
Design Current
Design Current Design C►&Fent
Swine
C►apacity Population Wet Poultry
Capacitya Population Cattle C+apacity Popu[ation
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Feeder
❑ Non -Layer
Feeder to Finish
QC�
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Pullets
❑ Beef Feeder
❑Beef Brood Cowl
❑ Boars
❑ Turkeys
Other
❑ TurkeX Pouets
Number of Structures:
❑ Other ❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
XNo
❑ NA
❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ANo
ElNA
❑ NE
other than from a discharge?
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 �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: scxz
Spillway?:
Designed Freeboard (in): +✓�. ��.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No [INA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 1ANo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes $ No ❑ NA ❑ NE
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
'�No ❑ NA
El NE
El Excessive Ponding ❑ Hydraulic Overload [I Frozen Ground [3 Heavy Metals (Cu, Zn, etc.)
J
[]PAN ❑ PAN > 10% or I 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift El Application Outside of Area
12.
Crop tyl e(s) 'L7EI�( Q� S6 �GNL_ /' ►1L(.E 7-7t /
P\)
13.
Soil type(s) L/MW U1 LL,& (rQf.K
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
tNo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
'ANo ❑ NA
ElNE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ElYes
M No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
*No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
�To ❑ NA
❑ NE
'Comments (refer to question #):. Explain any YES answers and/or any recommendations or.any other comments
Usedrawings of facili to`better explain situations:' use addition aI a es'as necessa
OWN
Reviewer/Inspector Name
x1f'_ Phone: 43T— cj
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

r
' Facility Number: 3J —�os Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists
0 Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 'P_No ❑ NA ❑ NE
❑ Waste Application M Weekly Freeboard C] Waste Analysis 3 Soil Analysis ❑ Waste Transfers ❑�nual Certification
[l Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes] No
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes )kNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes] No
❑ NA
❑ NE
General Permit? (ieI discharge, freeboard problems, over application)
' 1
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 Wo
❑ NA
❑ NE
Additional Comments and/or Drawings:
51julho
vs
'qJig/16
Al
C-). i �
jgga m
1,-�
a 41
ja)09
�
C)-��
R�pSE, U� c���QS `GZON� ► X1S 1 �l - Q �
Page 3 of 3 12128104

Type of Visit ACompliance 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: Q Arrival Time: c�+D_eparture Time: County: uAf Region:
Farm Name: _ 1 _1-lAl �MI TH J R . _�C_x,3 FAfL- Owner Email: a ,
Owner Name: cY�]t!N �M1Ti-i +' Phone: 95`off -StcS-3T4a )l24a�
Mailing Address: r• a • r LL t/A C N � S ICQ
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: a o 0 i = Longitude: 0 0= =
Design Current
city Population Wet Poultry
Design Current
Capacity Popula#ionCattle
Design
Capacity
Current
PopulatiFinish
❑ La er
❑Dai Cow
Feeder
rEI:]Wean
❑Non -La er
❑Dai Calf
Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Dry Cow
ElNon-Dairy
ElBeef Stocker
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
ElBeef Feeder
Beef Brood Co
❑ Boars
❑ Turkeys
❑ Turkey Poults
❑ Other
Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes A,'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
)4 No
❑ NA
❑ NE
❑ Yes
)kNo
❑ NA
❑ NE
12128104 Continued

Facility lumber:--3 I —5&S Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes )6 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: rINI sff
Spillway?:
d C
Designed Freeboard (in): ) ! . •..3 9.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes o
PiN
ElNA ElNE
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 0 No ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes 4No ❑ 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 0No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 'N o ElNA [_3 NE
ElExcessive Ponding ❑ Hydraulic Overload ElFrozen Ground ElHeavy 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 ❑ vikence of Wind Drift ❑ Application Outside of Area C
12. Crop type(s) JC C=Z (9"') SG. �Eae-L. I 1 1!L_4�1 LP 1 Dk�_
13. Soil type(s)
V
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes V' No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 9(No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes ON. ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
l8. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
w. A,
JST
S S
�� -0 6� eT Sow 1_ vL 6 r T�4 1 h-
�j�lf
i. S
G•��
-C.�� 61Ms r->IC_ ACV U
Reviewer/Inspector Name i N fly --_)� .1 Phone:
Reviewer/Inspector Signature: Date: Cj
Page 2 of 3 I2128104 Continued

r
Facility Number: 3 1 775�11 Date of Inspection I �tii JCt i !
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IN No ❑ NA ❑ NE
the appropirate box. 0 WUp [] Checklists ElDesign
gn El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ANo
❑ NA
❑ NE
❑ Waste Application [] Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑
'9/aste Transfers ❑ )4nual Certification
E] Rainfall ❑ Stocking ❑/rop Yield 0 120 Minute Inspections ❑ Monthly and I"
Rain Inspections []
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ko No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
DdNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes VNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ANo ❑ NA ❑ NE
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMF? ❑ Yes )qNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[jNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ No
,
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
`[�No
❑ NA
❑ NE
�, a�"a,,y`�.�` w4tt"4•:"_,�v�y V��` `'�.. .,.�„m a. -3u.. r� .. '...."�"ti.s;,,y�'�a. ,� ` ,;� � •, K -ikin f � y - x-,�
AdditianaYC©min,
ents
1?1 oc f Q C uQ2A-j rvi�) -T+j 15 C OC- 1G `
H,
Page 3 of 3 12128104

