310580_INSPECTIONS_20171231

NUHTH CAHOLENA
Department of Environmental Quai

Type of Visit: OfCo ance Inspection Q Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other D,Denied Access
Date of Visit: Arrival Time: j / Departure Time: � County: Region:
Farm Name: TT� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �r ,[ ` Title:
``
Onsite Representative: r�'{'� C `' / C , (/
Certified Operator:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
can to Feeder
Wet Poultry
Layer
]Non -Layer
Design
Eapacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Feeder to Finish Itt40 Y
Daia Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry P,oult .
Layers
Design
Ca aci
Current
P,o
Dry Cow
Nan -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
keys
Turkey Poults
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [:)No ❑ NA ❑ NE
❑ Yes [' Nc ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
Page I of 21412015 Continued

Facility Number: j - Date of Inspection: L s
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2TVo ❑ 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:
Spiliway?:
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
L� J N ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes io ❑ 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 LJ'lvo ❑ 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): __ r
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E<o ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
__E21. 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes XNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: ­�l jDate of Inspection:
24. Did t]`le facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No NA ❑ NE
2; is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [—]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No E).-M-A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA. - ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes EZreNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑o1Gb ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes L'J No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes B-Mo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any.otber comments.
Use drawings of facility to better. explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
AVa C
6.—Z f
1 w� (Ili Phone: 1* A 73, Y+
Date: 4A Z/
2/4/2015

Type of Visit: (0 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: �� Departure Time: � County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 3 oz. 6-&tt (j&L-1[a eo,, Integrator:
Certification Number: 9 9 -73
Phone:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Wean to Finish
I
I Layer
11
jDairyCow
Wean to Feeder
I
JNon-Layer
I
Dairy Calf
Feeder to Finish
'54
Design Current
U . Plflultrty C►_a ael_ Pao
La ers
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
I
jBeef Feeder
Boars
Pullets
I
I Beef Brood Cow
Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
A 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
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ YesVX0
[] NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: -SVO Ds ection:
u
Waste Collection & Treatment
4. Is'storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E(�o ❑ NA
❑ NE
r
a. If yes, is waste level into the structural freeboard?
❑ Yes
No ❑ NA
❑ NE
Struucc`tur�e 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
U/No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or en ' onmental threat, notify 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 Q N ❑ 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 Cj"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 to D NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E] IJo ❑ 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
❑ YesFj-eol
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes rNo
❑ 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 o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall InspectionsSludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes❑
NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 3 1- Date of Inspection: V1 w
24. Did the facilityfail to calibrate waste application equipment as re required b the permit? Yes No NA NE
PP9 Y P ❑ ❑ ❑
25. I the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E 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 o ❑ NA [:3 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes N
❑ Yes �o
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes + No ❑ NA ❑ NE
❑ Yes t3No ❑ NA ❑ NE
❑ Yes ff No
❑ Yes g t
❑ Yesra�No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as. necessary).
2 otIJE2rs A Cr,r-oAJJ i?E T�%nJt SEk�_D
Reviewer/Inspector Name:
Reviewerllnspector Signatw
Page 3 of 3
Phonc(1/a> 16 to � -739f)
Date: G
A & th t'
21412015

M
Type of Visit: Q Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: O Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:® Departure Time: ® County: �(/� ,j�/_ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: K) zz _14 E I'., Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design C►urrent
Swine C**opacity Pop.
Wean to Finish
Design Current
Wet Poultr3 C►►opacity Pop.
Layer
Cattle
DairyCow
Design
Capacity
Current
Pop.
Wean to Feeder
on -Layer
DairyCalf
DairyHeifer
Feeder to Finish
Farrow to Wean
Design Current
D Poultry Ca acit P,o
D Cow
Farrow to Feeder
Non -Dairy
Beef Stocker
Farrow to Finish
La ers
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
s
urkey Poults
Other
Other
H,Turke
Dischar2cs and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes 2�0
o
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: jDate of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
❑ Yes
MINo
[] NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure lStructure 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 env' onmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes VN
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CZNo ❑ NA ❑ NE
maintenance or improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes pl�o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L=J 1"0
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
FZ/No
❑ NA
[] NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ 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
2/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 Ko ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �< ❑ NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Fj__No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: JDate of Inspection: s
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [] Yes = ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YesgNj
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E/o
❑ NA
❑ NE
❑ Yes
LYJ No,
0 NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
No�' ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question ft Explain anyYES_answers and/or any additional recommendations or any other comments...,.
Use drawings offacility to better explain situatiods;(use additional pages,a°s�necessary).'
rf ,)1 C..� AS 6 ��►� ev � S��c.•�- Tj2� cs vN ����E W� � .
SE�p c.w(�_e HHeN D6XJ C
Reviewer/Inspector Name: ^� fj4RA 1z, U I
Reviewer/Inspector Signature:
Page 3 of 3
Phone. gloN —
Date:
2/4,20I5

Type of Visit: QJ Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: U Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: County_ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: W—a G C.Lu Integrator:
Certified Operator: Certification Number: V 0�3 1
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Dairy Cow
Dairy Calf
Dairy Heifer
Current
Pop.
Wean to Feeder
]Non -Layer
Feeder to Finish
L)
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr. P,outt . Ca aci_ P,o
Layers
Dry Cow
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
lLJto
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Faeili Number: 221 jDate of Inspection: j
Waste Collection & Treatment
V 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"J1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: cr c�I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
ElYes
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
r en
o' onmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[-To
❑ 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 [ 0 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ WE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes EZ/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 YNO ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes h}o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? [:]Yes U No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ;; No ❑ NA ❑ NE
Required Records & Documents TT
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes IN9 NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ Na ❑ 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 [3No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ❑ 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

