310573_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: & Co pliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: lZo j Departure Time: p a County: t UP Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
6
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: t f i U
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultey Capacity Pop.
Wean to Finish I ILayer 1 11
Design
Cattle C►►opacity
Dairy Cow
Current
Pop.
Wean to Feeder Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean Design Current
Farrow to Feeder I) , P,oult ,wC:.._aaci Pao
Farrow to Finish Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Illeef Brood Cow
Boars
Pullets
Other FFOuther=er
Other
Turke s
oults
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
[] No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes
❑ N ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[—]Yes
❑ NA
VNo
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure LA
e I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L.J� cy3 6vot--1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a.�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 6 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 0 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 environmentpl threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes 2(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2/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 ManurelSludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
© No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R'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
N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
D. NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
d o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other•
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes WN " DNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes .� No [DNA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail o 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 E6No ❑ NA. ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes FO/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ZNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ENo
❑ Yes En No
❑ Yes ONO
❑ Yes [No
❑ Yes No
❑ Yes ZNo
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
DNA ❑NE
❑ NA ❑ NE
Comments (refer to. question ##): Explain any YES answers andlor .any additional recommendations or any other comments.
Use drawin s: s (use additional pages, necessary).
g of.facility to better explain s�fu>kron p g scary)• . a...e.. _..�
�Zt SLd96£ SV2UEy' DoNL 3� OL�rl_sm UC CroACTd�- Grp r C,(.P
ReviewerlInspector Name: -�' Phone_9 1) / Wb 3
Reviewer/Inspector Signature: Date: I1 ga—Ill
Page 3 of 3 r 21412015

Type of Visit: IZ) Co pliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: (p Arrival Time: q a Departure Time: J a b 1 County: ✓P Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: _Dngzb CA EsTo ()IT Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
1-7lg3
Design
Swine Capacity
Current Design Current
Pop. Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
DairyCaw
Wean to Finish
Wean to FeederL
FLayer
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
18q
p
Design Current
Dr.. P,oultry Ca aci_ P,o
DairyHeifer,
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DW R)
[:]Yes [:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes u , o
[DNA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: 3j- Date of Inspection: 3 y
,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 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
`l
Identifier: L-A to Zr
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�14No ❑ 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 envi onmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [7Yes lNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ZNo [DNA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E7 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 E 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
EZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ZN o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
21140
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did facility fail to have the Certificate Coverage & Permit
Yes
No
NA
NE
the of readily available?
❑
[�i
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �l ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

• Facility Number: - Date of inspection:
-IV4. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes ❑ 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 [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes I__I 1`i0 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
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
I _I c
❑ NA
❑ NE
33. Did the Reviewer/lnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9No
❑ 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).
Tv w o &+--. 0 0J'X1C_C- s o
J � vlJ t✓ ,
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
Phone: Qlb C- 13 0
Dater
21412015

(Type of Visit: O Co pliance 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 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
(�
Onsite Representative: / 4 ' � ("lc S4A C f4 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: _ f 7i d —3
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Capacity
Pap.
Wet Poultry
Capacity
Pop.
Cattle C*apacity Pop.
Wean to Finish
airy Cow
can to Feeder
airy Calf
Feeder to Finish
2.(VI
I S9 9
Dairy Heifer
Farrow to Wean
Design
C+urrent
Dry Cow
Farrow to Feeder
Dt, KFUR ,
C•_a aci
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 P o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
F;;rNo
❑ NA
❑ NE
❑ Yes
BNo
❑ NA
❑ NE
Page I of 3 21412015 Continued

r Facili Number: - 3 Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3-
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 envi nmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E' Nci ❑ 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 [J"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 EJ/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes El"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes LJ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 1_J 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 FTNo
❑ 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. [] Y s ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ej'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FaciliV Number: - Date of Inspection: S /
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
�iryes
❑ No ❑ NA ❑ NE
the propriate 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
of o ❑ 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
❑ Yes
0 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[�] No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file 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?
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
❑ Yes dNo
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments "(refer to question #): Explain any YES answers and/or any additional recommendations or any;9ther comments:. "
Use drawings of facility to better explain situations (use additional "pages as necessary).
7 fk4--Q (C I u 1 S' T" hGr
rc 5 c P� rE aFt�S
I' N"1`Y" f f r'P c4r�C�
Zs, ��,f Si4 �G S��✓fj' �.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
I -' C{ ro , -
Phone: l 19 -7 13
Date:
21412015

S ✓
I
Type of Visit: &Co liance Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: aRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: b S 1 Arrival Time: ® Departure Time: i County: Olp Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: llil D GH CST n1 U-T Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 1'7 4 � 3
Certification Number:
Longitude:
Design CurrentINDesign
Current
Design Current
Swine Capacity Pop.
:Vet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
I
Dairy Calf
Feeder to Finish
9.1
Igor,
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. Poultry
C•_a aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ}
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes ❑ ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: s, Date of Inspection: y f it j
T
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Vacture 2 { Structure 3 Structure 4 Structure 5 Structure 6
Identifier: %
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �jin I
5. Are there any immediate threats to the integri 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 en onmental 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 im rovement?
P
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesrNo
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E/No
❑ NA
❑ NE
Rec wired _Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes [ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes o
[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 o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

A
jFacility Number: -,:; I=r�-7 a jDate of Inspection: 1; t14 1e
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [6No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 6/No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: /
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes WNo ❑ 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 ❑ LagootVStorage 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 dNo
❑ Yes ENo
❑ Yes �o
❑ Yes No
❑ Yes
❑ Yes
❑ Yes
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
JnIx ❑ NA ❑ NE
o ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use4rawings of facility.to better explain situations (use additional pages as necessary).
DX. Lr_ VjA �_t✓ N CE D S 1„ 00 o '� G�it-o ►+J[�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone��
Date: pr S
2/ 0Il

Type of Visit: 9moutine
pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 2 a 3 Arrival Time: g4s _ Departure Time: ® County: j Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �:)AUTD C 4 EStougr Integrator:
Certified Operator:
Certification Number: t 7(g3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Poultry Capacity Pop.
I ILayer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish l
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oult , Ca aci P,o ,
ILayers
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars Pullets
Turke s
Other Turkey Poults
Outer Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
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 &<o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes (Z"No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - ') 3 I Date of inspection: 2
3
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 l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
y +
Identifer: LA4600u
_
Spillway?: A'J�
Designed Freeboard (in):
Observed Freeboard (in): 3b �S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
FfZo
❑ 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
YNo
❑ 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
dNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q/No
❑ NA
❑ NE
maintenance or improvement?
Waste ARplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo
❑ NA
❑ NE
im r vement�
man enance o p o
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CZ/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
[—] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
['To
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [;Vo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3/No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
❑' Vo
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3/No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
N
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