Xx Division of Water Quality
Facility Number F 1 5(p 0 Division of Soil and Water Conservation
-- - - - - - - 0 Other Agency
Type of Visit 66 Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 46Routine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: '=f Arrival Time: ® Departure Time: County: �� N Region:
Farm Name: Owner Email:
Owner Name:. _ J c 3 Wyl l iA I TN Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: .�301y//w UI � 041V I F—g—
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 e Q t =is Longitude: = ° = ' E__1 u
_ Design Curren# : Design Current = :'`Design Current
Swine:. ,,Ca aci Po ulation WetsPoult : p ty p ry'' 'Capacity Population. Cattle Capgcity� _Populatfoit
,:. <.
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -Layer
Feeder to Finish 4 &C> - -
❑ Farrow to Wean Dry Poultry
Farrow to Feeder IN
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other ,
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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
❑ Non-Daiiry
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
i
�v
Number of Structures z�
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes AN o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
12128104 Continued

FaeKty Number: 31 —Z51 Date of Inspection I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ 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: S S T
Spillway?:
Designed freeboard (in):
Observed Freeboard (in): 3 y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes] No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
M. 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 ,EZNo ❑ 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
20 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ No
ElNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
1� No
11
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ 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):
l �► . t~ E� c.ap�o� cs�c �+-P�s�r�+ r �- [�T W� �cs�cz-�3
T '4g Fite e B6 A(LN a~ o6Z- A ?R, L J M 4vS 1 AWN E
M.OVJ I N 5 1 DE _'A Krc U3 4u S
Reviewer/Inspector Name PM"S Pbone: /0 nn�
Reviewer/Inspector Signature: GZtMDate: � oC(00 p
Page 2 of 3 12128104 Continued

f S
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps
p 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 ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
P�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[]�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PQ"No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
qNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
MNo
❑ 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
11
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
R '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
I'No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number
,OrDivision of Water Quality
0 Division of Soil and Water. Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q1 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: ,�� O rrival Time: ko!4471Departure Time: County: Region 'A
Farm Name: .-10 �� ��i71 ff� �� / /f�2 /Y� Owner Email:
Owner Name: afhnl Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representativ&-.:::�p /. �4-4I%
Certified Operator:!%z,0
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Title:
Phone No:
_ e
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = Q = I 0 {L Longitude: = o = c = ai
Design Current Design Current
Capacity Population . Wet Poultry Capacity Population
❑ La er
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
IE]Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity .P.opulatiow
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE r
❑Yes ❑No ❑NA ❑NE.
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
❑ Yes ANo
ElNA ❑ NE
El Yes ANo
❑ NA ❑ NE
12128104 Continued

Facility Number: 3—
❑ Yes ZINO
❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: , f!
Spillway?: 100
Designed Freeboard (in):
Observed Freeboard (in):
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
El NA El NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes /&No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan? A
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? Xyes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes YJ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes] No ElNA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Ycs/�INo ❑ NA ❑ NE
❑ Excessive Pondmg ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window , ❑ Evidence of Wind Drift ❑ Application OutsicLe of Area
12. Crop type(s)
13. Soil type(s)
0)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes gNo
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Ye sX No
17. Does the facility lack adequate acreage for land application? El Yes
Y�No
18. Is there a lack of properly operating waste application equipment? ❑ Yes XNo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA El NE
Comments (refer to question 9): 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):
6cw-r—
z Telq-5s
Reviewer/Inspector Name Phone: 0
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 ❑Maps ❑Other
❑ Yes XNo ❑ NA ❑ NE
❑ Yes 'ONo ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes eNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes )z 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 )Z(No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA XNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
7No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
o
VN
❑ 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
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
PrNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
No
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:
4C,1-21W-57.
An-
AL
12128104

r
Facility Number 3E
OrDivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit JO Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied AccefJss��
Date of Visit: q Arrival Time: is Departure Time: ounty: A-z Region: (d) '\ Q O
Farm Name: �O �• Owner Email:
OwnerName:0 Phone:
Mailing Address:
Physical Address:
Facility Contact: T Title: (� Phone No:
Onsite Representative: \ n i4ri Nil A4UX r &Ff_ (.ANQ0"j Integrator:.
Certified Operator: �DA)G� kn'j00d5k:T- Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 c = ` = 11 Longitude: = o
Design Current Design :.. . CurrentDesign Currentro
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
21911C30
Farrow to Wean
Farrow to Feeder
1, 000
1000
❑ Farrow to Finish
❑ Gilts
[] Boars
Other.
❑ Other
❑ Layer ❑ Dairy Cow _
❑ Non -Layer ❑ Dairy Calf
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures 2 �
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 ;ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�dNo
❑ NA
❑ NE
❑ Yes ZNo
❑ NA
❑ NE
12128104 Continued

