310576_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua!

Type of Visit: UCompliance Inspection () Operation Review O Structure Evaluation O Tec al Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Other 0 Denied Access
Date of Visit: Arrival Time: to Departure Time: t Z County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: n k {'1"e Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region:
Design C*nrrent
Swine Capacity Pop.
an to Finish
HNon-La
Design C►urren
Wet Poultry Capacity Pop. Cattle
La er Dai Cow
Design Current
Capacity Pap.
an to Feeder
er
Dai Calf
der to Finish
Dai Keifer
row to Wean
ow to Feeder
ow to Finish
L
Design Current D Cow
I) . P■outt , Ca aci Ro Non -Dairy
La ers Beef Stocker
Non -Ca ers Beef Feeder
s
rs
Pullets
Beef Brood CowTurke
er
er
s
Turke Poults
Other
Discharges and Stream Im acts
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)?
[—]Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [] Yes ❑ ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Faci lity Number: rj 1 - 15`7 6 1 Date of Inspection: Z /
W1 ste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 j
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA ENE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or env!mental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ No [] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [�To ❑ NA ❑ NE
maintenance or improvement?
Waste AppliCation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA
maintenance or improvement?
t I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ad
❑ 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?
❑ Ye
[] No
❑ NA
❑-KE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
[] NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
�TE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
Q-NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
to
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA TE
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 E
❑ 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 ❑ No ❑ NA
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

Facili Number: - 7 Date of inspection: Z A y
24' Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No ❑ NA
❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No ❑ NA
NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No ❑ NA
EfNE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No [3 A
❑ NE
Other Issues
,�
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑i 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
❑' Ih ,
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
ff NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
CAWMP?
Yes
NE
32. Were any additional problems noted which cause non-compliance of the permit or
❑
❑ ❑ NA
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ zo[:]NA
NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments,(refer toFquestron*) Explain any YES answers and/or3`any additional recomn'iendativns or;any other comments... E
Afof fac�lr a be .
g_f f.._ tte/y
r,expla�o�s�tuaoos.=(use additions! pagesras necessary/): Ukfiwins
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Reviewer/Inspector Name: 01-1 ✓1� 6 -.c // R ✓� qu't Phone: `16 73,1 y
Reviewer/Inspector Signature: Date: Date:
bi
Page of 3 2/4/2015

QMI o IC7fi
Type of Visit: Q'rRo"U
anee Inspection Q Operation Review p Structure Evaluation O Technical Assistance I
Reason for Visit:tineO Complaint O Follow-up O Referral p Emergency p Other O Denied Access
Date of Visit: Arrival Time: h Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Poultry C>apaci Pop.
I ILayer I
Design
Cattle Capacity
Cow
Current
Pop.
Wean to Feeder
11 INon-!Eer
I
Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I;►esian
D , P,aultr. Ca ac" P,o .
La ers
jDryCow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
�t6er
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
px_o_�E] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
D 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
Wo NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Ins ection: /0
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):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ff� ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ElYes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes M No . ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ko ❑ NA NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ONE
❑ 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
JE[`NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
aE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
rJ 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
lkeguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
01NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
E j Yes
❑ No
❑ NA
04EE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑'NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge SWN�
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [:]No ❑ NA
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

Facill ity Number: jDateof Inspection: ♦�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA LarvE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes ❑ No ❑ NA EJ ,V
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes ❑ No [] NA ❑" I-E
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 W'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 _ io ❑ 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? ❑ Ye&oM No ❑ NA ETNE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? Yes [_—]No ❑ NA E
34. Does the facility require afollow-up visit by the same agency? ❑Yes No ❑ NA TNE
Comments'(refeVrto.question # : Explain,any YES aaswers:andlor any additianal;recoai ne©dations or'.any other comments:'
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Reviewer/Inspector Name: 0OV-7
Reviewer/Inspector Signature:
Page 3 of 3
Phone: l b -71 D TM
Date: 7 e 4 j 7
21412015

Type of Visit: tt!�ompli nspection O Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visits utine 0 Complaint O Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit:Arrival Time: Departure Time: Z{ County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultr.V Capacity Pop. C►►attle
Layer Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
Farrow to Finish
D , P■Dolt, Ca aci_ P,o Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Gilts
Boars
Pullets
Turke s
3 urkey Po Its
Other
Beef Brood Cow
Qther
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
C. No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[]No
[] NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
i
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection:
3 41�j
Waste Collection & Treatment
4i,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):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [g<o
❑ 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
eNE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
EYes [:]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
[Erf4E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ❑ No
❑ NA
dNE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA
0,<E
❑ 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 ONE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA [3r�JE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No DNA dNE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes ❑ No ❑ NA E4"NE
❑ Yes ❑ No ❑ NA Eff qE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑`NE
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
dNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
2_NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
E
Page 2 of 3 1 21412015 Continued

Facility Number: 3 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑ No ❑ NA C1NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA F1 NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NoED-ZA ❑ 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-Q `4o_
❑ 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
ZNE
permit? (i.e., discharge, freeboard problems, over -application) .
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[:]Yes ❑ No
❑ NA
�NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
XrNE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes o
ONA
ONE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
�NA
❑ NE
Comments(refer to question;#) Explam any YESganswers,and/or any additional recommendations or any,other comments::
Use' i6'viinis of facili&to'=betteraezDlairi situations (use.additionaI oaffes'as necessarv).
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Reviewer/Inspector Name:
Reviewer/]nspector Signature: U�G�
Page 3 of 3
Phone: [phone]ay
Date: Z ) l
21412015

Type of Visit: Q �bmpl' nee Inspection U Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 5'-Arrival Time: ® Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Wean to Finish
11
11-ayer
lNon-Layer
I
I
I Dairy Cow
Wean to Feeder
I
Dairy Calf
Feeder to Finish
Dory Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
11
1] , P,oult . Ca aci P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
I Beef Feeder
Boars
Pullets
Turke s
Beef Brood Cow
Qther
Turkey Poults
Other I
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
No
❑ Yes A/
❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes o
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes �No
❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility, Number: 3 jDate of Inspection: t 2 n
Waste Collection & Treatment IYW
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? es ❑ 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):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E]'No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Ye ❑ 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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
❑ Yes [:]No ❑ NA ErNE
❑ Yes [:]No ❑ NA
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No
❑ Yes ❑ No
[—]Yes ❑ No
N
NE
❑NA
❑NE
❑ NA
Dl E
❑ NA
[INNE
❑ Yes
❑ No
❑ NA
�NE
❑ Yes
❑ No
❑ NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA �E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA 0"NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA
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