Wacility Number: - Date of Inspection: y l
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes [r 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 to provide documentation of an actively certified operator in charge? ❑ Yes F_]�Ko ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAN') certification? ❑ Yes Vo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes <o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes To ❑ 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 ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes [ "o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes LrNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes �o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes to ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facilitv.to better explain situations (use additional WETS as necessary).
W' c_u, STr(.L. OELOS' WotZK- ar.J
Reviewer/Inspector Name: 11_J0K "TMM4S mil.%, A Phone:
Reviewer/Inspector Signature: Mkmm 4 Date:
Page 3 of 3
11

Type of Visit: Qf Co Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: EMM County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ��Tii1tle:
Onsite Representative: i3Iry 0zx(�M C7�-.0
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: (v %
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
ILayer
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
WIXe7sign Curceut
D . P,oult . Ca aci P,o ,
Layers
Daig Heifer
Dry Cow
Non -Da'
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[:]Yes [-]No
[] Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ ❑ NA ❑ NE
[] Yes N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

FaciliNumber: - O Date of Inspection: i
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
LA Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IVNo ❑ 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 2No ❑ 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? FYes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes E. <o ❑ NA ❑ NE
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 ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes ❑ NA ❑ NE
❑ Yes ❑ 2t NA ❑ NE
VN❑ Yes ❑ NA ❑ NE
❑ Yes 1Vo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ WE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking[] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspectiro
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes .❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes d
25. GIs the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ICJ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑NA ❑NE
❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EOeo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes ff 'No ❑ NA
❑ Yes o ❑ NA
❑ Yes o ❑ NA
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. .
Use drawings of facility to better explain situations (use additional pages as necessary):.; .
Reviewer/Inspector Name:
❑ NE
❑ NE
❑ NE
ccrrgzEp 9vr sTEt,c. snmc- 1_6rr
Phone:
Reviewer/Inspector Signature:
Date: J
Page 3 of 3 1 21417011

131
Type of Visit: 'CIS Cg4npliance Inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: �C,J[ Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: C? ( Departure Time:© County: pLAO(.IPJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: .� (_4tC.V Integrator:
Certified Operator:
Certification Number: �b l
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
C*urrent
Pop.
Design Current Design C**urrent
Wet Poultry Capacity Pop. Cattle C►apacity Pop.
Layer Dairy Cow
Non -La er I Dairy Calf
Wean to Feeder
Feeder to Finish p
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
D , $oult . Ga aci P,o , Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[3 Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facitity Number: - [Date -of Inspection:
R
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
Identifier: L�
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ZNo ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envj/onmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑
Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
hJ 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?
WNco
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
❑ 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 D Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
K
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
L'J No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
d15
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rNoo
❑ NA
❑ NE
Required Records & DocumentsWN
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
D NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
2) . Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: - d Date of Inspection: 1 ?_.-
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [-]Yes No ❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ZINO ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes O No ❑ NA FINE
❑ Yes No ❑ NA ❑ NE
❑ Yes rJ No ❑ NA ❑ NE
[:]Yes hTo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
Zr �No ❑ NA ❑ NE
VIDNA NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
WAL_V HAS Vrz0flY CfLot,.�d . �EIrAbfE: ASA-p
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q /e q - ?
Date: Z
21412011

Type of Visit: 0 Co fiance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j Arrival Time: f® Departure Time: j j7 County: Df m rj. Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: _3(_c �jt Integrator:
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Wean to Finish
Wean to Feeder
fiNaM
Feeder to Finish 1040
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . Pc
Layers
Gilts
Nan-L
Boars
Pullets
Other I I IM 10ther
Latitude:
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Cow
ow
Cy alf
Her eifer
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes
No ❑ NA ❑ NE
[]Yes
[]No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes FfNo ❑ NA ❑ NE
❑ Yes Dio ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: ) - Q jDate of Inspection: S
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?
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1Structure 2
U46-VVr
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No[_] ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes mo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste 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 CNo ❑ 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?s
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Na ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
j 40 ❑ NA
TT
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
LA " [] 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 [2/No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2NA ❑ NE
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes VNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ YesrNo
❑ NA
❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes 0 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
❑ NA
❑ NE
33, Did the Reviewertinspector fail to discuss review/inspection with an on -site representative?
❑ Yes �Z9
❑NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or:any other comments I
Use drawings of facility to better explain situations (use additional pages as necessary).
fS►� i�t-�b fps Do Sbm I�✓j Ga,�„ �Ll1S�
1��p1.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
��N►�f FA atj(z(.�1.
Phone: j j i 7
Date: —�Ito 41
V411011