Facility Number: —
Date of Inspection 2 O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 0 Structure 2 ap Structure 3 Structure 4
Identifier: !__ rr
Spillway?: S t NO
Designed Freeboard (in):5 I q, 5
Observed Freeboard (in): +�
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes PNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ONo ❑ NA ❑ NE
❑ Yes )2fNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 11Z Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes jZfNo ❑ 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. ❑ Ye No
❑ 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 Soi
❑ 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
from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑NA El NE
�No El NA El NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
/No ❑ NA ❑ NE
Comments refer to question Explain an YES answers and/or an recommendations or an other comments
( � �� p y y y
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
0
Clmen"'-'5�Fri
_
Reviewer/Inspector Name Phone: /V" - 6
Reviewer/Inspector Signature: Date: -3 2 06
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes XINo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes ❑ No
❑ NA
❑ NE
the appropriate box.
❑ WUP Checklists ❑Design El Maps El Other
10
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 9 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 ZNo
❑ 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 PNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes [,'No
❑ NA
[I NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes XNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes O No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
.2fNo
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
/PlNo
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes YNo
❑ 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 X'No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes ZNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Quo 11*I leig,<- .z ' a fS,�� �✓o
�4 ��/L•� 6* 00'A
�,� � �Z�o• /�'��� � � Cam,✓ �s�- ��r� � �i' r C�ss-
Page 3 of 3 12128104

v
`Division of Water Quality
Facility Number �j 65 �D ate r Conservation
Eel
Other Agency
Type of Visit e Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit JD Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 QS Arrival Time: Departure Time: ' ounty:
Farm Name: \.�/Q/Y� Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representai
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: F70 = Longitude: = ° = 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
I 1 ❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes )9No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
gNo
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
12128104 Continued

.71 "Z
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
❑NA El NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -�n I.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes ZNo
❑ Yes ❑ No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA [INE
(ie/ large trees, severe erosion, seepage, etc.) /11
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 )Z No ❑ NA ❑ NE
$. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks) to
9. Does any part of the waste management system other than the waste structures require ❑ Yes U�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes "A 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 Drifi ❑ Application Outside of Area
1
12. Crop type(s &RA
7d &[A/9244
13. Soil type(s) pJ
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination" ❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
iose
4-16
Reviewer/Inspector Name �, Phone:
Reviewerllnspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check Yes /❑ No ❑ NA ❑ NE
the appropriate box. ❑ W P Checklists ❑ Design El Maps El Other IV
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste 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
[INo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
F(No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes Y"No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA PI'NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes VNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
ElNA
ElNE
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
VNo
❑ 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
VNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
V
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Lo
❑ NA
❑ NE
Aididomal Comments and/or Drawings
`� 1 `64 e AC'49QD
Owwex
I2/2&/04

Type of Visit (P Compliance Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit (4 Routine Q Complaint 0 Follow up O Emergency Notification C) Other ❑ Denied Access
Facility Number Date of Visit: %% w Time: 20
rO Not Operational 0 Below Threshold
[3 Permitted © Certified 0 Conditionai1v Certified 0 Registered pate Last Operated or Above Threshold:
Farm Name:'K�m� off 4L �O(..cwCounty:
Owner Name: � Oi{ o Phone No:
Mailing Address:
Facility Contact: l Title: Phone No:
Onsite Representative: P+ �i��/l
p integrator 0
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' 0• K Longitude 0' w
Design Current Design Current Destgta Current
Sine `Ca " titr= Po elation Pouf Ca aciri.1?a iilation _ :Cattle Ca achy-Y Po ifatroA .
❑ Wean to Feeder ❑ Layer ' EI'Dairy
Feeder to Finish ' i- ❑Non -La er I Non-Dai
Farrow to Wean
Farrow to Feeder O ❑Other
Farrow to Finish r ,:.M' Tntul i1e<ian ['�nsil `vita w :'
Present
No Liouid 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: 1501j Fi
Freeboard (inches):
05103101
Field Area
❑ Yes 1,11No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes A No
❑ Yes XNo
❑ Yes ONO
Structure 6
Continued

Facility Number: — 1p
Date of Inspection /�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
T Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste AvOication
10. Are there any buffers that need maintenance/improvement? '
11. Is there evidence of over applicatic ? ❑ Excessive P ding ❑ PAN ❑ Hydraulic Overload
12. Crop type 1�� F r± (�' �fJQ f_
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWM
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Rec9rds & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
I & Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 0 No
❑ Yes 0 No
❑ Yes ONo
ElYes � No
❑ Yes
W No
❑ Yes
JZJ No
❑ Yes 0 No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
VNo
❑ Yes
YfNo
❑ Yes FINo
❑ Yes XNo
El Yes X,No
El Yes XNo
❑ Yes ONo
❑ Yes EfNo
❑ Yes lallo
❑ Yes XNo
❑ Yes )ZNo
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Y71
�
'. 6 f S 9 "d L �ry '1 X S,.uAl ,a`. �' -'A.IA *War uv� '.ea r `-ID..F
Comore©ts (refer to queshvn � Eapla�n:auy YE&answers andlor any recommendatio&.or any;other comments:'
�.�:.
Use;drawengs of facHity to better ezpla�n situahans:{use acfd�t:anal pages as necessary) Field Copy ❑ Pinal Notes w�
Ij1FN,0 tA.q ?ziv� N
4 /r /1q 4110 `y i✓G. DjP41-2-,t1, e A OF �LL©,,M Z11-57 11 G--
`�ovs� �f //J�� �n„1G ��Zj►J� s��� V�� l�0<�E4f -�/`1
•;:
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Z
0510310I V Continued