Facility Number: at- Date of Ins ection: I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA Imo" E
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA Er -NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No OrKA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
❑ No ❑ NA
lE
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
❑ Vo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No ❑ NA
['j
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
ffNE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ Now❑ NA
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
61<o, ❑ NA
��E
c$1�
v
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ra�No ❑ NA
[ NE
Comments re er to uestwon answers and/or an a rt�on recommen at�ons or any of _e� comments.
9f Explain any, Y ..
Use drawings of facility to better explain situations. (use additional pages as necessary)..
V 0 HT f
Ll h Na } r< < ccc &/-5 'rol.�`i, /y4
e
7, o`er�ro -�, >1�^�< 5�t�4s�t'�,_�
y'n
61,
f,,c t ,re S 4--t &eC- , aJ bv^,f- r U n hT,Aown,
C t-/ rt-n f Con d t �,t l 5.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
9
2P / Z .
Phone: ` 0 7Yr 6 73 0 j
Date: �U/ �b 'r
21412015

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: _J)4outine 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: r_ ��i�` Pr L r r Owner Email:
r -
Owner Name: a .1'j'M 10 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
I
Design Current Design Current
Wet Poultry Capacity Pop. C►attle Capacity Pop.
JLayer Dairy Cow
Wean to Feeder
I
JNon-Layer
I Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
1) , P,oult , -a aci P,o Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Ocher
Other
Turke s
Turkey Pouits
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes J:;�No ❑ NA ❑ NE
a. Was the conveyance man-made?
❑ Yes
qNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[]Yes
�o
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
El Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[;] 16
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Condnued

Facility Number: - Date of Ins ection: ?i /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
❑ NA ❑ NE
❑NA ❑NE
❑NA ONE
❑NA ❑NE
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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
0 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 0 NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessarv).
blood/
/y?aV4Y'_ -rl-171-J" 0
Sa pia ��� s is an GQ,clrnlah,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
L Date: 2�
/4 4

Facility Number: - Date of Inspection: z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes .0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑Yeso ❑ NA 0 NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ,C3"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 E]"No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No 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 ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes D No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
❑ 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [:]No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

rypf f.Visit: 07Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: eRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ��
�7�"�—�
Arrival Time: �
Departure Timer -- �
County:
Region:
Farm Name:
I �jW
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
C*apacity Pop.
Design C►urrent
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Curren#
1l , P,ouI . C_a aci. P,o
Dry Cow
Non-Dal
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
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?
[:]Yes Ca"'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
[:]Yes
a No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
JZI-No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili 1-� Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No
❑ NA ❑ NE
❑NA ❑NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: _
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes ZNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
o No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
0 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
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 113ate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑NA ❑NE
❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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
Reviewer/Inspector Signature:
Page 3 of 3
❑ No
❑ NA
❑ NE
[:]No
❑ NA
❑ NE
❑ No
❑ NA
❑ NE
[:]No
❑NA
❑NE
Date:
/412011

il)ivis""ion of Water Quality
)H3aciii ilVumber ©- � ivis ®Dion of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: i5LRoutine O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: ClIV Region:
Farm Name: 1 Owner Email:
Owner Name: C. �� CZ �� Phone: q ,a - ,QR s -_4Q tDcl
Mailing Address: p� S 5'y C H+ C"/NQG Q 21 W//VC DoO S of
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: M GZ-K-�& Z-
Certified Operator:
Integrator:
�)O!i
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
WQTs
Design Current Design
Swine Capacity Pop. Wet Poultry C►apacity
Wean to Finish La er
Current
Pop.
Design
Cattle 0ZC,-apacity
DairyCow
Current
Pap.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
4 po
(S
Design
I) , P,oul Ca aci
Layers
Current
l;o
DairyHeifer
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
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)?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA 0 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 tNo
o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214120II Continued

Facility Number: 1 - S is IDateof Inspection: j % II
Waste Colleftion & Treatment
4. [s`storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: CAGOOff
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Oz a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) T
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 0
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, 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): & 9- SC
13. Soil Type(s): LJq
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes I No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �kNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes rA 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
T�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
[]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 Q Waste Analysis ❑ Soil Analysis ❑ Waste T nsfers Q Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [] 120 Minute Inspections Q Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: ( - S Date of Inspection:
24 Did the.ldeility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge Ievels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [:]No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes �] No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
j�
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)
7�
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA ❑ NE
33. Did the Reviewer/Inspectorfsil to discuss reviewlinspectiontyith an on -site representative?
❑Yes No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
Comments refer to question # : 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).
g°
— eON I-r FC)" r_- —SOIL S A E %CO RZ ' / i
Reviewer/Inspector Name: &,aS
Phone: qb —__4_�
Reviewer/Inspector Signature:
Date:
ohI
Page 3 of 3
21412011

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (1 b Arrival Time: Departure Time: County: Ll Region:
Farm Name: 'R12KEQ tS `rC�CE�S Owner Email:
Owner Name: (iZ� AzKP l4- Phone:
Mailing Address: �533 S NCL4 1 (:�4/,yjL4A��
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: lAA U�A Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0, = u Longitude: = o [= s = H
Design Current Design Current
Swine Capacity Population Wet Poultry_ C*specify Population
.• �r
Design Current
Cattle Capacity Population
❑ Wean to Finish
10 Layer I
I
Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
Farrow to Wean
ItI00
0
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ La ers
❑ Farrow to Finish
El Beef Stocker
❑Non -La Non -Layers
❑ Pullets
El Gilts
El Boars
❑ Beef Feeder
❑ Beef Brood Co
❑ Turke s
Other 01 urkey Poults
❑ Other ❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
XNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — 5--go
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1,--4
S�cture 2 Structure 3 Structure 4
Identifier: l
❑ Yes XNo ❑ NA ❑ NE
❑Yes ❑No El NA El 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
ko
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
] No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
' kNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
PNo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O 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) �>L 6= tO C
13.
Soil type(s) Ln
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
*No [I NA
[I NE
15.
Does the receiving crop and/or land application site need improvement? El Yes
�No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
Vk No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
0,No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
960 ❑ NA
❑ NE
( q )y y.
facility to b # : 'Explain an YE.S savers and/or p grecommendati ns or any other commepts
Co drawings (refer
better explain situations use additional pages as necessary).
Reviewer/Inspector Name CS:. 4 Phone:
ReviewerlInspector Signature: Date: Ii
Page 2 of 3 12128104 Continued