FaciliNumber: 31 - 73 Date of ins ection:
r
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 �rN. ❑ 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 Eo ❑ 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 �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 E: 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
[2`6
❑ 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
O/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
dNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
FO/No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Q/No
❑ NA
❑ NE
Comments: (refer to question ##): Explain any YES answers and/or any additional recommendations orany other comments.,
Use drawings of facility to better explain situations (use additiuiial pages as: necessary):
Reviewer/Inspector Name: A K OE LA, Phone: lt6 1 —
ja
Reviewer/Inspector Signature: Date:
cl-
Page 3 of 3 21412011

(Type of Visit: Q Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: (2�(Routine O Complaint O Follow-up Q Referral O Emergency O Other 0 Denied Access
Date of Visit: S Q Arrival Time: Departure Time: 17 ��,� County: I xt) Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: P!,SD Q4C&YivLM
Certified Operator:
Title:
Phone:
Integrator:
Certification Number: �-7 yg3
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Non -La er
Design
Capacity
I
C►urrent
Pop.
Design Current
C*attle Capacity Pop.
Daig Cow
Dairy Calf
Wean to Feeder
Feeder to Finish
Za Z
1] , P,oul_ .
I Layers
Design
Ca aci
Current
P■a ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 0 No ❑ NA ❑ NE
Yes ❑ No
Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
Yes ❑ o NA [:] NE
Yes VNo
NA ONE
EJ Yes NA NE
Page I of 3 21412011 Continued

Facility Number: - 5 Date of Inspection: Z
Waste Collection & Treatment
4. Isfstorage 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: (.ACrCr5tj 5
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): pZ �✓'
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 �o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes environment
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes Ej(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 U No ❑ NA ❑ NE
maintenance or improvement?
Waste Awlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Z�/No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
ff No
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[—]Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ff No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes
C?r/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 [DNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [a 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. �s ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Opsludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [3/No 0 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes O No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 5 t - jDate of Inspection: L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes aiN ❑ NA ❑ NE
25. the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 6No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ElYes YNo ❑ 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)
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ Yes
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
CZ/No
❑ NA
❑ NE
❑ NA
❑ NE
7
❑ NA
❑ NE
No
❑ NA
❑ NE
o
❑NA
❑NE
�N['J
o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional. recommendations or any other comments:':
Use drawings of facility to better explain situations (use additional pages as necessary).
�() LXATE Sty "E � .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
`.76 t, L Phone:
Date: 5 L
V4/2011

Divtstgn of Water Quality
f Fac><wty Number 3 I 5'� 3 0 Division of Soil and Water Conservation
Othe a g y
Type of Visit 7Routine
pliance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ,did Departure Time: County: eL.—ZJ + Region:
Farm Name: Owner Email•
Owner Name: Phone:
Mailing Address:
Physical Address:
Faeility Contact: Title: Phone No:
Onsite Representative: 'Au -to %N�S�tm Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = d = {I Longitude: 0
4 Desi n Current Dest n Current De ign:.Curr`.ent
g -
Swme�; Capacity 'Po ulal�on Wet PoultryCa a'ci Po ulation Cattle 'Capacity„ Population
_ P cr kt P'. .
❑ Wean to Finish ❑ Layer -" ❑ Dairy Cow
Wean to Feeder
.% ❑ Non -Layer I I
❑ Dairy Calf
Feeder to Finish I
Dairy Heifer
ElFarrow to Weanp
,,
; a
❑ Dry Cow
❑ Farrow Feeder
❑ Non
to
❑ Farrow to Finish
=: El Layers
it, -Dairy
❑Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
- ❑Pullets
❑ Boars
El Beef Brood Co
❑ Turkeys
'Othei El Turkey Pouits
.
-
❑ Other
❑ Other.
Numbe o Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 3 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑N El NA
❑NE
❑Yes
El Yes
LI No NA
❑ NE
El Yes
o ❑ NA
❑ NE
12128104 Continued

• Facility Number: 3
Date of Inspection C 7Sd p
I 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 Structure 2 Structure 3 Structure 4
Identifier: L- AG� [ LAC-,o G#J Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ENo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and: the situation poses an immediate public health or environmentalWeat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ N
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes LI No ❑ NA ❑ N
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes ZNo ❑ NA ❑ N
maintenance or improvement?
Waste Application ,s �
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U No ❑ NA ❑ N
maintenance/improvement? �,/
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElICJ Yes No ❑ NA ❑ N
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or lO lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
E
E
E
E
E
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L' I No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CrNi❑
NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
,
U No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
L4 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
Yes
El Yes
❑ NA
❑ NE
Comments (refer to question°#) Explain any YES;answe'rs andlor any recommend at tons ©r any other comments:
.�
ls�e. drawtn s.of facili to,better ex:i,n.-situations use addttton'al a es asrnecessa . .�
Reviewer/Inspector Name '(� Phone. R /q
Reviewer/Inspector Signature: Date: 1
Page 2 of 3 1 12128104 Continued

Facility Number: — 5 Date of Inspection +
i
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EfNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Cl Yes
L" No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections
❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
[2 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
hTo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ef No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
io
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ICJ Flo
❑ 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
hd No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes E No ❑ NA ❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ONo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑j1Vo ❑ NA ❑ NE
Additional Comments.and/or Drawings:- ..V =�
Page 3 of 3 12128104

S7
Type of Visit Com liance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: l`% it7 Arrival Time: Departure Time: County: j'L-_XA)Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �j Title:
Onsite Representative
: CI-IESt�
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = Longitude: 0 ° 0 , = "
Design Current
urrent
DesigrDesianCurrentwa
pacii Population
Wet Poultry C+apacipulation
Cattle Capacity
Papulation
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
110 Non -Layer I
❑ Dairy Calf
Feeder to Finish
$
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Da Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
La ersElBeef
rEj
Stocker
Gilts
Non -La ers❑Pullets
Beef Feeder
❑ Boars
❑ Beef Brood Co
❑ Turkeys
OtherWMI
I❑Turkey Poults
❑ Other
11—
JEJ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0NNo
❑ 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
El NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
VN
❑ NA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
l o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