ft
Facility Number: i7 Date of Inspection 1� I
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional Comments, and/or Drawings: <
/t/0Ti� ,'
G
104
A/D
-o,✓ /`mom ,' /32 o
InI, 4a �'O' V" 0,
❑ Yes ❑ No
❑ Yes �No
❑ Yes No
❑ Yes PQ No
❑ Yes !� No
El Yes /� No
❑ Yes ❑ No
05103101

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit `X Routine O Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: Time:
Q Not Operational Q Below Threshold
Permitted 0 Certified [3 Conditionally Certified 13 Registered Date Last Opera or Above Threshold: .........................
1,
Farm Name: County:..........._'.Y.L^�............................. .. ................
�' �n�-r......................................
OwnerName: ....... ....... ................................... ........................................................................ Phone No:...................................................................................
FacilityContact: .......................................................................... .... Title: ............................... ................................. Phone No: ................... ............. .. .......
MailingAddress: ....•---•......................••-......•......---•-............................-------------••---...............................-..---............. ..........................
Onsite Representative:. ......................... Integrator: _..G \ :....... ----- -----
w
Certified Operator: ................................................... ............................... .......................... .. Operator Certification Number: ..................... .....................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 64 Longitude �• �4 «
- Design. Current Design Current -Desiga : Current
Swrne Capacity Population Poultrycapacity.,, PopullitionCattle
. Capacity==Po �ulation
❑ Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish ❑Non -Layer ❑Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish TOW Design Capacity
Gilts -
❑ Boars T0W'99LW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
Holding Ponds Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes )�Na
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 X No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Eq-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes 9No
Structure t Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .........................................................................................................................................................
Freeboard (inches): 6�
"G
5/00
Continued on back

acilit�Number: Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan? ❑ Yes IN 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 Z No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 10 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes )EfNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 9No
I I. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes eg�No
12. Crop type .5: 1,J o— , 1J' 1P , Sg
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
lb. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, frecboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0 4 -Yi01atilUs:ot, dtf eiencies •ware pQteO d4trifng th�s'v�sit; Yop witi ec iYe pti IFu�thtr
corresi) rideii& abviiti this visit. ..:...................::..::::.:::. .
, s:omnetitseerto quesion aworayremndafoaoan.plainny, E
Jse dFa fwrags of fat lityto better 0izpwm.situaU1ons. use addition_ al pagesm as necesskry x e
lub 4 L-k 4
❑ Yes ,FfNo .
❑ Yes tErNo
CYes ❑ No
❑ Yes ❑ No
❑ Yes tZ No
❑ Yes J4 No
❑ Yes VNo
❑ Yes kNo
❑ Yes E No
❑ Yes allo
❑ Yes No
❑ Yes] No
❑ Yes 10 No
❑ Yes No
❑ Yes No
AL
r
Uy
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: [ V -- i-01 5100

[IFiteffity Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Xyes E] No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes KNo
28- Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, El 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? 0 Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan bells, missing or
or broken fan blade(s), inoperable shutters, etc.) El Yes *No
31. Do the animals feed storage bins fail to have appropriate cover? [I Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? El Yes ONO
Additional: Comments andfor!Drawings:-
5100

Dlvision-0
DfolSiOnna
r Conkiiiation _ r s
Type of VisitCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit A Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: QGa
0 Not Operational 0 Below Threshold
9permitted © Certified 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: ...............
Farm Name My Coun-\................
OwnerName:........................................................................................................................... Phone No:...................................................................................._..
Facility Contact: .................................................................. .... Title Phone No
MailingAddress:.....................................................................................................................
Onsite Representative:..r.............................................. Integrator: ...��v.; `s....................................................
Certified Operator:,••,,,••„ ..................... Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��� Longitude
Swine
Design Current
cannrity Po nilatinn
Feeder
Vean
o Finish
la4
❑ Farrow to Wean
Farrow to Feeder
WOO
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Poultry Capacitv Po ulation Cattle
❑ Layer ❑ Dairy
❑ Non -Layer ❑Non-Dain
❑ Other
TotalDesign Capacity
Total SSLW =
Desiigni. _ _ 'Ct _ v
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray; Field Area L
Holding Ponds./ Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
,� No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other.
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed. what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
; No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
No
Structure 1 S ucture 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:...........$Uw............ ........... Z.!....1................................................ .................................... ....................................
...... ................... ...........
Freeboard (inches):
5100
Continued
on bank