�r
Facility Number: —54& Date of Inspection 1 0
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes XNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes XNo
ElNA
[_3NE
the appropriate box. El WUP El❑ Design 0 Maps ❑Other
Checklists
21.
Does record keeping need improvement? If yes, check the appropriate box below.
ElYes No
X
❑ NA
❑ NE
❑ Waste Application 0 Weekly Freeboard 0Waste Analysis 0 Soil Analysis ❑
�ste Transfers❑�4ual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections 0 Monthly and
V Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 9No
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes 1No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
VNA
❑ 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
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
kL No
ElNA
ElNE
If yes, contact a regional Air Quality representative immediately
rr ``
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P No
El NA
[I NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewerlinspector 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
VWO
❑ NA
❑ NE
Additional Coin ments.andlor. Drawings:
k
A5I
Foq 5L_'LX0 •E &xCf-iL
CALAG" i' oyr �E 0 1
6)c_ C_Azr_'�' ) ssLAEb cics� �!�"�S a C3iGr�cT �c
Page 3 of 3 12128104

Division: i
Factl> tyNumber: ! Q Division
D.Other.sAg
Type of Visit Compliance Inspection O operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit ,Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: , 119T3 1 Arrival Time: 11 Departure Time: County: _ �Q� Region:
Farm Name: ?aUe s P(C��iCE12S _ Owner Email: n
Owner Name: C . [ pQ__KC- P_ Phone:
Mailing Address: 653 5/y e �'r� • /YC u -�� 4
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator• a 5 f O�
Operator Certification Number: 1 lY a
Back-up Certification Number:
Latitude: = c = d 0 « Longitude: = ° = 4
b. Swine Capacity. P,.opulation VVet9P©u
�. �
❑ Wean to Finish„ [] Layer
❑Wean to Feeder ❑ Non -La
❑ Feeder to Finish'-R
Farrow to Wean LiOCd
:Dry Pou
❑ Farrow to Feeder
In Farrow to Finish 3 ❑ Layers
❑ Gilts L1 Non -Layers
❑ Boars El Pullets
❑Turke s
Other'-7-
Turkey Poults
❑ Other r ❑ Other
Discharges & 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?
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
'$No
❑ NA
❑ NE
❑ Yes
0,No
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — S Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes K
o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �6vrt
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,_,(
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes i11 No El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) 1
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes '
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yes oNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ElNE
maintenance/improvement? 'A
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate ManurelSludge into Bare Soil
❑ Outside of Acceptable Crop Window /❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) L%1r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ 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?
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
PNo
❑ NA
ElNE
DNo
❑NA
ONE
K No
❑ NA
❑ NE
DR No
❑ NA
❑ NE
PiNo
❑ NA
❑ NE
Comments {refer to'questeon#) .:Explain any -
YES answer"s andLo'r any recommeadaions4oranyother�ctnen'ts
Use drawings of facility to better explain situations. (use _additional a es as necessa
o�D� mF, u, - Ao Ta e S
Reviewer/Inspector Name fJ��� ' N S Phone: `llto-�9%-3 $01
Reviewer/Inspector Signature: Date: 1 O
12128104 Continued

Facility Number: f Date of Inspection
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'A No [I NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes ++++XNo
���` ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists CED
0 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )(No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ Yaste Transfers ❑ 011111al Certification
0 Rainfall 0 Stocking ❑ Crop Yield El 120 Minute Inspections [] Monthly and 1" Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes] No
❑ NA
❑ NE
❑ Yes
ANo
El NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
Cl NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes ❑ No � NA ❑ NE
❑ Yes D.No ❑ NA ❑ NE
❑ Yes 41No ❑ NA ❑ NE
❑ Yes
�No
❑ NA
❑ NE
El Yes
VV No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
�(No
❑ NA
❑ NE
l'Coml. ta~ g e W, e ,
Addttroaar?_ R .
ments$andlor Drarv�ngs_ +.
CIa C L BIZ97-J6Al i- SL(A1) (YE S(A(ZUC-y
cop u,, OF C_ACOOAI �3 ES nG Al S ,- pckT
1212&oa

Type of Visit 'Compliance Inspection O 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: Arrival Time: i�r === 1 Departure Time: County: Region:
D
Farm Name: 1 P4e-1(_fiZIS �CJZCQZ--SS Owner Email:
Owner Name: wm C Phone:
Mailing Address: N C "t Iry L&!3P1A! . /V C- Qo
Physical Address:
Facility Contact: j Title:
Onsite Representative: 'Ti ag2:LL Pan-K &Q
Certified Operator: C- r Qzy_f_—�
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: w of 5 J
Back-up Certification Number:
Location of Farm: Latitude: = 0 = = 1i Longitude: = ° = 6 0 [1
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Design C>urrent
Wet Poultry Capacity Popula#ion
❑ La er
❑Non -La er
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
Farrow to Wean
LfCXd
Dry Poultry
❑ Dry Cow
❑ Non
❑ Farrow to Feeder
❑ Layers
-Dairy
ElBeef Stocker
❑ Farrow to Finish
Non -Layers
❑ Gilts
❑ Beef Feeder
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
El Beef Brood Co
Number of Structures:
❑ Boars
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 K No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility; -Number: fK 1 - S Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
X No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: LAG601V
Spillway?:
p
Designed Freeboard (in): 1 1
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
PINo
❑ 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
*4 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes V 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 V No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) ,{IA Urn to i 4 S M 4(_c_ Cn o w 6� o2zj c"A c.
13.
Soil type(s) C-1
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
DdNo
❑ 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
KNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
4No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
$UNo
❑ NA
❑ NE
'Comments (refer to question.!). E plain aity YES a&irvers andla� any recommendah ns or any ot6e 'c me�nts
Useidrawings'.of facility to better explain situations. (use additional pages as necessary). h r n
Reviewer/Inspector Name - ( Phone: 10 —_:�Ip
(O 3
Reviewer/Inspector Signature:. Date: / / 6 a�
Page 2 of 3 12128104 Continued