I
Fa�tlity Number. 3 S $0
1
Dtvision of Water Quality
Q Division of Soil and Water'Conservation
D,'Other. Agency
lType of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
ReasonforVisit O Routine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: y9 /l? Arrival Time: Departure Time: County: p Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: atLt4Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e = f Longitude: = ° [� g
n
Design Current . - Design, Current
5w one _Capacity Population _ . W Po ltry 'Capacity Populate©rr Cattle ^ '
El Wean to Finish ElLayer ❑Dai Cow
❑ Wean to Feeder ❑ Non -Layer ` ❑ Dairy Calf
Feeder to Finish b /p °_ ❑Dai
k
Heifer
' El Farrow to Wean " s ❑ D COW
�Di� Poultry
-=�»
❑Farrow to Feeder ❑ N D
❑ Farrow to Finish
w ❑ Gilts
❑ Boars
❑ 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?
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I III
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 C No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
YJ No
❑ NA
❑ NE
Page 1 of 3
12%28/04 Continued

sA
Facility Number: 3 r — S'$o Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:i�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D<o
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ENo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
ental threat,
enviWyes
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0"'No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
,�{
EJ No
❑ NA ❑ NE
maintenance or improvement?
Waste Aaalication
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
.�``
El, o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
2No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CJNo
ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
6NNo
❑ NA
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E No
❑ NA
NE
El NE
17. Does the facility lack adequate acreage for land application?
ElYes
13/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
Cl Yes
�No
❑ NA
❑ NE
Comments refer to question #): Explain any YESanswers andlor any .i ecommendations or any other comsrients r
_ n
Use drawings of facility to;better explain -situations. (use additional pages as necessary)°:
7.) IZk+o VE S"AUL, 7"x-E E ofl�_ f3AC-GCSTD(r GLC 11—C w14U.,
Reviewer/Inspector Name Phone:C
Reviewer/inspector Signature: Date: 2 S�
Page 2 of 3 12128104 Continued

i
Aacility Number: Date of Inspection 3 ID
c
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 Cl/No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists g p El Other
❑ Design ❑ Maps
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Ld No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,L���,,'ffNo
Ly'1Vo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified'operator in charge?
❑ Yes
,/
b[1 o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LJ No
❑ NA
❑ NE
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 2'No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E(No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
D No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
U3"No
❑ NA
❑ NE
AdditionaTComments and/or Drawings: u r
Page 3 of 3 12128104

C
lType of Visit copliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
ReasonforVisit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 5N91 Arrival Time: ► f �Q Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Q v--fr�JT W►_;-rcw ALA— Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: 0 Q 0 { = Longitude: = ° = 1
Design Current
Swine Capacity Pop: ulation
Wet Fonitry
Desig!11n
Capacity
Current
Fopulation
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Layer
❑ Dairy Cow
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
0
SM
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑Other
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
E Boars
Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ,❑I No [-INAEl NE
❑ Yes <o ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
Page I of 3 I2/28/04 Continued

Facility Number: -s Date of Inspection 6
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structur 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
LEI No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
/ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
E2 o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
LEI No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
TNo
ElNA
ElNE
T
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E I No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
drawings of facility to better exjilam<situattons. (use additional p
51-4ALA— INZk& Id WRLL 2.44Wf 4PieAS'6
Reviewer/Inspector Name d v L JA Phone(Y
Reviewer/Inspector Signature: Date: -1124
PoQP 2 of 3 12128104 ntinued

Facility Number: Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the approprrate box. [] W UP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes dN1
El NA ❑ NE
[I Yes ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis El Soil Analysis ❑ Waste Transfers
�N�o
L�J 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?
El Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZINo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
' o
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O/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
Ck o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,�,�
�..,1'Isio
❑ NA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
U 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
M/No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[:�'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0,C.,00mpliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit (O Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: r o/ Arrival Time: Departure Time: County: il�i�LdN Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ig"^_�T pix-r" &cu
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: =1 o Longitude: = o = 4
Design Current
Swine Capacity Population
Design Current Design C►urrent
Wet Poultry C►apacity Population Cattle Capacity Population
Wean to Finish
fEl Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ La er
❑Dai Cow
❑ Non -La er
❑ Dai Calf
y j
d
Dry Poultry
❑ La ers
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Non -La ers
❑ Pullets
❑ Turke s
❑ Beef Feeder
❑ Beef Brood Co
❑ Boars
Other
❑ Other
Number of Structures:
❑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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes WNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
ElNE
❑ Yes
El No
[3Yes
NN
ElNA
❑ NE
ElYes
Lid No
❑ NA
❑ NE
12128104
Continued

Facility 1lTumber: 31 — Date of Inspection a
' Waste Collection & Treatment �
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes OJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure ] Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 56
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes C j(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 4o ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes U 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 2I No ❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [I Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 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)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LJ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
V No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
CKo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ N
El NA
El NE
18.
Is there a lack of properly operating waste application equipment?
Yes
El Yes
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name /11h'4__ Phone: CP/p 7 9 %3 X
Reviewer/Inspector Signature: Date: D
17/79/nd !'nnlrnuvd

Y
Facility Number: Date of Inspection I sf
Required Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[<o
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑' t�o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspectionss E] Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ETNNo
ElNA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ No
ElNA
❑ 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
B o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
Q<A
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑lido` ❑ 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
CfNo
❑ 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
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
0''No
CT No
❑ NA
❑ NE
Page 3 of 3 12128104