Faciliiy Number: — Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 4 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ,Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? Yes N0
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ,KNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes b�No
t2. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes XNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ZNo
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 VNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
t<No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WC1P, checklists, design, maps, etc.)
❑ Yes
VNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
kfNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
NrNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
0No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
NrNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
b?No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
,ONO
�Va violatiQris. ... . c..... were noted S. Yoit will feegiye Rio #'urther ;
corres�oric)tence. about this visit. . . . . • .
Comments (refer to question #): Explain any YES' answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessar-
y _
) ll n
Vt-q�1 G� V
f ✓
a� SU W t1517513 e11V pp,
kr
�c t'_3

I
4
Facility Number: 43 Date of Inspection 7-') {71 Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 9Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes KNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? 'KYes Id 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 P No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes CKNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes OfNo
JA4dkfia94,C'omments and/or rawzngs:.
►�-..'-, ��• .cep , "�C1 *1;
L\ 46 3 • Cam - C (
#t
5/00

P(Division of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
J.
E
sit Compliance Inspection O Operation Review p Lagoon Evaluation
r Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: © Printed on: 7/21/2000
Q Not O erational 0 Below Threshold
0(permitted 0 Certified ❑ Conditionally Certified © Registered Date Last Operated or `Above Threshold:
Farm Name: .......... .Q....'1[ ► ................................................................... County:...... �f......`1�........................ .... ....................
....
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
FacilityContact: ............................................................... ...... Title: Phone No:...................................................
MailingAddress: ..................................................................................................................... ............................. ....................
Onsite Representative:.. .. ..... integrator:.....
Certified Operatvr:......... . Operator Certificativn Number;,,,,,,,,,,,,,,
Location of Farm:
T
❑ Swine, ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �° Longitude �• C` ���
Design Current
Swine CanaCitV Population
❑ Wean to Feeder
$Feeder to Finish
12, 90
❑ FarroW to Wean
Farrow to Feeder
I GW
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Po ulation Cattle Capacity Population
❑ Layer I ❑ Dairy
❑ Non -Layer I 1E] Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag-nn Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Imuaetti
1. Is any discharge observed from any part of the operation? ❑ Yes WNo
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) El Yes ❑ No
c. If dischanx is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system'? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ,Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ,o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �No
Structure 1 Slructure 2 Structure ? Structure 4 Structure 5 Structure 6
Identifier: P� ....................................................
Frechoard (inches): 36 3S
5100 Continued on back

Facility Number: 3 — Date of inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑Yes"No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes \ �to
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes �No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes JgNo
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 D� No
11. Is there evidence pf over application? q Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes allo
12.
Crop type kK , b a ^_s� Soil Wes
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
1 0
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
S�No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination'?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
kNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
WNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
14No
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
DNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Wo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
NNo
21.
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
CR�No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑Yes
K No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
RNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
E `No
.
o VIolafioriS.00 aeeCleliCii�s were ngtea-OtWing4his,vlsit.-Y:oit will•receiye iio further. :
•.-cor'respondence.aboutthisvisiL-'..'.*
::::.::............... :::::::-.,.-.•--...-.-....:
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):
ku L-�5 :�na,
�t---tee C� �� ���- �� �-�eti•-,,.� �� �� � -- �., PCL44,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: ^'aa­4 0 5100

Facility Number: — Date of Inspection( a J Gtl
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Ayes ❑ 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
29. 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 No
32. Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover? ❑ Yes WNo
Q d.. t,,f a �� , `� '� �c�-..�,� ff � � ►r yam_

Division of Soil and Water Conservation -,Operation Review
13 Division of Soil and` Water Conservation :._-Compliance Irispecteoii� ,
iv>:.ston of Water Q4aLty'-hCompliance Inspection a
. _ Other Agency Operataon=Review- e _
Iff Routine 0 Complaint Q Follow-up of DW ins ection Q Follow-up of DSWC review Q Other
Facility Number 3/ Date of Inspection L~%
Time of inspection 3 36b 124 hr. (hh:mm)
10Permitted,eCertified 13 Conditionally Certified 13 Registered JE3 Not O erational Date Last Operated:
Farm Name: C-t�, k Af._ ---- �... �.1. ..................................................... I.............. County:.............�.� J..s , t ^!.................
Owner Name: . .. Phone No:..--
Facility Contact:.............................................................................. Title:........................ ..... Phone No:
Mailing Address: ...........
I
Onsite Representative:.. t?. ............ Sl.x.......�............................................... Integrator:.......C� LL,�......................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
Latitude * ° .4 Longitude 9 ' "
Design Current = -Design Current Design Current
Swine . - - Capacity Population Poultry Capacity Population Cattle Ca acity. Population
❑ Wean to Feeder ..I[:] Layer I I ❑ Dairy
❑ Feeder to Finish' ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean -
ElFarrow to Feeder ❑Other
❑ Farrow to Finish Total Design CaAacity
❑ Gilts, f g fl .cls'fr -
❑Boars To
ta1.SSLW
V (Nuinber of Lagoons. _10 ❑ Subsurface Drains Present I ❑Lagoon Area ❑ Spray Field Area -
Holdirig Torids / Solid Traps ' ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is die estimated flow in gal/min?
d. Dees discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
[-]Yes '`No
❑ Yes �No
❑ Yes dNo
❑ Yes VNo
❑ Yes EZElYes
❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _4'.0%0V
Freeboard (inches): ............ f�................ ...........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes "P4o
Continued on back
3/23/99