1
'4
Facility Number: 3 —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):Z-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ yes
LI 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
LI 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 t eat, notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
Zo ❑ 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
[f Yes
[�/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LI No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L'l o
❑ 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?
18. Is there lack
❑ Yes
❑
�
❑ NA
❑
❑ NE
❑
a of property operating waste application equipment?
Yes
Ia No
NA
NE
V.
�,• S�^..agy„4,, ,.- ¢ -, _.- -=,r ...^ .•b ..� - ",�-- i s ..w,;waty " � �Y �'%`i: °�+}d ai'°h�L"c-3�� -tre '°" � .,� �� � . �s
:Comments (refer,to quesfton #) : Explam, .any YES::a'nswers an(lor any'recomu endations or any oE
„Unecessary
lier comments: fi °�
se dri ingsFof fadlrty to better explam situations: (use add�honal pages as necessary):
SE oT LATe- -
Reviewer/inspector Name V u04.t I Phone:(�)O))19 13V
Reviewer/Inspector Signature: Date: t -7 AID
12128104 Continued

1 -
Facility Number: 3 —5'� Date of Inspection l Z Ib
Renuired 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 O No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. IJ 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 Inspectionss El Weather Code
22. Did the facility fail to install and maintain a rain gauge?
ElYes
[J"NNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IJ —No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
BNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
M-No
ElNA
ElNE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3- o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑Ko'
❑ NA
❑ NE
Other Issues ��
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes Q o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
DI/go ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,�/`
lLl No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
/No
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
❑ NA
[INE
33. Does facility require a follow-up visit by same agency?
ElYes
,
L No ❑ NA
❑ NE
12128104

Type of Visit O Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f+ Or7 Arrival Time: 'L36 Departure Time: County: �U(�� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: DMU C'AIE-SMUIE
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c = ' 0 Longitude: = ° = d 0
dl
Design Current Design Current
Swine Capaty Population Wet Poultroy Capacity Population
Design
C+attle C►apacity
Current
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
❑ Non -Layer I
I
DaiLy Calf
Feeder to Finish
o'Zt LA
ab
Dry Poultry
❑ La ers
❑ Dairy Heifer
❑ Farrow to Wean
❑ Dry Cow
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑Non -La
❑ Gilts
Elers
Pullets
❑ Boars
❑ Beef Brood Co
❑ Turkeys
Other
Number of Structures:
❑ Turkey Poults
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation? .
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes WNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ o El NA
[I NE
El Yes
go ElNA
[INE
ElYes
LJ No ❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 3 [ — s 3
Date of Inspection 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 Structure 2 Structure 3 Structure 4
Identifier: C 14 tJ LjA(yao,►i I�
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes jNo ❑ 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
LLJ No
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
iNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
,�
LJ No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Z No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2(,_,(No
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]E Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1�6140
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ (No
❑ NA
❑ NE
-
Comments�(refer,�to,„Pgneshon�#) �-Explatn any,�YES answers�`and/or any recommendations�oany other comments.
-
�I3se�drawmgs;of:facilrty�to better�explam�s>ihrattons�(use addthona�pages as necessary}.
1W
�7�.
Reviewer/Inspector Name Phone O 17016 — g
Reviewer/Inspector Signature: Date: o
Page 2 of 3 t 12128104 Continued

Facility Number: — S 3
Date of Inspection G o�
Recmiired
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
ENo
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
MNo
❑ 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
ZN o
❑ 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
ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
' o
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ef 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
E�No
❑ NA
❑ NE
General Permit? (icl discharge, freeboard problems, over application)
--//
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ETNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Additional Comments and/or. Drawings: h.
Page 3 of 3 12,128104

Q Division of Water Quality /
Facility Number 1 �1 S } O Division of Soil and Water Conservation
-- - Q Other Agency
Type of Visit 0 Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 3 1 - Lq g I Arrival Time: ® Departure Time: �� County: _fk�&azd _ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: -Tvnnm-e C-W-11#301t Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: =1 o =' 0 Longitude: = ° 0 C = «
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
[9 Feeder to Finish QiS4 1,100
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: F
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes nNNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes dNo ❑ NA ❑ NE
El Yes WNo ❑ NA ❑ NE
12128104 Continued

Facility Number: 3 l —
Date of Inspection 3 u v
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ElVJ 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: CA Gd6d
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
LI 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
Cff No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
LI 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
CNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
fNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu., Zn, etc.)
[—]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes � o
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes Lf No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name �j o }{1/ !q /�u� Phone• qd ! —7
q 4 � 7 3 q
Reviewer/Inspector Signature: Date: 311 ti/K
1212RI04 Continued

Facility Number: 3 1 — s Date of Inspection 131a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L' I No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ENo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
[4 Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall R(Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
�0"No
LEI No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ErNNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E3 No
❑NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
ElNo
E /NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EfNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
b 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
ErNo
❑ 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?
El Yes
,�_ ,,�
[2<
El NA
El NE
33. Does facility require a follow-up visit by same agency?
ElYes
No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

i vision of Water Quality
Facility Number O Division of Soil and Water Conservation
C) Other Agency
Type of Visit ,,00mpliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit. Arrival Time: / D 6 Departure Time: County: D"Otx✓ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: & yn t� UF
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
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =c 0 f [= 4, Longitude: = ° = 4 = 1{
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_- ❑ La er
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current.
Capacity Population
❑ Dairy Cow
❑ 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?
0
❑ Yes P to ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 00 ❑ NA ❑ NE
❑ Yes ❑1 No ❑ NA ❑ NE
12128104 Continued

Facility Number:
Date of Inspection 4 ►.
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 I Structure 2 Structure 3 Structure 4
Identifier: LA &vv,,j
Spillway?:
Designed Freeboard (in): �, S
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 ❑ <o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes IJ No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm ntal 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 9No ❑ 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 ff No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 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
[] IKo
❑ NA
❑ NE
I7. Does the facility lack adequate acreage for land application?
❑ Yes
�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;No
❑ NA
❑ NE
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):
771
Reviewer/inspector Name Q 2 N �.(�� Phone: - 9
Reviewer/Inspector Signature: Date:
12128104 Cohtinued