1'
Division of Water Quality
Facility Number ��M
0 Division of Soil and Water Conservation.
0 Other Agency
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
C7pliance
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: .S 'f t Arrival Time: ' 3 Departure Time: County: 01"CrOJ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:�-
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: 0 n = 4 = Longitude: = ° = ` = f4
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
El Feeder to Finish zlq-D 2�0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ 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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ NA
ElNE
ElYes
E!o
9? No
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 Date of Inspection S 7 v7
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑YesLI
,.,�(
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: _LA&Rod
Spillway?:
`
Designed Freeboard (in):
Observed Freeboard (in): y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[3 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?
FfYes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes UNo ❑ 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 Y No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
,[(No
d No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
7� Il/Cr' S�wlE 6 KA0 WdR:r— aAl O Z)L L- waLr,,S . FEw- rr T1 ''F CLaq'T SK•►.cITVG
ICI �U1 Loci Gv O-J P C S.1 G i�-� D AjIE ,
Reviewer/Inspector Name V;4 4S -Ad2df . Phone:
Reviewerfinspector Signature: Date: 63
I-WalU4 c.onnnuea

r
Facility Number: 31 — S$7 Date of Inspection
Required Records & Documents ����
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes L�J NNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ll No ❑ NA ❑ NE
the appropirate box.
❑ WL1P El Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ZNo ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[Y No ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo ❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
d o • ❑ NA
ElNE
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
d o ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑1 No ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-cornnliance 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
D o
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�.�
LI 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
f!'] 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
dNo
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Q4
❑ NA ❑ NE
Comments and/or Drawings:
12128104

M
Facility Number 31 Sg a
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: y U 610 Arrival Time: ® Departure Time: �7 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: $rL�N1-�►1t>rCN EU,_ _ _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
swine
a ❑ Wean to Finish
_` ❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
-Other
Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: c = I = Longitude: = ° = 1 u
Design Current Design Current Desi
,apacity.,..Population Wet Poultry Capacity Population Cattle " Capr
❑ Layer ElDai Cow
. ❑ Non -Layer 1 1, ❑ Dairy Calf
❑ Dairy Heifer
`Dry Poultry El D Cow
ElLayers
ElNon-Layers
❑ Pullets
ElTurkeys
❑ Turke Poults
100 ther
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures..
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
t a 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 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑]No
❑ Yes
L'f N
El NA
❑ NE
El Yes
LSNo
❑ NA
❑ NE
11/18104 Continued

Facility Number: 3 1— gd Date of Inspection
Waste Collection &'Treatment
4. • Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure,I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: � 6eo try/
Spillway?:
Designed Freeboard (in): ' f
Observed Freeboard (in): `7 Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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 O No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes N [—INA ❑ 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 ElYes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 23 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift/ ❑ Application Outside of Area
12. Crop type(s) IT C4"44j (# 4 G )
13. Soil type(s) I-TLAA -0d
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. is there a lack of properly operating waste application equipment? ❑ Yes
2'/No
El NA
El NE
BNo
El NA
[I NE
2-.'No
❑ NA
❑ NE
❑NA
❑NE
VN
❑ 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):
2�4) 0?DA I-t ca��N ,vEs�r� w.rrt s �- 0
Reviewer/Inspector Name F_ n,A)bt e, Phone: %/l% 7g4 7.Z. L3
Reviewer/Inspector Signature: Date: a �%
rage Z of I ZZIZO/V4 t.untinueu

Facility Number: 3 1 —5-0 Date of Inspection
Re aired Records & Documents
' 19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA
Wreadily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists
❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections
El Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [2 No ❑ NA ❑ NE
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 property 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?
Comments and/or Drawings:
❑ /No ❑NA ❑NE
Z❑ No ❑ NA ❑ NE
❑ Yes
[2,1�o
❑ NA
❑ NE
❑ Yes
❑ No
aNA
❑ NE
❑ Yes
❑ No
EJNA
❑ NE
❑ Yes
2'�o
❑ NA
❑ NE
❑ Yes ❑ No S NA ❑ NE
❑ Yes
To
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
L7 No
❑ NA
❑ NE
❑ Yes
NSNo
❑ NA
❑ NE
❑ Yes
91'No
❑ NA
❑ NE
❑ Yes
2-No
❑ NA
❑ NE
Page 3 of 3 12128104

V_ )
Type of Visit J6 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I/P//_VIOLA Arrival
Farm Name: .Z/
AiZi] Y"�
Owner Name:
Mailing Address:
Physical Address:
Departure Time: _ County:
Facility Contact: /� �� Title:
Onsite Representative: A! .r'/I'GG*
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
Owner Email:
Phone:
Region: (i{/�
Phone No:
Integrator: 10 'a'0.5 ea". 0
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 0 A Longitude: ❑ o=
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ff []Layer
11 ILI Non -La et
Other
❑ Other - - - - - - - - —
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Points
❑ 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 Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: Tj
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 Y No
❑ NA
❑ NE
❑ Yes XNo
❑•NA
❑ NE
12128104 Continued

ti
Facility Number. —5961Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Strp ture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): L-jI
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ❑ NE
(iel large trees, severe erosion, seepage, etc.) to
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 W(No ❑ NA ❑ NE
$. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes (�INo ❑ 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 Axea
12. Crop type(s
13. Soil type(s)
u
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
(VrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
0No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
A1,_zA0
fo-,e �Fs���✓�o F�����.o_
ReviewerAnspector Name Phone:
Reviewer/Inspector Signature: Date: O�
12128104 Continued