FacilityLNlumber: -71 ;, Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes INo
(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 XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes )l No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ZZNo
Waste Application
tO. Are there any buffers that need maintenance/improvement? ❑ Yes . P No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes �Vo
12. Crop type C-SE,AA,Q
13.. Do the receiving crops differ with those desi
.C(wJ ...a.�&
in the Certified Animal Waste
14. a) Does the facility lack adequate acreagelfor land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
t5. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Plan (CAWMP)? ❑ Yes JZ"No
❑ Yes 0 No
'Yes ❑ No
❑ Yes J21No
❑ Yes �No
[:]Yes P'No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ON
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? (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? J,�
(ie/ discharge, freeboard problems, over application) ❑ Yes o
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 YNO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes YJ'No
10 •Violations ;oi- di f cieucies were pgted during this: visit: - YO will-k&6ye lid #'uirther ; ;
. ... s... de' ' 'A' ' f this visit: _
C66iments (refer to quesiioru #) ::Explain any yES answers iaai6r atiy recommendations o 'any other coa►ments
Use.drawings offac'I to betfenexplain situati©ns (use addshonal pages:as necessary) r "
-7 c> jr _ O ve- Fat_ t; a 6j L A k) a a.-4 et-rmc -ru 4-f_ dr, ` -xF_r S AUo-J r-O
1 b E � �A- C� �i S E•� �
ns� cq%AV b� sMr+U- ��r<cx�s .Jo '� � END �Y4 Rr�uc L.on��tJU P-A�,
z�, rs4�ay�
C I ac,- t�rl��� oti. ,�l„ —
/ ems. 26 Ito zqegz�'
Reviewer/Inspector Name E . i- : "/-� • ' ,.. =t
�i'] =_ 7.C? i�<' _
_
Reviewer/Inspector Signature:
Cc,_._
Date:
3/23/99

Fpcility �jluraber: 3 I Date of Inspection 7 �
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below XYes ❑ 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 JYNo
28. Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt, ElYes 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 /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 VNO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? P/Yes ❑ No
Additional. Comments and/ror-Drawings::. S
�Z ��U � ��� L i tFE.S �� ��� �� � MET ►.1�o i ti S �S �S� Ttd,g �r—
�fk N k-5 A LL 1 G Pd E� t_. j I-\ � s j A �Y- i L�. A,. -KO
3123/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Routine O Complaint O Follow-up of DWQ inspection O Follow-u of DSWC review O Other
Date of inspection
Facility Number 3 i Time of Inspection 24 hr. (hh:mm)
© Registered (Certified © Applied for Permit 03 Permitted 113 Not O eratiortal Date Last Operated: ,,
Farm Name. .. �&ra.......ini u tc,........ 5md... { ............................. County:...... .i� in ...........................................................
Owner Name: Obk:.............�Yh3.! -... ,::.................................... Phone No: .....- ... Zr�.�` �.. 7 ...................
Facility Contact:
.................................... Title:..-----.......................----......--.----.----............ Phone No:...
MailingAddress:.... ..Q.... Q.�C... l�I............................................................................... .........P&i ...... �.{.�..f..l.!��r................................... ..4.S??........
OnsiteRepresentative: ............. r. �...........�..GlNfi?�..................................................
Integrator:
........... cArY.a.1.6....................................................
Certified Operator: ..................................................
Location of Farm:
Operator Certification Number,...... ...................................
...........4 *a. 2.4 t ...................................
..................................................................................................................................... ...................................................
Latitude 0• 04 0"
❑ Wean to Feeder
Feeder to Finish
2 a
❑ Farrow to Wean
ED Farrow to Feeder
006
❑ Farrow to Finish
❑ Gilts
❑ Boars
Longitude �• �` �"
3= Design Current
Poultry Capacity, Population ,Cattle ,
❑ Layer ❑ Dairn
❑ Non -Layer ❑ Non-
❑ Other ,
Tota! Design Capal
;T©tal' SSI
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
MNo
2.
Is any discharge observed from any part of the operation?
❑ Yes
O No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gaVmin?
MA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
I] No
7/25/97