4
Facility Number: 3 — Date of Inspection I 71 �c7 I I
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 B'No ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check a appropriate box below.
es
❑ No
❑ NA
❑ NE
ElWaste Application El Weekly asWeekly Freebotc Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall 12 Stocking ❑ Crop Yield ❑ 120 Minute Inspections R Monthly and 1"
Rain Inspections
❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
CJNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KJ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Y rNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
M<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ENA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [TNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[fNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,�/
L�1 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
2No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[�No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

a
.a
Facility Number 3 57
la Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit c—ommpliance 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: 3 Ob Arrival Time: Departure Time: County: A Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Aja ckg tj Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 = ` = " Longitude: = ° "
Design Current
Swine Capacity Population
❑ Wean to Finish
`Y ❑ Wean to Feeder
® Feeder to Finish I PA A q I ai 8
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
Design Current Design'-_­.,:,0
Wet Poultry Capacity Population Cattle Capacity Pop
❑ Layer
❑ Non -Layer
Dry Poultry.
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dga Calf
❑ Daig Heifer
❑ Pry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures ' C
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes LS No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
L"J Nc
❑ NA
El NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes &No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Lip LO-006- LA6601J
Spillway?:
Designed Freeboard (in): 12
Observed Freeboard (in):.` 3� -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes LS 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 envi7yes
ental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes dNo ElNA ElNE
(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 ElYes dNo ❑ NA ❑ N
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ElYes [Xo [INA ❑ N
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes dNo ❑ NA El N
ElExcessive Ponding ElHydraulic Overload ElFrozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > 10% or 10 lbs ElTotal Phosphorus ElFailure to Incorporate Manure/Sludge into Bare Soil
ElOutside of Acceptable Crop Window ElEvidence of Wind Drift ElApplication Outside of Area
E
E
E
12. Crop type(s) fR ^ (- 6) 96 o
13. Soil type(s) Au
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[]Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;rNo ❑ NA ❑ NE
dNNo ❑ NA ❑ NE
3 No ❑ NA ❑ NE
E]�No ❑ NA ❑ NE
[2 No ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):.
�,� iZLte�E WA" Ne_+U ZtAf'A 'A_D & AV t61/6 - n W1JMG TO Se ao t.rx- t. To Ov✓4. �
bvrLxM4, 1 **G STAI-Cad- W14pT A CC%OW w ERA T141C.W Ta .,n4%PA&J& r96, LmAL S,
Reviewer/Inspector Name J_0A j fA2A1E (A- Phone: 11U,0 7f( - 7;-65
Reviewer/Inspector Signature: Date: a I L
n___ -0 _C 1'1H0AaA

I
Facility Number: Date of Inspection 3 o(D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
El
E N
El NA
❑ NE
El Yes
LJ No
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below,
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
/❑
LXi
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
G�NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
L`� IAA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[ NA
❑ NE
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
04o
❑ NA
ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
El 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
eNo
❑ 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
;lo
❑ 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
1Cl No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
rApReason for Visit Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 11/49 5 1 Arrival Time: � Departure Time: County: Region: Cam• �i Ls
Farm Name: Owner Email:
Owner Name: 4/14 ' i45 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
r
Onsite Representative: Lz7?) / lSril/Gl TT Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 1 0 Longitude: = o = 6 =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 1 !>
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars i
Other
❑ Other - - — --- - -- - - -
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
L. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current I
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �TNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
O No
❑ NA
❑ NE
[]Yes
W(No
❑ NA
❑ NE
12128104 Continued

�t
Facility Number: ,31 — Date of Inspection Of
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
S cture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 41/ ` Z4Fd
Spillway?: /1/0 Nn
Designed Freeboard (in): /7-0
r y
Observed Freeboard (in): /rp
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes p/ 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 0 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? Z Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ 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 [__1 NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 23 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 7ZZPZ�
'tion Outside of Area
12. Crop type(s) 6 e�nu4� (//,Ij5�,�� 44�
� � 1
13. Soil type(s) _ Z/ 6 _
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V] No
[:1 NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
d No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
JO No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O No
❑ NA
❑ NE
_.. .. - �.
...,:-'. �- •-•.�. .ter_.,. _yA_ :..-. a,:�a . .>.. rs .a 4 423..
nJ 7,9P tf�
Reviewer/lnspectorName Phone: /4'3c-3PGl7
Reviewer/Inspector Signature: Date: NJ
12128104 Continued

U ny�
Facility Number: 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to instatl and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JZ No ❑ NA ❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2 I No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;a No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
jo No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;A No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VrNo
❑ 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
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Z No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss reviewfinspection with an on -site representative?
❑ Yes
Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Z No
❑ NA
❑ NE
Additional Comments and/or Drawings:
yl� -6;r v :ZPQ-2
-SFPT Gt%STf / P�zCltrz�sJs �' s 0 rG4 C90V : o �. S
l�✓,�Rs�o fi�.�5� lyl�����✓�u.,-, F�S�rc�cy�� �a�_..s �4� /bo�1 �,✓��
Wes
12128104

Type of Visit lCompliance Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit i Routine Q Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number ,'•�) 3Date of visit: iWi7my - Tune: I /S
10 Not Operational 0 Below Threshold
Permitted WCertified © ConditionaUyCertified 13 Registered Date Last Operated or Above Threshold: ........ ...------------
Farm Name: ... � ......�E ..�+ l ... a +.. e .................... County:......:�pWPUA
.......................
Owner Name:
Mailing Address:
Phone No:
FacilityContact:...........................................................------ Title: ... ...................................................... Phone No: ...... ............... ...-......
Onsite Representative: ,, , _....�... caes.l..14.�.Y.1.A.... Integrator: gf wf it ^.... �
�............._... In tor• ..................S .............
Certified Operator: ... ........ ...................................... .. . . . . . . . ....... . ..... . . . . ....... . .................. Operator Certification Number:........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��� Longitude �• �° ���
Design Current Desk Crirrerxf W. D�gn ` Current
Sys ire _ . -"
Ca va Po ! Ca' sicr Po _ Cattle acr
ulairon ___`___,_ airon- _. p _Population
❑ Wean to Feeder
=]
Layer
(] Dairy
,.
Feeder to Finish
-ZI r{
O
❑ Non -Layer
(] Non -Dairy
Farrow to Wean
FEFarrow Other x
to Feeder
Total Llestgn Capac>tty 5
❑ Farrow to Finish
Gilts
=;0
Total SSLW
Boars
Number of Lagoons
yME-
'
,.. _
_
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes VNo
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 gaUrnin?
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 XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ YesINo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:.........I........................ .............. Z........... ......... ................ ............
..................................................................................... ......................
Freeboard (inches):)
12112103 Continued

Facility Number: — Date of Inspection bN
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes /No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) t
ItF❑ Yes ;ZNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JM No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Y110
25. Did the facility fail to have a actively certified operator in charge?
[IYes
XNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
0
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El Yes
l
No
28. Does facility require a follow-up visit by same agency?
❑ Yes
INO
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNO
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
XNO
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Facility Number: 31 —573
Date of Inspection I le O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground
12. Crop type --�{ tzw►t�DQ, � � a S M iR cry
13. Do the receiving crops differ with those designated in the Certified Animal Wa
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?
Odor Issues
❑ Copper and/or Zinc
Management Plan (CAWMP)?
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge att r below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
?. G AS C ot,JEti LAGoo A/ W ALj S A)C-C- 0
. Y
J?E Gong 5
Reviewer/Inspector Name
❑ Yes ;Zlqo
❑ Yes idNo
XYes ❑ No
❑ Yes RTNo
❑ Yes XNo
❑ Yes XNo
❑ Yes RfNo
❑ Yes ;Zlqo
❑ Yes o
❑Yes o
❑ Yes No
❑ YesXNo
❑ Yes /jNo
❑ Yes j�No
❑ Yes /XNo
❑ Yes XNo
❑ Yes ZNo
�_an other'commeQts:= ,
❑ Field Copy ❑ Final Notes
XMP0.•o vWC-&T .
Reviewer/Inspector Signature:
Date:

r
FDtvtsion of Water Quality 7
L Dtvtsron of Soil and Water Conservation
k
Type of Visit _("D'lr ompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Routine 0 Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 � I
Date of Visit:
0 Permitted 0 Certified 0 Conditionally Certified 0 Registered
Farm Name: �� O "'Lt` ��7 / h �J -2,
Owner Name: . ""` °` ! C h S
......... .................................................__..............._...................
Facility Contact:
Title:
3 IS D Time- �� Printed on: 7/21/2000
0 Not Operational 0 Below Threshold
Date last Operated or Above Threshold: .........................
County: _D.Vp--ri.n............................................ ......
Phone No:
Phone No:
MailingAddress:...........................................................................---...............---...................................................................................._..................... ..........................
OnsiteRepresentatne: DGLi%,..-•-•--• �-� h•� -•----............... ---......... Integrator: ''41!�!.i ....f '-.. rd1A. Dd................
Certified Operator:
Location 'of Farm:
Operator Certification Number:. ............................
❑ Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude • �� �44 Longitude • 1 46
Design Current
Canacity-Ponulatinn
Wean to Feeder
eederto Finish
z !
_
#~arrow to Wean
,
Farrow to Feeder
Farrow to Finish
- Gilts
v'= Boars
Design Current Design Current
Poultry Capacity Population Cattle.. Pa "ulation
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total ss
of-Lagaoiits ; 2- l Subsurface Drains Present ❑ Lag;Z Area Spray Field Area
Ponds{SolidT[taps No Liquid Waste Management System
Dischagg & Stream Imuacks
1. Is any discharge observed from any part of the operation?
❑ Yes
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
JdNo
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. It discharge is observed. what is the estimated flow in gal/train?
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?
ElYes VNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes �(No
Waste Collection & Treatment
4- Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes /No
Structure I Struc,t re 2 Structure 3 Structure 4 Structure S
Structure 6
Identifier: ...... 1 S4
•. ............................. Z..`........................................----•---..............................-------------•..... _......... ...........................................--------....
Freeboard (inches): Z 5-
5/00 Continued on back

Facility Number: 31 ­5r7 3 Date of Inspection 3 $
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
/No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
INO
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
'PTNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
,dNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
/'--' No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
ONO
12. Crop type Oe"- rA a
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ONO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Pr" No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
ZNo
15. Does the receiving crop need improvement?
❑ Yes
ONO
16. Is there a lack of adequate waste application equipment?
❑ Yes
5TNo
RRe uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
IbNo
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
j2rNo
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
ONO
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ON0
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 'ONO
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes J2rNo
24. Does facility require a follow-up visit by same agency? ❑ Yes '�TNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes VfNo
E No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comnnenti (refer to question t Explain any YES answers,anal©ranyrecommendatton �:or an of er comments '_ ,
Use drawof rngs facd►t} to better explain s�tuatzons�;(use add�honal pagesgasunecessa'ry�) `^ ❑Field Copy ❑Final Notes
�.� p
'7• N..4, le Leave A 6eA-e,­ jlasS ro✓err alp, l"oakl WeilIs; y��. et,ou►�
ho7 r1oL./ 411e f et4 aoh. -ta close q� ;T WeArs 4-- C"Co4e
l9, 2 an I s-oil 4-c0 rosvl-ls no4 bot<k ye} �o ,rot•^tiPles sew let
Nate bey Zaoi r��s h'1� . Ghcs n v�}. /Deed Ao sY�e a r,Ur
'q t^,as1e a�a! �s>'f d�l��d w/i!� (,D do S o�'ct�o�fie-04 i,eve-,t14c
4e, 'trcula4z' 44e ni4-o'en a plied a,"-1 P -r-l< 2'S ' coon-0
Reviewer/Inspector Name S Oi/tiC' E,f� -}ttrl r J
Reviewer/Inspector Signature: Date: F I S7 OZ
05103101 Continued

Facility Number: Date of Inspection 3 !S OL Printed on: 7/21 /2000
r
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes_J�rNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ZNo
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 ONO
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 RfNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments an orDrawings: ) _ - -
ire ed Ta 6e .S u re le Us e /J7 4o 641 c v I,g4e Ltl o4in - / �J
OVevlGt 4ke 4�) C-ee re co e r)e'l41 ke�� .
5100

State of North Carolina
Department of Environment
and Natural Resources
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Kerr T. Stevens, Director
May 2, 2001
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Thomas Chestnutt
Thomas Chestnutt Farm #2
816 S NC 1 I
Magnolia NC 28453
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL REsouRCES
Subject: Notification for Wettable Acre Determination
Animal Waste Management System
Thomas Chestnutt Farm #2
Facility Number 31-573
Duplin County
Dear Thomas Chestnutt:
A letter dated January 15, 1999 was sent to advise you about concerns associated with Certified Animal
Waste Management Plans and the method by which the irrigated acres within the plans were calculated. Only
the acres that are wetted can be credited in the waste management plan as receiving waste application. Any
acreage within the plan that can not be reached by waste application equipment can not be used as part of your
plan.
An evaluation by John Hunt on 7/20/99 was made to review the actual number of acres at your facility
that receive -animal waste during land application. The evaluation of your facility has yielded one of the
following two results as indicated by the box marked with an "X'.
Category 1:
The evaluation of your facility could not be completed due to a lack of information.' Please
contact your Technical Specialist to assist in providing John Hunt the necessary information
to potentially exempt your facility from undergoing a complete wettable acre determination.
Please submit this information to John Hunt, at 3800 Barrett Drive, Raleigh, NC 27609,
within in 90 days of the receipt of this letter. If you have any questions please contact John
Hunt at [phone]. If within 90 days you are unable to provide John Hunt with the
information you are automatically required to complete a Wettable Acre
Determination as described by Category 2 below, within 180 days of receipt of this
letter.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

Notification for Wettable Acre Determination
Animal Waste Management System
Page 2`
Category 2:
❑ Your facility has been identified by the Department of Environment and Natural Resources
as a facility that may have overestimated the number of acres actually receiving animal
waste. Therefore, some or all of your fields may be exceeding the allowable loading rates
set in your Certified Animal Waste Management Plan.
In order to resolve this issue, please contact a designated Technical Specialist to have him
or her conduct a Wettable Acre Determination for your facility. The Technical Specialist must
be one that has been approved by the Soil and Water Conservation Commission to conduct
Wettable Acre Determinations. Many Technical Specialist with the N.C. Cooperative Extension
Service, the Soil and Water Conservation Districts, the Natural Resources Conservation
Service, and the Division of Soil and Water Conservation have received this special
designation. You may also contact a private Technical Specialist who has received this
designation, or a Professional Engineer.
All needed modifications to your Animal Waste Management System must be made and
the Wettable Acres Determination Certification must be returned to DWO within the next
180 days. If the needed modifications are not made and if the form is not returned within the
required time, DWQ will be forced to take appropriate enforcement actions to bring this facility
into compliance. These actions may include civil penalty assessments, permit revocation,
and/or injunctive relief.
Once a Wettable Acre Determination has been completed, a copy of the attached Wettable
Acre Determination Certification must be submitted to the address listed on the foram. Please
note that both the owner and the Technical Specialist must sign the certification. A copy of all
the Wettable Acre Determination documentation that applies to your Waste Utilization Plan
must be kept at your facility. DWQ and the Division of Soil & Water Conservation Staff will
review all documentation during their annual visit of your facility. An additional copy must by
kept on file at the local Soil & Water Conservation District Office. Please note that if you install
or modify your irrigation system, a designated Irrigation Specialist or a Professional Engineer
must also sign the Wettable Acre Determination Certification.
Please be advised that nothing in this letter should be taken as removing from you the responsibility or
liability for failure to comply with any State Rule, State Statute, Local County Ordinance, or permitting
requirement.
If you have any questions regarding this letter, please do not hesitate to contact Sonya Avant of our
Central Office staff at [phone] ext. 571.
Sincerely,
V
Kerr T. Stevens
cc: Wilmington Regional Office
Duplin County Soil and Water Conservation District
Facility File
Brown's of Carolina_ Tnc_

`. "^' '` ..arRi VSMI4R V+ mate Qu"
r
L
- O'Dtvision of Suit at lMater Cotiset vat s _
t OWeir:Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint. O Follow up O Emergency Notification
O Other ❑ Denied Access
Date of Visit:
Time:
EZE 21
Facility Number
o Not rational Q Below Threshold
#Permitted 0 Certified [3 Conditionally Certified 13 Registered
Date Last Operated or Above Threshold:
FarmName:
ty•
...................................../.................................-----......`�'...•• _._.
OwnerName:......zax?�� ........ ti? ��. ...............................
Phone No:......................................................................» ... » :.
FacilityContact:.....................:........................................................ Title: ................................................................
Phone No:................. ........._....»...».»
MailingAddress:....................................................... . ...............................................
Onsite Represent T
........... ..
.......I.............................................................. :. _....... ._
Integrator:
ative:..... 1.,17`,trJ.....�r(.. ........ ... .. N ..... ................
........
g ........................... ....._
Certified Operator: ................................................... .............................................................
Operator Certification Number:..........................................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• ��u
Design , Current. Design . CurrenY
i
-D6si :- Ciurreat
Swine " - Ca acl4 : Population Poultry Ca city Po uladon .: Cattle Ea sci u,-- Po nlafion ; rt
[I Wean to Feeder
❑Layer
_
❑ Dairy
❑ Feeder to Finish
❑Non -Layer
❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
TOW D&igh Capacity
❑ Gilts
_
_._:
❑ Boars
:Tofal SSLW
Number of Lagoons
❑ Subsurface Drains Present ❑ Lagoon Area
. ❑ Spray Field Area
.:Holdrng PoiidiISolid-Trips.'
❑ No Liquid Waste Management System
= '� r
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes �No
Discharge originated at: ❑ Lagoon [I 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 �N0
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
❑ Yes No
2. is there evidence of past discharge from any part of the operation?
❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ]-No
Waste Collection & Treatment
j
4• Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes 0Na
Structure I Structure 2 Structure 3 Structure 4 Structure 5
6z - -
Identifier: . I ......... .. �`r..................�(.1��................ ............
Structure 6
Freeboard (inches):
5100
Continued on back

Facility Number: Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observe ? (ie/ trees, severe erosion, [:]Yes �No
seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed through a waste management or �No
closure plan? Yes
(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 /VNo
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 V,No
11. Is there evidence of over application?
6�/_
❑ Excessiv Ponding ❑ PAN%%❑ Hydraulic Overload ❑ Yes �No
12. Crop type ` v� da %%i�f�_ (J'7�� �lJ��iJ
13. Do the receiving crops differ with those designated4n the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(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?
::ISO-yiQlations:oi• defieient&9-were hoed-duringthis:visit;- You will-feeeiye fic further
correspondence. asotit this visit.
9) 7V 7o- k�EP 6^57s d 2oPIC 4
15)Ar­ema�04- jr
❑ Yes 9No
❑ Yes )XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes X No
❑Yes No
❑ Yes x o
[]Yes lVfNo
❑ Yes /� No
ElYes [2f No
❑ Yes V No
❑ Yes XN0
❑ Yes [ dNo
❑ Yes �] No
El Yes to
�/Uo
1W
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
5100

Facility Number: W Bate of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below []Yes P!rNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes into
28. Is there any evidence of wind drift during land application? (i.e, residue on neighboring vegetation, asphalt, ❑ Yes —01<0
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 2f.4o
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 j�o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes P<o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
5100

Type of Visit M
�Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit qQ Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Numbermber
Liate of Visit: 11•.7 o ^CJ'Ci Tiine: 4 = 47 Printed on. 7/21/2000
�
Q Not O erational Q Below Threshold
PermittedXCertified 13 Conditionally Certified © Registered Date Last Operated or Above Threshold
Farm Name: ...........1.�.f �.E !/...... �'Sf .1 U �``✓ /+� 2� County. � ........................ ..........w! 1 ..........
Owner Name............_��'.iT } C�tes� h v Phone No:
....................................................................................................... ........................
Facility Contact:.............................................................................. Title: Phone No:................... ................................
.............................................................
MailingAddress: ................................... ........................................................................................................................ ..........................
Onsite Representative :.................... ..�%r.0 ....... . 1 � .. .. Integrator:............. �FJ v/ v'
.....u............:................................................................
Certified Operator:.......-..... Operator Certification Number :..........................................
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish '' r❑Non-Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons L ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System .
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: Lagoon Spray Field Other
❑ g ❑ P Y ❑
a. If discharge is observed; was the conveyance ratan -made?
❑ Yes
❑ No
b. If discharge is observed• did it reach Water of the State`? (If yes, notify DWQ)
El Yes
❑ No
c. li' discharge is observed_ what is the estimated ]low in gal/thin?
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
PNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
VrNo
Waste Collection & Treatment
4- Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
No
StrWture I Structure; 2 Structure Structure 4 Structure 5
Structure 6
t^r4 rr
Identifier: .... ..........- i .-.
Freeboard (inches): � -Z
5100
Continued on back

Facility Number:1 _57 51 Date of Inspection � Printed on: 7/21/2000
:1 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [j yes [No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes XNO
(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 �CNO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes N0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes o
`Paste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 'No
1 1. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type [ �,� 5 5
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes `SNo
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 �No
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, 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?
El o viglaficjris;or deficiencies vt�ere itbfed di}rtng 4bis;visit.' • Y:ot1 will •receive Rio: rukther.
corj-espondenke: abo' u' f this visit. . .. . .... . ... . . . .. . .... . . ' . . . ..:
Comments (refer to question #): Explain any YES answers and/or any recommendations or any.other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
❑ Yes rtNo
No
❑ Yeso
El Yeso
❑ Yes
Yeso
❑ Yes No
❑ Yes VNo
❑ Yes No
❑ Yes No
A.
Reviewer/Inspector Name 1Z U S._5 Co i �
Reviewer/Inspector Signature: !-_'� Date: 5100

Facility Number: Date of In-spection ZCi. Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge aWor blow [:]Yes �No'
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �j No
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? ❑ Yes
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or)(NO
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Ye o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes o
14rtamonai comments anator orawtngs: ;'. 11
5100

- D Division of Soil and _Water Conservation =operation Review.
- .Division of Soil and Water Conservation "Compliance inspection
r
ivisiion of Water Qiialrty Gomplianee Inspection
- :.130thO Agency'. Operation iZevtew
JR Routine 0 Complaint 0 Follow-uup DWQ inspection 0 Follow-up of DSWC review 0 Other J
Facility Number Date of Inspection T z9
Time of Inspection I o _ l'S 24 hr. (hh:mm)
:]
[3 Permitted PrCertified (] Conditionally Certified 0 Registered 10 Not O erational Date Last Operated:
C`o ns � C1,�E n%u Z ....... County:........--- t i nJ
Farm Name:......1........................................�...........�..............-.-.-....................-........ �.�I.............................. ....... ..........................
Owner Name: .......................................................................... Phone No:
FacilityContact: .............................................................................. Title:.............................................. .................. Phone No: .................. .................................
MailingAddress:............................................................ ................. ..................... .... .... ................................................................................................ ..........................
Onsite Representative: ... QA.1 i.a Cri .5.�1 v '.............. .. Integrator: $,> �.1..i5....�1.� ........... .......... .... .... ........
Certified Operator:..... ..............................................
Location of Farm:
Operator Certification Number:
A
.........................................................................................................................................................................................................................................................................
Latitude & 6 ° Longitude ' 4 44
Design Current ' Design" Current , Design Current
Swine . IY P
Capacity Po ulation Poultry Capacity Population Cattle Capacity Population .
❑ Wean to Feeder'
LjrFeeder to Finish
Z1 g
Z t 8t
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
�Niimber of Lagoons. ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
,HoldingTonds / Solid Traps 0 ❑ No Liquid Waste Management System
Discharges & Stream Impacts
. 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 than -made?
h. 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 gallmin'?
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: Z�' E
STACkv- Z
F b d ('n hes)• rµP rg, P
❑ Yes [/No
ElYes 6No
❑ Yes VNo
El Yes [7No
El Yes Qf No
ElYes 2(No
❑ Yes KNo
Structure 6
I .......
ree oar i ..��...........yc.. .....-... ..I.......... ......................................................................................................... ..................................1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, []Yes _d No
seepage, etc.)
3/23/99 Continued on back

acility Number: 31 —,V3 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? [--]Yes ZNo
(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 XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ;D"No
12. Crop type C • JO P—
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,6No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes V No
b) Does the facility need a wettable acre determination? ❑ Yes 2fNo
c) This facility is pended for a wettable acre determination? ❑ Yes ;k"o
15. Does the receiving crop need improvement? El Yes PNo
16. Is there a lack of adequate waste application equipment? ❑ Yes ONo
Required Records & Docuritents
IT Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ANo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(e/ WUP, checklists, design, maps, etc.) Cl Yes P?'No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) P4es ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? Cl Yes ;ir&o
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes '[�'No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yeso
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes R<No
24. Does facility require a follow-up visit by same agency? ❑ Yes ON o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes VNo
0: iVo yiglatioris:or• deficiencies Vv�re hb ed diWi ft his:visit; • Y'oit 'mri l- eeeiye fio; fu>� titer
corres6onnenceI a3atit t$is visit.... • . • . • . • . • . • . • .:.:.:.:.:.:.:.:. .:.:.:.:. • . . • .
Cornntents (refer.to question #); ;Explain any YES.�answers and/or any recomMendations o any other commeeits:
Use;drawings of facihty,to better explain situations {ase additional pages as necessary) y
tip) F7Ar.�L] r, Cs- AR£ Q4E_&�,J?9.q p t-a z p A
Reviewer/Inspector Name m l
Reviewer/Inspector Signature: �� �.� t„r.. Date: -7 9
3/23/99

acifity Number: 3 — 5� Date of Inspection Zo
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
VNo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
IVNo
P'No
roads, building structure, and/or public property)
29.
is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
0 No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
br broken fan blade(s), inoperable shutters, etc.)
❑ Yes
o
tNo
31.
Do the animals feed storage bins fail to have appropriate cover?
ElYes
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
O/Yes
❑ No
Additional -Comments and/orPramgs w :_
rJ ro
Errsu IzE_ I T + s n f SA-_, P4C_- ?R-1 Pit-y,
_J
3/23/99

E'] Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
10 Routine O Comulaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Date of Inspection f'T I
Facility Number Time of Inspection �� 24 hr. (hh:mm)
© Registered 13 Certified © Applied for Permit © Permitted E3 Not Operational nn Date Last Operated:
Farm Name: ��6:. .. rf....�z.. .............. County:........ i�VAA..................................... .......................
OwnerName: ..........................11,,�Mi.�L...,1r1.t ...........SLi.... ...............................1,....Phone No:...C319�.1� .,::�.�.7 ........................................
FacilityContact: ..............................................................---.------....... Title:................................................................ Phone No: ................................... ................
MailingAddress:........................................................................................................................................................................................................... ...
Onsite Representative................TitY1t .. .........C"figLG .................................. Integrator: ........ 19,mj l.S...................................
Certified Operator;........ ..........................................
Location of Farm:
Operator Certification Number; .....................
... I........ ...... .inkt.Sk... s' ' Q....... Q:�..... i ., .... l.k.,.... l.:.. ...vr,.....S.....50.. ......Q..........SR....l 5..1..:.............................................................................
...... I................................... .....................---.................-----.---------..................------..... _........---.......---..
Latitude 000' 46 Longitude • ' "
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes [P No
2. Is any discharge observed from any part of the operation? ❑ Yes EA No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes P No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 1� 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
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 1P
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

Facility Number: — 7
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
P No
Structures (Lagoons,Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
P No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: �' Z
Freeboard(ft): ..._....... .i....... ......... ....... I............................ .
10. Is seepage observed from any of the structures?
❑ Yes
(B No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
P No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Applicatian
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............... �?�96............. .....-•-- sx±!a�...4 nih ........................ ---.......................---..................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
R No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18. Does the receiving crop need improvement?
❑ Yes
91 No
19. Is there a lack of available waste application equipment?
❑ Yes
14 No
20. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22. Does record keeping need improvement?
- CK 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
q, No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
y No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
1P No
0• No.violations-or. deficiencies:were•noted•during this'. visit. .Y.ou:will receive no further
eorrespundehO about
�;%L, wo.kt Skovjr] ID, Loo, a&, dfik�{ta��1
�ou:ta-
zz. [ zkt'r- bAkVC- s vkWkO 19.e Lt� a, w l bg J� t, 1ao =t 5. SQ�oy vtica�s s lw�l�� `6- 4V, 61
7125/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: `f � Z_ /UDate: zv

❑ DSWC Animal Feedlot Operation Review
`ram � � NO
.�
®DWQ Animal Feedlot Operation Site Inspection x
® Routine 0 Com lain[ 0 Follow -tie of MVQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection ' q `J
Facility Number 3'J `r
Time of Inspection 24 hr. (hh:mm)
© Registered 0 Certified 0 Applied for Permit E3 Permitted [3 Not Operational Date Last Operated:...
Farm Name:.. Counh : '
.. uV.".tL 4....0 :5. �1 .... 0 ..Y...W1... ..Zr......... .,}.�e..hl�.a!L.............................. ... .i.. Q
Owner Name........... ........ .....C..Sn„R Q..i.xt Lt .......................... Phone tio:....�.9.1..11i..J...�.�..�....`...�?..3.�...�................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
iNlailingAddress:...... ...i...V ....... .........PAC......... 1.A................................................. .1'...�....................... Z.x..q...5
t
OnsiteRepresentative:.`!`i�.i,ti.c�.S...........
Integrator:..-.�r3..t,,3_.._.S...................... K� 1....
Certified Operator; ................... ..-..._. Operator Certification Number:.............-
Location of Farm:
Q.t1...e q 5.....s.t..tl.l„�....d. ...1..4. �1.�i..:-e.Y.i..nr�.......... ......� ... ......;rv,..�.r? �......So.�y.....� ....l.�n......................
Sc.s i.A.!..WA-L........-•.----.#-•u....- .Q....-...................... ......................."..................... .......................... ............... ......._..._........ ........................................ .
Latitude • 1 '1 Longitude ®• ° .4
Design Current Design Current Design Current:
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
..........
❑ Wean to Feeder JE1 Layer I I ❑ Dairy
® Feeder to Finish ❑ Non -Layer 10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity Z gLi
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons Molding Ponds ID Subsurface Drains Present 110 Lagoon Area I0 Spray Field Area
❑ No Liquid Waste Management System
General
L Are there any buffers that need maintenance/improvement! ❑ Yes [9No
2. Is any discharge observed from any part of the operation? ❑ Yes R-No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is obscnved, did it reach Surface Water? (If yes, notify DST Q) ❑ Yes ONO
c. If discharge is observed, what is the estimated flow in galltnin? _ l
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes RNo
3. Is there evidence of past discharge from any part of the operation? El Yes ®.No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes R No
5- Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes [LNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes C0 No
T Did the facility fail to have a certified operator in responsible charge? ❑ Yes f� 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,Holding Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier: # .
Freeboard(ft):........................... .......................................................................................
10. 1s seepage observed from any of the structures?
❑ Yes 0No
❑ Yes EkNo
Structure 4 Structure 5 Structure 6
.....................................................................................................
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)
x- ,r..t.f................................. v...................................................
15. Crop type ....�4�:.�.v�:�...L.i...,.41k
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20_ Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Pennitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
B-No.violations or deficiencies were noted during this'visit..Yo'U.w'i11 receive -no fuither
' correspondence about this'visit: ;
Reviewer/Inspector Name
Reviewer/Inspector Signature:
❑ Yes E[ No
❑ Yes 1 No
❑ Yes 9 No
❑ Yes 21No
❑ Yes ® No
.......................I——
❑ Yes
........
® No
❑ Yes
® No
R1 Yes
❑ No
Yes
❑ No
❑ Yes
,® No
❑ Yes
No
❑ Yes
® No
❑ Yes El No
❑ Yes ® No
❑ Yes 4K No