0
Facility Number:jj� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes /No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VrNo ❑ 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
[ tNo
El NA
❑ NE
23.
If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment?
El Yes
//❑ No
O NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
J0
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
El NA
El NE
If yes, contact a regional Air Quality representative immediately
�No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
A No
❑ NA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Commenis and/or Drawings:
1 Q o
V, 149
r0a 05 NorAtio Pw_ddfP*_�
l2/28/04

Type of Visit *0Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit WF3outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 1 Tune:^�
O Not O erational Q Below Threshold
© Permitted [3 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ..... .,0-4V;za _ C .. f .— — County: ..KJ�1° !►� ... _ _ _ .. _
Owner Name:... _ ._. ..�(/.+e�rl i» .! .,f�.7�C �.... �. .. ...... _ Phone No: .... .� ._ .. ._... W -._ ...._.
Mailing Address: .............
Facility Contact: ............. ..... .. - - ... Title:.. _. _... .. Phone Na•
Onsite Representative: �E /!iy ��Gfr.,,.__ Integrator: L�S�QI�
Certified Operator: ---,,.. ........ .. �- ._ ....................... Operator Certification Number:
Location of Farm:
lJ Swine ❑ Poultry ❑ Cattle ❑ Worse Latitude a d 0" Longitude • 4 «
Design "Correa# " Design ``Curreuf`= < WDesgn Carreut
L _
Sine. Poultry =Ca tity elation. Cattle __� ._�Ca as Po uititiion � _ Ca a . Po�ulat,on
Wean to Feeder = ❑ Layer - Dairy
Feeder to Finish rJ ❑ Non -Layer ] Non -Dairy `=
Farrow to Wean
d ,
' Other r
a<
❑ Farrow to Feeder
Farrow to Finish
Total Design Capacity a
Gilts w
-_
❑ Boars TBtai SSLW
Nuiunbeir of Lagoons .'
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
WNo
❑ Yes fflrNo
Structure 6
Identifier: ............................... •-........................... ..... -•.................................
Freeboard (inches):
12112103
Continued

•acilittNumber: !a —
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 maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Ov rload ❑ Frozen Gro nd ❑ Copper yr Zinc
12. Crop type �. �. Cr-• 1�!%
13. Do the receiving crops differ with those designated in a Certified Animal Waste Management Plan (CAWMP)?
I4. 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?
I5. 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 at/or 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 '0 No
[:]Yes J9 No
❑ Yes Lff No
❑ Yes WNo
❑ Yes A No
❑ Yes PNo
❑ Yes 0 No
❑ Yes '0 No
❑ Yes QfNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONo
❑ Yes PfNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes ;0 No
v
_Comments (refer to gnestron #) Eitplara any YES,i6ii4ers snob; any recommendations or any other comments: .
W s
:Use of fa to better lara situations {use:addttioi A as aecessa
&S �' pel; *3'?- Field Cop Final Notes
tl
-
25 l 115'1011 So w ePo�T SPwe o P�
l
=
55
o Apo
Reviewer/Inspector Named
ReviewerAnspector Signature: Date:
12112103 Continued

FacRity Number: 38Date of Inspection
Re aired Records & Docurnents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? XYes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑
Yes 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
0 No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
11No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
to No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
V No
28. Does facility require a follow-up visit by same agency?
❑ Yes
PNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
A No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

tType of Visit / Compliance Inspection O Operation Review O Lagoon Evaluation
Rea"n for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
r Date of Visit:. // ?i Time:
Facility- Number
t � -
..�... -- - - Q Beloa• Threshoid
Pet7nitted E3 Certified Conditionally Certified E3 Registered Date Last Operat or Above Threshold: .........................
n LD
Farm Name: ..Jut. F�L2.._..T-%L.Tr ..,. �.LtS. ........................ County:.. y.................................
.. ........ ....
....................
Otivner Name. ........... Phone No:...................--.........--..................-..._............................
..•.................. 11 f ........--.--- r� . r ...............
Mailing Address:
FacilityContact: .............................................................................. Title:.............................................. .... hone No:
Onsite Rep resentative;lRe.f ....j -..... !...'...1.... V00f,.k . ... Integrator.......rk9_:...�..t.0'.e..Q....................................
Certified Operator:
Location of Farm:
Operator Certification Number: .............
1215wine ❑ poultry ❑ Cattle ❑ Horse Latitude �° ��K Longitude
Subsurface Drains Present 110Lagoon Area ID Spray Field Area
No Liquid Waste Management Svstem
Dischar-es & Stream Imnacts
I . Is any discharge observed from any part of the operation? ❑ Yes INO
Discharge originated at. DLagoon ❑SprayField PlOther
a. If discharge is observed, was the conveyance man-made? 0 Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) 0 Yes El 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} +10 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? t� Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Yes 'VNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:---------.....�.....----------....... - -- ,.........................-----------•• -----. ---.........---- /2...
Freeboard(inches): ............ +.J;.1............... .................................. .................. I .................. ................................... ......... I.........................

;,'-
Faciiity Number: / —� j g 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 ansatered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance.Irmprovement?
8. Does any part of the waste management system other than waste structures require maintenancehinprovement?
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 maintenancerimprovement?
11. Is there evidence of over application? ❑ Excessive P
12. Crop type
13. Do the receiving crops differ with those designated in the Certi
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?
Overinad
I6. is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage &. General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with.any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewimspection with on -site representative?
24, Does facility require a follow-up visit by same agency?
25- Were any additional problems noted which cause noncompliance of the Certified AWMP? .
❑ Yes XNO
0 Yes XNo
1"..Yes YNO
❑ Yes #No
❑ Yes No
❑ Yes /ZNo
❑ Yes A No
❑ Yes o
Yes /0No
❑ Yes �No
0 Yes �No
❑ Yes No
❑ Yes / No
0 Yes j2(No
0 Yes No
.0 Yes W'No
0 Yes �No
0 No violations or deficiencies were noted during this visit. You will receive no further.correspoudence about this visit
. :, ,�-Ek..it �.;:. is :k,,, Y2.: .':Y:. ::@., v::t.+> ,�-;,. c,k•- .,;;:.'tiriv
�i..�]]4_� - IQ#iEk `,�11llfVa:tai�y¢:�..'ii[ICYIYiOff�y�i'.'��
,e-
4_,- ::a'•i`.^:.. .:.`F.L.a..},^1,,._...:..., .. .::.:4Z::,�cL-:�:::t,,:
:3>r+
- t::2<cc•':: r+:._c:,:,,�„ ,s,,.i ca:: ,{:�}t.:
=•zi
{_.-. _,,.:�a{w;{t:"
4aeia`are
Field oP3' .� Final Notes
..<::
.:lyc')':. .]]..i]}r:
_ :: _... h. c:?e.:,,...':�:::.x:.:-..,..:�::..'M
�/'2ED. 5
/P�CO��S !rJ
qV
- - - - 'f..3:::.--':-:::t:.; :.. - ::{{... :.3f.,fti,- .i:4:. - ^.:A:?x -- ^:•.IXi{!.::ti.. -
Reviewer/Inspector Name ..,..:..:= "r - - -• � .:.::::=.;: .: ...:.. ... ... .....>:.. ,{.{<. ....,.._ ..,,.
Reviewer/Inspector Signature: Date: 44111 A

1105103101
Facility Number-. ] — M Date of Inspection
Continued
Odor Issues
2& Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27_ Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift dining 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?
0 Yes VNO
'Yes �No
• Yes �(No
❑ Yes XNo
• Yes ho
• Yes
❑ Yes ❑ No

[Type of Visit l�Compliance inspection 0 Operation Review 0 Lagoon Evaluation I
for Visit rQ Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other El Denied Access
I- Facility Number Date or visit:
K f
[?�&rxnitted 13 Certified D Conditionally Certified 0 Registered
FarmName: ......... Dj............... ..... .. (411 ...........................................
Owner Name:......... ;:: AXN-k ............. ..... ................. ct--c ....................... I ........
Facility Contact:
Title:
MailingAddress: ......................................................................................................................
Onsite Representative:......41141. W. .............................
Certified Operator:
Location of Farm:
Time:i VJ
10 Not Operational 0 Below Threshold I
Date Last Operatedir Above Threshold:
County: ........... .............. ...
Phone No:
Phone No.
....... I ......................... ............................................ .........................
integrator:,,,,,,, ... .........................
Operator Certification Number: .........................................
,14--swine [] Poultry 0 Cattle [3 Horse Latitude 0 i 49 Longitude 0 4 1 i4
Design Current Design Current Design Current
Swine -.Capacity. Population Potiltry. Ca act Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer [I Dairy
�Feeder to Finish_ ID Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
0 Farrow to Finish
Total DesighVaility::C.
❑ Gilts
❑ Boars :T
otal SsL W.`.'
Number of Lagoons t y10Subsurface 'Drains Present PLagoon Area JE]Spray Field Area
'/,SAd:, Tr'a"bs;7z1
o No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon E] Spray Field E] Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c, If discharge is observed, what is the estimated flow in gal/min?
d. Docs 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?
01/01/01
El Yes AINO
0 Yes 0 No
❑ Yes [I No
❑ Yes [I No
E] Yes No
E] Yes No
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
identifier: ............. .........................................
Freeboard (inches): ...............:.. ........................ .....................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
0 Yes
seepage, etc.)
�No
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
No
immediate public health or environmental threat, notify DWQ)
CT�(any of the structures need maintenance/improvement?
ElYes
Ao
8.. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
KNO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum Iiquid level
elevation markings?
❑ Yes
KNO
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
El Yes
o
12. Crop type z
13. Do the receiving crops with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
1No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
'ENo
b) Does the facility need a wettable acre determination?
❑ Yes
d�No
c) This facility is pended for a wettable acre determination?
❑ Yes
9�o
15. Does the receiving crop need improvement?
❑ Yes
VTlo
16. Is there a lack of adequate waste application equipment?
❑ Yes
,lNo
ere a water s ary.-�-F�e4ti`o�es--���.T�^
Required Records & Documents
19.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
[:]Yes
PNo
20.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
6(No
���N0
21.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
22,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
23.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
o
25.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
26.
Does facility require a follow-up visit by same agency?
❑ Yes
'No
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
Odor Issues
28. 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?
29.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
VNo
01/01/01
Continued

Facility Number: ` — Date of Inspection Printed on: 1 /4/2001
30. Is there any evidence of wind drift during land application? {i.e. residue on neighboring vegetation, asphalt, []Yes I"Na
roads, building structure, and/or public property) VVV�'''
31_ Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 9No
32. 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
33. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Elv
Yes ®No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit./
01/01/01