TaeilitrrNumber: 3 i — rb,�'
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes (2 No
Structures (Lagoons.Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes R No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:L z.........................
Freeboard(ft): ........... Ui............I................Z.$....._.......................................... .................................... .................................... ....................................
10. Is seepage observed from any of the structures?' ❑ Yes P No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes P1 No
12, Do any of the structures need maintenancelimprovement? (j Yes ❑ No
(If any of questions 9-I2 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes y No
NVaste Application
14. Is there physical evidence of over application? ❑ Yes 91 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
i � {
15. Crop type b21Cn'Uh.'L........... 1b,���...kA�kY� ........ .........scJln4h.
... R Y?1i.............. ..................................
16. Do the receiving craps differ with those designated in the Animal Waste Management Plan (AWMP)? E5VYes ❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
10 No
18.
Does the receiving crop need improvement?
❑ Yes
,� No
19.
Is there a lack of available waste application equipment?
❑ Yes
CONo
20.
Does facility require a follow-up visit by same agency?
P1 Yes
❑ No
21,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[A No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
99 No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
91 Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
0 Yes
❑ No
0- Ndviolatioins-at: deficiencies. were noted-dueing this;visiL- You:r'ill i-ecei've-n6,furtt%er, : -
: c6&604ndence A464t-this:yisit:.:
o� 5 kot W 'fire k1W f- rci tfd,d, 1 K [ T; z i, [aVQIX'V �
aX.Zu16 be owtj, Ronk shoA be �M��� in s6rm wJw divtni*- &J aaf 4v 1cr,,. O.ow
a; ��+r
11P. SVftAVG-nnuCk 64W c►.. f:rto -z Ai UM Co l,. to, bertWJw ►ti Atli zk
iz. Wv� shaulr� ci,.a. A � { re. � l eck Gu(rr"4- Gro ? cl � t i. pretd Z.k oX a1 !� a� a-�rd nw
C"t4 c_CYc e. kjivm. w+ CtZ6 ,%f SMIJ\ grxn"n_ 4- wiry a.nriclkc S�aV�� yc e�f0'Wv�dd -�o 14-
k.(A • J SO
1*. reAes 63 �1109a 1*211 ©Vc�ro,,:cr,�% A n.;�"T,. or. IM&II 1)"atr, IA- 3416A,)1t-6`1I,
ib--n$`Ib,�4L I zL-1A(tgkGj 3V-4zIhyjAG 36-37-%s/ac_ 7125/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:)?4 Date:

Facility Number � 5 �
E3 :;�• of I!tshrrtirm
Time Rif' Inspeclinu �24 hr. (hh:mm)
p Registered M Certified p Applied for Permit a Permitted � of Operational Date Last Operated:
Farm Fame: Bohn.Smith.Jr..:Sass.Fart[n........................................................................ County: Duplin WIRO
Owner Name:. lohti.................. .... sm.iikjr................................................... Phone No: 56X-_347& ...................................................................
Facility Contact: ....................................................... ...Title: .... Phone No:
Mailing Address: P..O.Btox,417............................................................................................ PjjikJHiUAC ........................................................ 28572 ..............
Onsite Representative: ............. . . ...................................................................Integrator:..
Certified Operator: Jnhn..C.................................. Swith ................................................. Operator Certification No mher: M51 .............................
Location of Farm:
Latitude ©•® _1 Longitude ©. ® FTT_T�
_ - esign un•ent
Swine 'Capacity Population
p Wean to Peeder
Ig Feeder to ruts
p Farrow to Wean
® Farrow to Feeder
Inno
p Farrow to Finish
p Gilts
p Boars
esign Current Design jurrent,
Poultry Capacity Population Cattle Capacity. Population,
p Layer
p Non -Layer _
p ter
Total Design Capacity 3,480
Total' -SS " W 856,
Number of Lagoons./.Holding Ponds I JE3 Subsurface Drains Present p Lagoon Area p Spray Meld Area
o iquid W aste Management System
General
1. Are there any buffers that need maintenance/improvement? 13 Yes r3 No
2. Is any discharge observed from any part of the operation? p Yes p No
Discharge originated at; p Lagoon ❑ Spray Field p Other
a. If discharge is observed. w as the conveyance man-made? p Yes p No
b. if discharge is observed_ did it reach Surface Water? (If ves. notify DWQ) p Yes p No
c. If discharge is observed. what is the estimated flow in ;al/min?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ) 0 Yes p No
3. Is there evidence of past discharge from any part of the operation? p Yes p No
4. Were there any adverse impacts to the waters of the State other than from a discharge? p Yes p No
5. Does any part of the waste management system (other than lagoons/holding ponds) require p Yes p No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? p Yes p No
7. Did the facility fail to have a certified operator in responsible charge? p Yes p No
7/25/97