Facilify Number: 3 1 Date of Inspection U 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ,❑ WUP El Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑Haste Transfers ❑ )41nual Certification
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
OLNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[%No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
IA NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
% No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Fj No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Additional Comments'and/or:Drawrngs . ;
Page 3 of 3 12128104

Division of Water Quality
Facility Number .� O Division of Soil and Water Conservation
Q Other Agency 7,
Type of Visit oCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 19 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Z Arrival Time: Departure Time: �� unty: �� Region:
Farm Name: 2 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o [= & Longitude: = o =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
L❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ©,
h. 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 oNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ANo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: 7 Date of InspectionI
Waste Collection sc 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
❑ Yes
X�'No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Ye No ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ,[� No ElNA El 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, _eNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ,�No ❑ NA El 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 ❑ Ye% — No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes `o ❑ NA ❑ NE
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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) 1 n -
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
El NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
El YesNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes�No
❑ NA
❑ NE
18.
1s there a lack of properly operating waste application equipment?
❑ Yes LNo
❑ 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):
��`G�� �U�InJ T 1C�©t[JN �i✓ ��9-C�S� ,� /1 ,EC�,�S �/'�je/ - �,�J a
�juzi.D �!✓�. f_
Reviewer/Inspector Name Phone: /U Y(-o
Reviewer/Inspector Signature: Date: ZZ
I2/28/04 Continued

Facility Number: 3 Date of Inspection S O
_Re2uired Records & Documents /No
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes '0 No ❑ NA ❑ NE
the approprrate box.
❑ WUP ❑Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P(No El NA El NE
El Waste Application El Weekly Freeboard El Waste Analysis [I 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes 0 No
❑ NA
❑ NE
❑ Yes No
RfNA
❑ NE
❑ Yes [2fNo
❑ NA
❑ NE
❑ Yes 0"No ❑ NA ❑ NE
❑ Yes XNo
❑ NA
❑ NE
❑ Yes ❑ No
�IKNA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes '4 `No El NA El NE
El Yes �/J No El NA El NE
❑ Yes I[J No ❑ NA ❑ NE
❑ Yes JZI No ❑ NA ❑ NE
Additional Comments and/or Drawings:
/,W77/9
31
12,128104

Kaci�ty..N.umber
Division of Water Quality
0 Division of Soil and Water Conservation,
0 Other Agency
Type of Visit O'Com iance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �i D Departure Time: County: P Ut� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: , l Title:
Onsite Representative: hii�2{�—�� 1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
91 Farrow to Wean
14 6 6
L V5
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other _ --
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ 9 ❑ Longitude: ❑ ° = 1 = u
Design,, Current
Wet Poultry Capacity Population
❑ La er J.
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
FEI—Turkey Poults
❑ Other
"Design. Curre t"
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of5tructures r
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 4o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
❑Yes
❑ Yes
�❑No
LI�No
❑ NA
El NE
El Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection ci 44
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: C_(ioaA)
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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental_ threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L1No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LDS 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 Vo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LTN ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Z W J &'o 1
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?
D"Gs
[-] No
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
Ir No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
C o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[21 Io
❑ 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 F l Phone: _ 73 PY
Reviewer/Inspector Signature: Date: 4
Page 2 of 3 I2128104 Continued

Facility Number: 31 —; 76
E Date of Inspection
Required Records & Documents
19.
Did the facility fail to have 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
g El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Li No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
PTNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
"
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
7No
❑ N�
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
ElIJ Yes
E❑
No
❑�
❑ 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?
El,., Yes
�'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D 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
F No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
�,/
2i 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
L7No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
2No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

wr
Qf Division of Water Quality
==acifity�umber `j �p Division of Soil and Water Conservation
00Agency
Type of Visit A Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ,0 Routine O Complaint O Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: ! .SW) Departure Time: County:&4/ '-d
1
Farm Name: Aee K1z 5 Owner Email:
Owner Name: Akk'6x Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Aemlo_
R�
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: '�
W %k
Location of Farm: = ° = ` � " g' = ° ❑ ` = "
Latitude: Longitude:
Design Current
Design
Current
DesignIN Current
acity Population
WetPoultryCapac ty
.Populaho ...:: Cattle ,. :. ;.Caapacity
Population
Wean to Finish
❑ La er
❑ Dai Cow
Wean to Feeder
❑ Non -La er
❑ Dai CalfFeeder
to Finish
❑ Dai Heifer
Farrow to Wean
IFE—]
Dry Poultry
❑ D Cow
Farrow to Feeder
La ers❑
❑ Non-DairyFarrow
to Finish
Beef Stocker
Gilts
Non -La ers❑
❑Beef Feeder
Boars
Pullets
❑ Beef Brood Co❑
Turke s
❑ TkPoults
Other
❑ Other
Number of Siruetures:
Discharges & Stream Impacts
i . Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
10
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

_ Y
Facility Number: -5 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes JA No
❑ Yes ❑ No
S cture 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: O
Spillway?: 9
Designed Freeboard (in): A?Jr
Jr
Observed Freeboard (in): 45
El NA El NE
❑NA El NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) fid
4. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
/W�� i��n�dow ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) ,�ii�xla4 1(�/4YL,F 1 Sr�`COd�,L,.D)
13. Soil type(s) ,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
❑ Yes ANo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes �6 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VfNo
❑ NA
❑ NE
11,1197-e/
Reviewer/Inspector Name
Phone:
M
Reviewer/Inspector Signature: . �/ / %i%if' _ Date: / 2(Z=5' _
12128104 Continued

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

Type of Visit Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification Xf Other 0 Denied Access
Facility Number / Date of Visit:
Permitted © rzz�.
ed E3 Condi ' nally Certified 13 Registered
Farm Name: __h - `2--..
Owner Name:
Mailing Address:
Tune:
Dnerational O Below Threshold
Date'Last OperaM or Above Threshold:
County: - Lz1tl . _ _ .�. Q
Phone No: IIA
Facility Contact: .. _ - Title: Phone No:
Onsite Representative: �% R & & �, Integrator. dj
Certified Operator:
Location of Farm:
Operator Certification Number.
U(5u+vine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• !� �_��� Longitude �• �' Du
= Destig�'
`Swine Cavity
Wean to Feeder
Feeder to Fuiish
arrow to Wean
Q
Farrow to Feeder
Frrrow to Finish
tJilts
Boars
Other
;lilL�i'17a72J-i
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? OYes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field 0Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes IRKNO
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) OYes ❑ 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 ONo
2. Is there evidence of past discharge from any part of the operation? AYes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103 Continued

Facility Number: — Date of Inspection 70 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 maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste A hcation
10. Are there any buffers that need maintenancerunprovement?
I . Is there evidence of over application? If yes, check the appropriate box below.
tp Excessive PonQ, ding ❑ PAN ❑7;7,-eA
rauhc O
12. Crop type \ I/lnd,0,4
13. Do the receiving crops differ with those designated
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
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor 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 doing 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.
[:]Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
;Xes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
)dyes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
'Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Field Copy ❑ Final Notes
W�����ar� (;v.✓.��/CT�'� �,�(��5 � �f��/�f�" . %�5�i�✓fD ��iP�rd�I�
)40*v- A4c-':;Vz
P,��,�'.
��E�,�p ,� � ��/�� �r%¢s�,e G�•¢s �'%-tea- .L� � �fA-r/�
/, l;ink
�J,�-ram �•�f Gl��-s rE ,o r ,,xPp6'.o 707- 4Bcs�
Reviewerlinspector Name
Reviewer/inspector Signature:
Date:
12112103 Continued

Faciiity Number: - Date of Inspection
TAT
Required 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 Plant readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ 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
❑ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ o€emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�{No
29. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional probl=s noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, slap questions 31-35)
❑ Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbmakers 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
j3 No violations or deficiencies were noted during this visit. You will receive no fbrther correspondence about this visit.
P�E_ 6 -4 y�
i1 �F Os -oMPRO Arewo�_'
b�- .. 4VOA le czod ,#& 4awpde�r
l2UM3

Facility Number:. _... — _... Date of Inspection:.
.. , :• .
Additional Comrrients=and/or Drawings-
AO)
/rj�F'GZ,�tr, � �Ga��- -- !!LL �' �/!?D�DrJF� f/iP.�?�✓�
Ov;zo�
o A6'
Ql Q S
P�''S o'�H 6�' "' �a5Ss��✓
/ olv
�OfFze�)
Flo
qI 0
4/30/97

Type of Visit 0 Compliance Inspection Q Operation Review O Lagoon Evaluation I
for Visit 0 Routine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Permitted 13 Certified 0 Conditionally Certified © Registered
Farm Name:
Owner Name-
EE Tune: :OD
Not Onerationai O Below
Date -Last Op ornA,bo""v��e Threshold.:
County: _�'ri
Phone No:
"Mailing Address:
Facility Contact: - __ Title:.... Phone No
Onsite Representative: Integrator: ��.P�-f/6��211F
Certified Operator:
Location of Farm:
Operator Certification Number:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 6 &4
Desrgn
_
_Ct `Destigu
Curreat =
C t
Desegn arreD
. "Po on Cattle
ulzP
Pb
nPSwine
troa •-
Wean to Feeder
Layer
Dairy
-
Feeder to Finish
Non -Layer
Non -Dairy
-
:: arrow to Wean
-
Farrow to Feeder
r�
F�a�jrr`�ow to Finish
n � ' _
-. Total>De's nf,C lip
Gilts
-'SS
iy .� Y �5
-�
'Tt>►tal`SSLW ��
Boars
Nber of lagoons ` ';
s,'n-s. ter, r �',1ii''5�
Discharges & Stream Impa a
y
1. Is any discharge observed from any part of the operation? ❑ Yes : 0"No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ;9 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ;KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard phis storm storage) less than adequate? ❑ Spillway ❑ Yes (INo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier:
Freeboard (inches): LW
12112103 Continued

Facility Number:
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Anvl9cation
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑
12. Crop type
❑ Frozen Ground ❑ Copped and/or Zinc
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA
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
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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.
❑ Yes Z No
❑ Yes RrNo
❑ Yes ZNo
❑ Yes (XNo
❑ Yes PNo
❑ Yes 19 No
❑ Yes ;�No
❑ Yes VNo
❑ Yes PNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes a9 No
❑ Yes XNo
❑ Yes WNo
❑ Yes XNo
❑ Yes A No
❑ Yes ZNo
Field Corn ❑ Final Notes
U04)aWc1-40 6s /f %/� w -WI-0 i Z-&� 0//�/ ,�/��,E,�,o �,✓
I/w/Om'V0 �o�nPLZ/fiJc� CiCvkT �GJy-frea
�f}Et/h !b AiV�N/N�`i!n
W,rr-h4 '5" (�// SUrJ (�I`-rLsoQ_ C.t�� fff ado - l.�,r /��� /VO (.�✓ Tz„/uo �c 5
FGncJ e%s,6XVZO. ,Oa N "16
G��.SS4i-J I
Reviewer/Inspector Name
L,
Reviewer/Inspector Signature:
Date:
12112103 Continued

[Fa7cffitY Number: Irate of Inspection
_Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes gNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes 9No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Z 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 2f No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes 0 No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 9No
27. Did Reviewer/inspector fail to discuss reviewlmspection with on -site representative? ❑ Yes No
29. Does facility require a follow-up visit by same agency? ❑ Yes No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes )�No
LAMES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes VNo
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 r Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
41,
%}G 0S ��''�'o X!�YPGzvV �fl�✓T� I &�j-7��515p2{f/¢f�i�l
Air "W "f
F®4 6,epD min A/tov&,€1J7-S�
�y�GQ � pR9✓Em�N7S.
1 ell
,EC Aczsr
3mg
1,u j64 V4046k �� � r►'�s . �,2s v a o uJ `rae �G. C34
/v C.o,�RFc� ��sc�vF.,a a 4� 61;4910 V. Hw
12112103

Type of Visit NACompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit o Routine 0 Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: Time: n
Not O erational 0 Below Threshold
12 Permitted IN Certified ©Conditionally Certified 13Registered Date Last Operated or Above Threshold:
Farm Name: Gf �'� Or fS County: Atl0/.Ih
Owner Name: Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: OW r12✓ Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ' u Longitude o ° Du
Discharges & Stream Impacts,
1. Is any discharge observed from any part of the operation?
❑ Yes RNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:_ .
Freeboard (inches):
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes %No
❑ Yes &�LNo
❑ Yes ONo
Structure 6
05103101 Continued

Facility Number: 31 — Date of Inspection I $ 3
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes a No
seepage, etc.)
6. Arc there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes IQ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes KNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes K. No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? Cl Yes tallo
Waste Anglication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes Z No
12. Crop type &P"-'WA-X'E ( hv-* ze_ -) , 614 ev vee'
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
® No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
] No
Renuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Eallo
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
E No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
10 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
®,No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
K No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
allo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
M No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
®No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
M No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to queStioil Explain anq YES_answers 4ndlor anv recommendahans ar any`otlier comments ,P C
Use drawings of facility to bet#er.expfain situations. (use addition4lp ges as necessary) H ❑ Field Copy ❑ Final Notes
rP %� con,
lrl 5 r ru; ld reS�P� Q/�' ��ar f, ih f Ao- aw�--igAe 74�e
Reviewer/Inspector Name �—
Reviewer/Inspector Signature: Date: 7i
05103101 r Continued

I Facility Number: -3/ 1 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of property within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
El Yes C�To
El Yes JQ No
El Yes [9) No
El Yes CR No
0 Yes COM No
El Yes 91 No
El Yes KNo
Additional Comments aJiid/o6],DraWingsVz-'
FW.
05103101

of Visit OCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: O 1 Time:
3 l 'T
0 Not Operational Q Below Threshold
0 Permitted 13 Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: .......... _... ......
Farm Name: ............ Afrl.....PdrCY.................... County:
.................. ......... ..........
_
OwnerName: ......... '.d.'�..... k.t►............................................................ Phone No: ............................................... ..................... ......
....._ :.
FacilityContact: ..................................................----•---•---................. Title:..................................................... Phone No:
MailingAddress: ......................................................................................................
OnsiteRepresentative:...9.A.`.�..............................................................SJSLch t'OtYB✓ Integrator: Zumber:
....................................................... .....
Certified Operator: ................................................... ............................................................. Operator Certification ..................._.....................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 64 Longitude • d 44
1Destgn Current `- - . Design Current Destgn,- Cnrrent
PultCattle .._PoCaacPulatSwine . illation :_: u ❑ Wean to Feeder ❑ Layer I 1 ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
Farrow to Finish Total Design Capacity
Gilts -
❑ Boars -`-,Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area . ❑ Spray Field Area
- Holding Poiuds LSolid Traps__ ❑ No Liquid Waste Management System
ih-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0"No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes j2rNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [] Yes J;]'No
c. If discharge is observed, what is the estimated flow in gal/min? 11 % A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ONO
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes j2FNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �ff No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier1_47a .............................................................................................I.............................
Freeboard (inches): 30
5/00 Continued on back

Facility Number: 3 j =7 Date of Inspection
S..Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 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 maintenancelimprovement? ❑ Yes dNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ONo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 0No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes -&No
12. Crop type r•. ydGt
r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 0 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 'VNo
b) Does the facility need a wettable acre determination? ❑ Yes ONo
c) This facility is pended for a wettable acre determination? ❑ Yes ONo
15. Does the receiving crop need improvement? .9Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes E;j"No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes )ZrNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes .,O No
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes FNO
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
[:]Yes ;dNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes J'No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes 0 No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspcetor fail to discuss review/inspection with on -site representative?
❑ Yes J No
24. Does facility require a follow-up visit by same agency?
❑ Yes ONo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes JzNo
Q VIf 3�i(II�S,9 d�fC�CIiCi£'$ W TE �lQ f'dal1.I`. Vf. Wli�•><eCi . ,
. . Sul'. .
. . . . .YOB . .
comes dance anti this visit:
Comments (refer to question #) Ex YE5 answers afad/or auy secomaendrat3aus or,auy other touaEineuts. _m-
[]se dra facile to better explarn"situations {use additional pages as ne€ssary _mtY _ _e .
6- td&d 4o „,tiProVe ber rt u de, Crdp qKd el�r-,+ r► -Fe w► pS-� �-� pan .
•
i
_r- a reco,-k a✓,e rjek4fy beef-.
Reviewer/Inspector Name S /�✓ E'S'- .a z _ J
Reviewer/Inspector Signature: d0 Date: 10 ILI I2 DQj 5l00

Facility Number: Date of InspectionJJOrAJ/#JJ
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes [:]No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes � No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 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 .0 PNo
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 ONo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [:]No
lAdditionaMominents:andforDrawings: -
A,
5/00

FFacility Number Date of Inspection :TF
Time of Inspection � 24 hr. (hh.mm)
ermitted 0 Certified 0 Conditionally Certified E3 Registered Not O erational Date Last Operated
D pc�i-:r
..Farm Name: ......5..r�.......... .. ................................-.........-................. County:.......1-- ,:1!-.....................................................
Owner Name• Phone No . �" 9S'` 3 TT
Facility Contact: .............
Mailing Address:
Title:
Phone No:.....
Onsite Representative:. 1Q' .••...•...... Integrator: ,,,,,,,
Certified Operator:.................................................:.............................................................. Operator Certification Number:..........................................
Location of Farm:
r
................. ..................... ................-. - .. ....... .................. ......... .............. ......... ... T
Latitude ' 4 4 Longitude ' ' "
Design ; .'Current' Design - - Current' Design Current
Swine CapacityPo ulation Poultry Capacity:. Po ulalion Cattle„ Capaci Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non Dairy -
Farrow to Wean a[jQ
-
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total.Design,eapaeity
❑ Gilts ;
❑ Boars Total SSLW-
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps JEI No Liquid Waste Management System -
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes El No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes (9No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: to 910
Freeboard(inches). .................................... .............. I .....................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes XNo
seepage, etc.)
3/23/99 Continued on back

Facilitj Number: "3— 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 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 XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? XYes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes MfNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes XNo
12. Crop type Sel
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 XNo
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? $,Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes gNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes &' No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes KNo
19. Does record keeping need improvement? (iel 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 XNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes N[No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes )SfNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes KNo
24. Does facility require a follow-up visit by same agency? ❑ Yes XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes P(No
yeolatigns:or deficiencies were . Ofje . dui frig 4:his:v... Y:o. will i-eeeiye iio #'ui-ther
corres oridence: about this visit .. ....... • '
Cammenis (refer -to'--,-,, on #):-,Explain-any YES answers and/or any recommendations or any ot)ser comments' -
Vse drawings of facility to-better;explatn "situations (use'aonal pages as necessary) , f -
�_.:
llj��5 i`\ -�1Ci�,1r sl CGv�'i 1C1� 1.4v� v�ld���
e W e�3•. ��°� ��h� � inr2R y ��� �,[�2��--GAS ��'rG�d � �`
CA
U �ti
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: W

Facility Number: — Date of 111spection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
KNO
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
`\
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
dNo
Additional Comments an or rawin s:.
tnr t ►,-q, v,-i`�S
3--q s 4C cy,'Ix (zv- ' c;
CC(
n
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vs , a-3 1. 1 A--x Vie
2
id,
f s -QiG dtiL �fQL . 60 r (��1 Cit1� ' � rx 01 '

Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
E Permitted 0 Certified 13 Conditionally Certified p Registered 10 Not Operattona Date Last Operated:
Farm Name: P.arker'x.P.orkers.......................................................................................... County: Duplin WIRO
OwnerName: Harry ..................................... Parker..............................................
FacilityContact: ...............................................................................Title: ...............
Mailing Address:. 131P.arker.Ln1.P.O.Box.162...............................................
OnsiteRepresentative: .................................................................................................
Certified Operator:Harry..................................... Parker ....................................
Location of Farm:
Phone No: 9.14-28.5-7.264..........................................................
....... I .... I ... I ......... I .... ...._ Phone No: ....................................................
.Chiaquapin..NC.................................................. 28521 ..............
......................
Integrator: Murphy...Farmly.karms......................................
.......... Operator Certification Number: 16259..........
Latitude ®• ©4 ®41 Longitude ©• ®6 ©6&
esign CurrentDesign.- urrent - - _,;; ;Design " ~unrest:
Swine Capacity_ Population _;Poultry ^Capacity Population. Cattle T ^ ^T„ capacity aPopulation =.
❑ can to Feeder
❑ Feeder to tnis
® arrow to can
p Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons1 2 -' ❑Subsurface rams resent ❑ agoon rea ❑ pray ie rea
Holding Ponds / Solid Traps ❑ o tqut aste anagement System _
DischarlZes & Stream Impacts
l . Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If dischan,e is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in 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? Ci Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
.................
Freeboard(inches):...............30............................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
3/23/99 seepage, etc.)
p Yes ❑ No
p Yes [:]No
p Yes p No
❑ Yes ❑ No
? ❑ Yes []No
❑ Yes p No
Structure 6
p Yes ❑ No
Continued on back

Facility Number: 31 _576 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? []Yes []No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? p Yes []No
Waste Application
10. Are there any buffers that need maintenance/improvement? p Yes []No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN Yes []No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16_ Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit 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?
11 • XO i6titions`or-'defii~iencres-were.noted:dul-itig this visit..You.ivill:re'ceive nofurther.:::
............... ... ... ... . .
�orxespaudencC about #his:visit......:::::::::::::::::::::::::: :
]/I V�F'OPAIf1FftPH�
freeboard available. No problems observed.
❑ Yes []No
❑ Yes p No
p Yes p No
p Yes ❑ No
❑ Yes ❑ No
p Yes ❑ No
❑ Yes p No
❑ Yes p No
p Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[]Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
p Yes []No
Reviewer/Inspector Name Any (ai►`Johnson - C. Koontz (DLQ) e
Reviewer/Inspector Signature: Date:

t 0 Division of Soil ana _Water Conservation, .. Operation Review ;
{: Dinsion of Soil and Water Coaservahon _;Compliance Inspection , ; '
°a
�Drvision of Water Quality -C-64 ance-Lispectton E
Otliei Agency Operation -Review_
ry
Routine Q Complaint O Follow-up of DW2 inspection Q Follow -tip of DSWC review Q Other
Facility Number Date of Inspection EMP
Time of Inspection �24 hr. (hh:mm)
Permitted [3Certified 0 Conditionally Certified 0 Registered 0 Not O erational Date Last Operated:
(Farm N.
�° 10--F �6 v� 2vS County:............ ��{.�"1...............................................
Owner Name: ................................................... ....... Phone No:..............
Facility Contact: ........... ..... ............... .................... ................... ........ Title:.............. .......I........ Phone No:
MailingAddress: .... ...................... .........................................................................
Onsite Representative: Ol..+l..:Q.`r.................................................................................. Integrator: ................................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
.........................................................................................................................................................................................................................................................................
Latitude Longitude • ��°�
Design Current Design '_Current, _ Design .Current
SCapacity PaulaoPoulCwine y atle " Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
HGO
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
-'Number of.Lagoons.
® ❑Subsurface Drains Present ❑ Lagoon Area JE1Spray Feld Area
Holchng Ponds1. Solid Traps ❑ No Liqui
j
�' d Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes allo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ,KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ............. 3.k............. ................................... ......... .............. .... ......... ............ ._..................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3123/9
...............................
❑ Yes XNo
Continued on back

Facility Number:'31i —
Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
KNo
❑ Yes
❑ Yes
LV% No
❑ Yes
gNo
❑ Yes
O No
❑ Yes
X No
11. Is there evidence ``of over application? ❑ Excessive Ponding El PAN El Yes �No
12. Crop type 1ph r Shc
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?
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?
:: ed� iiirr>tng �this;visit; ;will •receive �o: IFurther - :::
6iri so&ridence: a�botit. this visit........ :
R'Yes ❑ No
❑ Yes ❑ No
WYes ❑ No
❑ Yes gNo
❑ Yes Is, No
❑ Yes W No
❑ Yes J No
❑ Yes No
❑ Yes JjNo
❑ Yes 04No
❑ Yes NrNo
❑ Yes fNo
❑ Yes ONo
Comments'(kefer to question:#): Explain;aQy YES answers and/or airy_recommendations:or-any'other comments. - --
Use drav►Juis.of facility to-lSetter.explain=situations {use additional pages as necessary)
.tr KJ L.seb
Yert,�.,�-ej--ems.
s
rice �val r� �-, L� py11, s�.r��e -Vol', "� e�r✓� e"-,-\
3/23/99

Facility Number: `j — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes '15(No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of property within 24 hours? ❑ Yes p<No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i_e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNo
31.'Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ;9(No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 19Yes ❑ No
tional omments. an orrawm
3/23/99

Longitude �• ��"
Design, . -;Current
Pov '' Capacity Populatio altry n an
❑ Layer ❑ D
❑ No ❑ N
n-Layer ❑ Other r
[] Division of Soil and Water Conservation 13 Other Agency
W Division of Water Quality
Routine 0 Com taint 0 Follow-up of DW ins ection O Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number 3 Time of Inspection i zo 24 hr. (hh:mm)
© Registered 19 Certified 0 Applied for Permit I.Permitted 113 Not Opera Date Last Operated:
Farm Name: ...
County:..... .L!}?.h' .....................
Owner Name: ............... .1 kf9 1.6 "AtK................... ......... Phone No:..�1„ti.�4�..��'a -�.��
Facility Contact Title: Phone No:
Mailing Address: 33...... ?IF& ........................ .. C `�k� �t i/�. .................. ` ..........
.. ,4 t...... �- --- .
Onsite Representative:........... Ar.r.-4........... ...... I ............................ .... Integrator: ....... A... .......................
Certified Operator................................................................................................................ Operator Certification Number .........................................
Location of Farm:
li.+rm......i... s�,...... s41! .�' ............. �R...1gr7..�...iti...,r e........A........ SIL.iYat:..............................................................
........ ........ ........ ...........................----.....---... ............-----....----..
Latitude �• ��
DesiLxn Cui
❑ Wean to Feeder
❑ Feeder to Finish
KFarrow to Wean
❑ Farrow to Feeder
y
❑ Farrow to Finish
❑ Gifts
❑ Boars
00, 2-4>v
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field [:]Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
I-
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoonstholding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes tj No
❑ Yes• No
Pt
❑ Yes No
❑ Yes ® No
❑ Yes (h No
® Yes ❑ No
❑ Yes M No
❑ Yes 09 No
Continued on back

Facility Number: t
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes [g No
Structures (Lagoons.Holding fonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 52 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 0
Identifier:
Freeboard(ft):............ ..................... ....................................
10. Is seepage observed from any of the structures? ❑ Yes EN No
11.
is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes
a No
12.
, Do any of the structures need mainlenance/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 Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notifv DWQ)
_
15.
Crop type .............. �P_M.1A................................................. Y�P..................... .... ....._........ ................................. :........... ........................
I............................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AW,MI')?
❑ Yes
MNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
N No
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
W No
20.
Does facility require a follow-up visit by same agency?
jai Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
5d No
22.
Does record keeping need improvement?
❑ Yes
MNo
For Certified or Permitted Facilities Only
,
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
,® No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes(]
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
® No
No.violations or de'ficieneies.rwere noted-dur'ing this.visit.- .You.W'ill receive no further
. correspondence shout this'.visit:•
Coinments'(refer'to,question #): Explain any 11S answers and/or anv recommendations or any other con vents;
Use drawings of facility to better explain'situations. (use additional pages -as necessarti ).. 3 `
.L.oc4
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7/25/97
Reviewer/Inspector Dame 7
Reviewer/Inspector Signature: Date: 98"

Routine O Com faint O Follow-ue of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection l 97
Facility Number Time of Inspection iZ`30 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1?5 for 1 hr .15 min)) Spent on Review
[j9 Certified ❑ Permitted lor Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: .. _ . -.... _..........._..... .......... .._.... .�..... _ .� .. .........................
FarmName: _ .. + 5 .. t1" 1. -..... ....._... _ .... _ ...... County: _b1'.. kr .... ... _..._...... �.... »..__.
Land Owner Name• YA Imo. _..............
Phone No:. -('I ..... .......... ........ .._...........
Facility Conctact:... _ ..... _ .. 'title: Phone No: ..........
Mailig _ �. t ......Li11u kair..
ng Address: .....%lf):. ...... ....__.... _....._ ....__....._.....,
Onsite Representative:Integrator:
Certified Operator: ... t! .. �, .... _.... Operator Certification Number: A.0..,.......
..
Location of Farm:
T V7....LI.tS hz .
.......... a'
Latitude --0 6 " Longitude ©• ®®G
Type of Operation and Design Capacity
DesrgnCurrent Design Current , - Ues�gn ' Current
Swine a r r a ,.. y::
2
Ca acr Po ulaEian Poultryr Ca aci Po `elation.: Cattle *,Ch acr Po uEation
❑ Wean to Feeder ❑ La r ❑ Da'
❑ Feeder to Finish ❑ Non -Layer ZAEI Non -Dairy
Farrow to Wean C>C> 2� v
Farrow to Feeder a _
Farrow to Finish. �
-. ....:..T TotaI SSLW Go(, za
❑ Other 4
w Number of�Lagoons f Holdrng Ponds
'
❑Subsurface Drains Present'
u
❑ Lagoon m s Area ❑ Spray Field Area
,.---. - ........ ........
-General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
2. Is any discharge observed from any part of the operation? ❑ Yes In No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ER No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in 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 15a No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 9 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require 69 Yes ❑ No
maintenance/improvement?
4/30/97 Continued on back

Facility Number:....-.._
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONO
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
qK No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
69 No
Structures LLaogoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
® No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
�_.... .. _ ....._..... _...._....... .... ......... __..... _ _..... ....
........ _
... ....
10. Is seepage observed from any of the structures?
❑ Yes
KI No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12. Do any of the structures need maintenance/improvement?
Yes
❑ 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 Application
14. Is there physical evidence of over application?
( Yes
❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...-----r. .........-..... ................................. ..............
_2L1�.. r s ..........-- ..
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
[ No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement?
❑ Yes
® No
19. Is there a lack of available waste application equipment?
❑ Yes
® No
20. Does facility require a follow-up visit by same agency?
❑ Yes
IQ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
IN No
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
[D No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
W No
24. Does record keeping need improvement?
❑ Yes
U No
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Reviewer/Inspector Name __��_
Reviewer/Inspector Signature: Date: `j L h7
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97