Division of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: I y Time: D Z !Tinted on: 7/21/2000
Facility Number
Q Not Operational Q Below- Threshold
[Permitted IlCertified © Conditional ,Certified j] Registered Date Last Operated or Above/Threshold: .............
/ /� Counts':...... /, ... ...................(.�P :.......
Farm Name: ........ ..�)W�.9.......................... _Q ........ f�'. .......... ...
OwnerName:.... f..al........... Phone No:.......................................................................................
(........................................................
Facility Contact: C>�J......................�.�...L�---......... Title: ......`.'..�111U'f�....................... Phone No: ...................................................
Mailing Address: .......................Oz.
.......
Onsite Representative:.,.. ...../� .... integrator:.....�
....._.._
Certified Operator :............ .1 ..................... ("�'J..l ...... ...................... Operator Certification Number:.. ,;;PV, ....
Location of Farm:
I
Q�Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �� �•° Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Po ulation
❑ Wean to Feeder ❑ Layer ❑ Dairy
Weeder to Finish ❑ Non -Layer I I❑ 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 ETSpray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Dischare5 & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Vo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) El Yes ❑ No
c. if discharge is observed. what is the estimated ]low in gal/min? _�40 -
d. Does discharge bypass a lagoon system'? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes *o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes 3(No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ....... 13S.. . ........ .................................... ................................... ...... I ............................. ......................_................................................
Freeboard (inches):
5100 Continued on back

Facility Number: 3 / — S Date of Inspection Printed on: 7/21/2000
5. Are these any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes YkNo
(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?
9Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
,(No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
fi(No
11 _ Is there evidence of pver application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
47
12. Crop type J
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAMP)?
❑ Yes
NfNo
r 14. a) Does the facility lack adequate acreage for land application?
❑ Yes
,<No
b) Does the facility need a wettable acre determination?
❑ Yes
52rNo
c) This facility is pended for a wettable acre determination?
❑ Yes
150-o
15. Does the receiving crop need improvement?
❑ Yes
XNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
WNo
Required Records & Documents
—17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
VNo
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
1KNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ANo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KLNo
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes
$�No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
PUONo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
SkNo
24. Does facility require a follow-up visit by same agency'?
❑ Yes
Ko
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
0: �10 •violaiions'ot. &fide dine •were noted• di�•ritiii this'visiL • Y:oi.t WRI receive {id rui-th¢r
corresporidenke. Abut. thL'S .visit. - . - .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
7J1nr01VlWen V
,,1
�- �d
Reviewer/Inspector Name !e '
ReviewerlInspector Signatur—e-:�—
I
Date:

Facility Number: — Date of Inspection Printed on: 7/21/2000
Odor Issues
2fi. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or hclow ❑ Yes )4No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes O(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �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 ic
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ElYes
Additional omments and/orDrawings:
5100
5100

Division of Soil and Water Consei'vahon = Opei ation•Review
.� _
Division of Soi! and Waters.
-0 , . ,- Cpnservahon CompLance Laspection ,, ��
�Division of Water Quality CompI ce I nspecti6n
'Other Agency Operation Rev�ew,�
_ -
Routine OComplaint Q Follow --up of DWQ inspection Q Follow-up of DSWC review ()Other
Facility Number Date of Inspection
-- --- -_ -- - Time of Inspection Qt7 24 hr. (hh:mm)
O Permitted l�Certified 3 Conditionally Certified E,] Registered Not O crational Date Last Operated:
Farm Name: I/tia pY1��...... County:..... � .`1........................................................
................-....................
Owner Name: ................................................... .......................-..... Phone NoV•�7).0?—'j�.i. ....C77�-_..a'..1gl(,�"f)
FacilityContact:.............................................................. Title:................................................................ Phone No:............
MailingAddress....................................................................:..........................................................-... .........................
Onsite Representative^ ...... Integrator:
....s......
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
A
............................................................................................................................................................................................................................................................I..---..-..- �
Latitude �•�° �•� Longitude �• �� ��°
- Design Current''`" Design Current Design Current,
Swine Capacity Population Poultry: `Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish t-{a w: [] Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts,
❑ Boars >. ::_Tot-I.SSLW
Dischat es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [> NO
❑ Yes [ffNo
❑ Yes 0 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard(inches): ......... �................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ;XNo
seepage, etc.)
3/23/99 Continued on back

FaZility Number: e3�() I 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 0 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ["No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes '0:4No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
15No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
PTNo
12_ Crop type-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
CR No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
;N� 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
OiNNo
16.
Is there a lack of adequate waste application equipment?
Yes
❑ 'No
Re uired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
.MNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[, No
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
allo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
O No
21-
Did the facility fail to have a actively certified operator in charge?
❑ Yes
MNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [YNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 9No
24. Does facility require a follow-up visit by same agency? ❑ Yes VNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes CK No
0: � d violaiigns:oT ileficiehcies were ngted• 066h,this:visit: , You ' * ill •i•eeeive ii, tui-ther
�corres�ondence. about. this .visit_ '
Comments (refer;tti.quesfon #) Explain any YES answers and/or aitiy recommend'atrons of any offer comments
,.
Use drawings of facilE tn;better explain situations •(use additional pages as necessary)
,.,._.. _
67,
rr rr r 4.il
(r�e
4,.
1 ►`� ��-► �t� ,fie `lam ���Gi i-6 t + r�
3/23/99

Facility Number: — g 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 Ayes ❑ No
liquid level of lagoon or storage pond with no agitation?
2T Are there any dead animals not disposed of properly within 24 hours? ❑ Yes I�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes X'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 U�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 g No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
ikon - Comments an /or, rawmgs:.
3/23/99

HR
�q �❑ Division of Soil and Water Conservation ❑ Other Agency
K.P,. Us,
® Division of Water Quality
10 Routine 0 Complaint O Follow-un of DAVO inspection O Follow-up of DSWC review 0 Other
Facility Number 31
13 Registered ;" Certified 13 Applied for Permit [3 Permitted
Farm Name:.......... 4.vih.... ri.c.t....... ..�-....................
Owner Name
Date of Inspection
Time of Inspection .:' 24 hr. (hh:rnm)
Q Not O eratinnal Date Last Operated:
County: '�....
Phone No:..�al...12���:....�tre.i?.......................................
Facility Contact: ....... ..ill;.Pr............................ ...... Title: ...... Lluw............................................ Phone No: ..�g14.�..�7..�.'..�,t!ZQ.......
Mailing Address: ..�',,,.,..,
g!?......clf%I.....,.t��.c......:..................................................bwr.....n....N.c...............................
Onsite Representative:.. Nw. 3...T.r,.1.Le ltift9ns,
..................... g
ra _..:.. Inte tor:...... .Y.I'J...................................................
r - GG //
Certified Operator;:, tw-.f' ....�........................... . �&1..... ...................................... Operator Certification Number:,(X.5. ......................
Location of Farm:
Latitude Longitude
Longitude•
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes [V 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?
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 lagoons/holding ponds) require
mai ntenanceli mprovement?
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?
7/25197
❑ Yes ® No
❑ Yes
[T No
❑ Yes
Od No
❑ Yes
(d No
❑ Yes (A No
❑ Yes CQ No
❑ Yes No
❑ Yes No
Continued opt back

Facility Number: 3 —0
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures fLaQoons,Ilolding Ponds,, Flush Pits, etc.1
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes] No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (ft): ............L5...............
10.
Is seepage observed from any of the structures?
❑ Yes
P No
11.
Is erosion, or any other threats to the integrity of any of the structures observed.)
❑ Yes
® No
12.
Do any of the structures need maintenance/improvement?
2 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
IM No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)1
15.
Crop type _A_Orn..........S_D.JAb.LG �. .............. t rn ............ e-t r�u.t7L .................... ..... Y y.n........:.............
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
KYes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
WrNo
18.
Does the receiving crop need improvement?
MYes
&No
19.
Is there a lack of available waste application equipment?
❑ Yes
9,No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
CR No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
5ZYes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes 64 No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes H No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ❑ No
No.violationsor defiiciencies.were noted during this,visit.- .You'will receive no further
cotrrespbndence about this'. visit.
Use dt a"rigs of facility to`better explatnsttt>iations (use additional pages as necessary) 4 , R . ' S
yy
IZ..,Floc��; n�
t t; . 5oyla ¢atn � � r, �; t ! t) � t,c � �r+o►�t � �vr Zv rr.. ,
I . vdtA Skt;U)�e irr+�rcir( rzn,
anal S; S Skov�d be V ijew. ricorj- r SWJ be d �y
Val fsvrw6t. r t 1�'-AVVr.W' i VyL'y+lkor\ t h&P :S)VW be- i j\ Lej1+1fle6 pl&kx, LLti-� or-
s6yl�ec�
7/25/97
Reviewer/Inspector. Name
Reviewer/Inspector Signature: %��,�r� • ,� Date: W 1$'' 12
,�l

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
David Price
David Price Farm
441 Scotts Store Rd
Mt. Olive NC 28365
SUBJECT: Operator In Charge Designation
Facility: David Price Farm
Facility ID#: 31-580
Duplin County
Dear Mr. Price:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner -of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form -must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31,1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919/733-0026.
Sincerely,
A. reston Howard, Jr., P.E., Director
Division of Water Quality
Enclosure
cc: Wilmington Regional Office
Water Quality Files
P.O. Box 27687. IK•y�
Raleigh, North Carolina 2761 1-7687 �� C An Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 50% recycled/10% post -consumer paper

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995 _
Time:--f-t-�u `J �
Farm Name/Owner:D1- 1:! 1'cle
Mailing Address:
County: - (j_ D\
Integrator: Phone:
On Site Representative: Phone:
Physical Address/Location: -1/wO r ` s4ff SR 132 6�rJX dA5 _
Type of Operation: Swine " Poultry . Cattle
Design Capacity: 7 2 J yf' h" h Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: '5 _' `" Longitude: 7 7 Elevation:' Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storin event
(approximately 1 Foot + 7 inches) <!M or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)?
Is adequate land available for spray? (9 or No
Crop(s) being utilized: 6
Yes or(oWas any erosion observed? Yes or&o
Is the cover crop adequate? Yes or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling . e or No
100 Feet from Wells? o ''
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or�
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or 9
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or& - If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage,with cover crop)? Yes or No
Additional Comments: _ � e C� i.�t 1 f z'."o �Ce c;rw� � ( /0 `��
Inspector Name
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.