aci ity Number: 31 _565
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Iinldin,_, fonds. Fhi�h l'i1s_ etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I S11-H Ure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft):
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
p Yes
p No
p Yes
p No
Structure 5 Structure 6
p Yes
p No
p Yes
p No
p Yes
p No
p Yes
p No
p Yes
p 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 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?
2I. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities ©nIN,
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?
Q ovio tions.or dencies_wereaote uringt isvlslt. ouwi .receivena u er.•.
"kes06n0laee about - .. . - . . .
t was made to assess it facility is a likely candidate for State groundwater study. Observations of spray
i public roads.
y fields looked relatively dry; however, other fields in the area looked wet.
brick house (newer) is located at northeast corner of spray field #2. No well was seen. .
brick house is located across SR1704 from spray field #2. A well was seen.(cinder-block,cover).,.
brick house is located at end of spray field #3. A well was seen (cinder block cover).
manufactured home is located to the south of spray field #1. A possilile_well.was seem.(metal cover).
]rouse (older) is located to the northwest of spray field #3. A well was seen (brick cover).
p Yes p No
p Yes p No
p Yes p No
p Yes p No
p Yes 1] No
Yes 13 No
p Yes p No
p Yes 13 No
p Yes p No
p Yes p No
were i
7/25/97
Reviewer/inspector Name Andrew3G Helmiiiger=
Reviewer/InspectorSignature:
Date: Z

f
a Ir - !1 i
mom
a

❑ Division of Soil and Water Conservation ❑ Other Agency � r
In Division of Water Quality
Routine O Complaint O Follow-u of DSVQ ins ection O Follow-up of DS%VC review O Other
Facility Number
5 Date of Inspection ±Z i
Time of Inspection 24 hr. (hh:mm)
© Registered 0 Certified © Applied for Permit Permitted 10 Not O eratia}nal Date Last Operated: ..............
Farm Name:....... .k!�+.i._L.v.-....s.._... .Y.�`'a ... County:....#?.U...�,{..�n�...................
Owner Name: ...... a.!s. n ....................S.w`.�..1. `7,�. Phone No:.....C._g....Q...i.........'..6..,`.......
..)....................... )
Facility Contact: .................................. ...Title: ...... Phone No:.,`�,�,�,�„,.�g.'.1'1
MailingAddress:. V-0....... R.o.K....... ......1............. ........................ ...........................P...�.. .1E-- H .1..1.. ..�.....................a .
Onsite Representative:...,�..1?..,'4...!!1......�.lM �.. 1_. ST`r. �........................... Integrator:...... BCDJ. r...........................................
Certified Operator....................................................................................... . Operator Certification Number
Location of Farm:
Latitude • =' " Longitude r-�• 66
Design .Current Design ;Current,:: Designer 'Current
r
Somme Capacity, Poliufatton Poultry Capaetty Pgpulattori Cattle Capac;iy Pnpuistion
❑ Wean to Feeder x ❑ Layer JEI Dairy
❑ Feeder to Finish
❑ Non -Layer 1E1 Non -Dairy
❑ Farrow to Wean
- g
> ❑ Other _ a
El Farrow to Feeder
Tote Design Capad y
❑ Farrow to Finish
,rt
❑ Gilts
' TotiUSSM
❑ Soars
Number Lagoons / Holdtn Ponds ' ® Subsurface Drains Present ❑ Lagoon Area ® Spray Field Area
of g,
g ` T ❑ No Liquid Waste Management System
General
i.
Are there any buffers that need maintenance/improvement?
❑ Yes
® No
2.
Is any discharge observed from any part of the operation?
❑ Yes
f'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a.. if discharge is observed, was the convevance man-made?
❑ Yes
® No
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
❑ Yes
® No
c. If discharge is observed, what is the estimated flow in gaUmin?
A. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
91 No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
ONo
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
E�No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
RYes
❑ No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
& No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
;'No
7/25/97
Continued on back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Roldin Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure ? Structure 3 Structure 4
Identifier: ..{�
Freeboard (ft): ........
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes
® No
❑ Yes
No
Structure.5 Structure 6
❑ Yes
"N No
❑ Yes
KNo
Yes
❑ No
❑ Yes
Ej'No
❑ Yes
&No
15. Crop type ... .............................. 1 i.x-rh.t.�n..................AJ.......... Sm.►!vv.!-►^¢rx.'"..a.Y►.►%-v0.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes CKNo
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19, Is there a lack of available waste -application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[3-No. vialations-or. deftcie'tcies:were itoted,during this.VisiL- You.'W'ill receive'na•ftirther;
: correspondence about his:visit:-::
�b a"-+t. S a t-[ L c. w LA-4, . cac t o
C,a r vt-c+ l i i t n W a Z i•
❑ Yes 19 No
❑ Yes (a No
❑ Yes UNo
❑ Yes CgNo
❑ Yes KNo
IKYes ❑ No
❑ Yes RNo
2'Yes ❑ No
JR Yes ❑ No
uk. Ise d u i, r o �A-r Cn� c wa r s s l i i dr1 h4 ✓� 3. }� l t o vv�a 1 u r��
V 6A.-S a S ^-c, r-'L� o w 5 f ` °`'7 r'
i 2 5• d Y.va tiv a Ie @A- �. Q ra tz i [ i �- -5 HA.m. t a. r O. 1 " o-R-tt a-S �'"1 R4
1.1 a 1 U_ o f D q-�-+ c^ w 1 l ]LV_ S e.A f '[-per- '�c 1 4-,j i �a... .
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: s . jj_QY. , L r, Date: