310650_INSPECTIONS_20171231

NUH I H CAHULINA
Department of Environmental Qual

i Z G_�_D
Type of Visit: O-Compli nspection V Operation Review (.)Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral p Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Region:
Facility Contact: / Title: Phone:
Onsite Representative: �r Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
W an to Finish
can to Feeder
Design Current
Capacity Pop.
It 53;_4
Wet Poultry
fa er
Non -La er
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Design
i
Current
P,o
DIX Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[-]Yes
. /No ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
[—]No ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
[] NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
NA
rNo[:]
❑ 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 1 of 3 21412015 Continued

Facility Nurnber: jDate of Inspection: 7
Wasti Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O_Ko I❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): V
Structure 2 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.)
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Ejl' o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, 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? 0 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 r �No[_NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2rNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes�No
No NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ YesgNo
N NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No [] NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I ° Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Nutnber: - Date of Inspection: 3 /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [2-❑ 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 ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No B5A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No ❑ NA ❑ NE
[:]Yes D-N`oo NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ego ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
<No❑ NA ❑ NE
No NA ❑ NE
No ❑ NA ❑ NE
Cammentsd(refeir to question`#) Ex�pEtain any. YES answers "and/or any' add itional; reeommenda ions or`auy other com`in nts.
Use drawings of f$ l tyto' better ezplatn situations (use additional piges�as necessary)`
Reviewer/Inspector Name:0!t/t 4' 9 r '�t/� Q [j Phone: f'') 7Tb 213�- v
Reviewer/Inspector Signature: Date: O 3 LI-2.3
Page 3 of 3 21412015

(Type of Visit: Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: f Arrival Time: (J'LO I Departure Time: County: ,�Lr� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number: 1
Certification Number:
Latitude: Longitude:
Swine
Design : Current
C►apacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
C►attle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
b
on -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Drr P,oult .
Layers
Design
C•_a aci
Current
P,o
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Otli-e—EA
Other
Pullets
I JBeef Brood Cow
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 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 dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes I
No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection: 2O
Waste Collection & Treatment
4. la storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E/No ❑ NA D NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L,;a
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 M No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Yo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ o
❑ 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
ZNo
❑ 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
b(N o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Vo
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfalt ❑ 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
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: - Date of Inspection: O 2 a
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C2�`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 E�f❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes No [] NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes dNo ❑ NA ❑ NI?
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 CJ 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 ZN�
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
CNE(-(4 Cgo)TrA , ?,rVoT FOR- SET Bf CK5.
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
Phone: / {6 -T3 �U
Date: 6
241201

Type of Visit: O'Compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: (2/Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1'a ( Arrival Time: Departure Time: U= County: r Region:
Farm Name:
Owner Email:
Owner Name: - Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Y LCL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
17 2,"
Design Current
Capacity Pop.Finish
Design C«urrent
La er
Dai Cow
Design Cnrrent
Feeder
Non -La er
Dai Calf
to Finish
Design Current
Dr, P,oul Ca aci P
La ers
Da' Heifer
Cow
Non-Da
Beef Stocker
to Wean
to Feeder
to Finish
L
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
11111111 Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ❑ ❑ NA ❑ NE
ElYes [/ ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: Date of Inspection
",r
Waste Collection & Treatment
4. Ikstorage 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 j 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 d No ❑ NA 0 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 E2fNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes if 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 ZNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes []No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes No
❑ NA
❑ NE
Required Records & Documents
Xo
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 YNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes k
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of inspection: I p I I(�
24. Did" the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. 19 the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes RNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA [] NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes FZ�No ❑ NA ❑ NE
Other Issues
2& 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes ENo ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes E7 No ❑ NA ❑ NE
❑ Yes Zo ❑ NA ❑ NE
❑Yes QN' ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or: any other comments.._,
Use drawings'of facility,to':better explain situathons""(use additional pages as'necessary):` .
Reviewer/Inspector Name:
Phone: (! / I h _ ! � 9
Reviewer/Inspector Signature:
Date: 10/ I
Page 3 of 3 1 21412015

Type of Visit: Q . pliance Inspection U Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: Co(Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: { Arrival Timer Departure Time: County: 11 0 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �1.I q�.) �l/i t Lam. Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 1'�7 �40 Q
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop. C►attle
La er DairyCow
Design
C*apacity
Current
Pap.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current D Cow
Diy P,oulte, Ca aci_ P,o Non -Dairy
I Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Beef Brood Cow
Other
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes ❑ No
❑ Yes o
❑ Yes �o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

[Facility Number: -
Date of Ins ection: 16 ;
Waste Collection & Treatment
Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
jNo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure,, II} Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA &6&J
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 environmFNo
1 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [:2/No❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ElYes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No. ❑ NA [3 NI
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil.
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
I5. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
640
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C K0
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
9,No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�ZNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
21412014 Continued

[Fasifity Number: - f3 Date of Inspection: 10 t
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ej'No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
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 LCJ No ❑ NA 0 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes U<O
❑ Yes 914/0
[—]Yes WN0
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
V
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
(Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facilitv to better exolain situations (use additional napes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone ITlw)� ! (;
Date: Cd
h k
214120 14

Type of Visit: 0 Co ptiance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ►� 1 /(s/1-� 1 Arrival Time: 04 -] Departure Time: CountyRegion:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: �JU All TMO hLn AA— ... Integrator:
Certified Operator: Certification Number: 1-7 Z(Pb
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Design CurrentNIE
Capacity Pop.
Wet Poultry
I 11-ayer I
I JNon-Layer I
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pap.
airy Cow
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , Ploult ,
Layers
Design
Ca aci
C►urrent
P,o .
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other I I
Other
Turkeys
Turkey Pouets
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)
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 ❑ ❑ NA ❑ NE
❑ Yes rNo
NA ❑ NE
Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: t _ 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 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 �}
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[_;� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[:jNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
dNo
❑ 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
<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[:fNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[2/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate 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
C /N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
a N
❑ 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
[3 i10
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
Required Records & Documents
19. Did facility fail have Certificate Coverage & Permit
Yes
NA
NE
the to the of readily available?
❑
[yNo
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
CA/No
❑ NA
❑ NE
the appropriate box.
❑ W1JP ❑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 I " 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 Q No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - v Date of Inspection: 7 `113
24. Did the facility fail to calibrate waste application equipment as required by the penri . ❑ Yes a ❑ NA ❑ NE
25. Cs 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 VNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concem?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 1Vo
❑ Yes "[-j No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes / No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
[� ❑ NA ONE
No ❑ NA ❑ NE
(Comments (refer to question #): 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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phon�: /p 6
Date: 11
21412011

(Type of Visit: (25 ruoutine
pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Il Z Arrival Time: 9y S I Departure Time: I d 50 County: J UI?La;AJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: J0112P A) Mzu'm integrator:
Certified Operator:
Bach -up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 1-7-4 0
Certification Number:
Longitude:
Design Current
Swine Capacity Pop. Wet Poultry
Wean to Finish Layer
DesiON gn Current
-•opacity Pop.
Design
Cattle Capacity
Dairy Cow
C►urgent
Pop.
X
Wean to Feeder
ii —$'p
pUp�
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dr, P.oult .
Design Current
Ga aci P,o
Dry Cow
Non -Da'
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
I
Turkeys
Turkey Poults
10ther
0
Discharges and Stream Impacts
Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes go ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [ No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: 3 - &50 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?
Structur 1
Identifier: LA(0
Spillway?:
Designed Freeboard (in):
Structure 2 Structure 3 Structure 4
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Observed Freeboard (in): Lly
41
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Vj No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environment I threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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
Z
❑ NA
❑ NE
maintenance or improvement?
YNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[3 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 ❑ 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
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�yNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
1260
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ 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 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

rFaciUty Number: -
Date of Inspection: I 1--
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. It the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
No ❑ NA ❑ NE
No ❑ NA ❑ NE
❑ 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 ❑ 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 ❑ Y c s 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes C No ❑ NA ❑ NE
❑ Yes [''No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes tNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any,other.comments:, ;..,, A
Use drawings of facility to better explain situations (use additional pages as necessary). r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: I1� -)3g
Date: + 1 12
21412011

(aS 6
TypUof Visit: (Z) Co pliance Inspection O Operation Review O Structure Evaluation p Technical Assistance
isit: R
Reason for Voutine O_Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: la Arrival Time:© Departure Time: /b County: pvptz�j Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Ud jA i4-rVAtJ fY _n _L L-& _ Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number: 17 'oo 0
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design C►urrent Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Dai Cow
Wean to Feeder
0
0 a er
L
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current D Cow
I)r, P.oultr. Ca acity P,o . Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other101
Turkeys
Turkey Poults
t0ther _ __ I Ell
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 EQ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: jDate of inspection: 16 2O
—41
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
' a. If yes, is waste level into the structural freeboard? [—]Yes ❑ No
Structure I
Identifier: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 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?
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes WNo ❑ 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 o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes �No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes VN�❑
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes io
❑ 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 �7No
❑ 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 U Co
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 6"No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: JDate of Inspection: 110 2.0 11
24. Did tqe facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dTN�
❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes WNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ 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 To ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 121<0 ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments Use drawings of facility to better.explain situations (use additional pages as_necessary).a
-i ! �j
Reviewer/Inspector Name: / t/ A e,4A Phone: (7
Reviewer/Inspector Signature: ale Date: C6 2a
Page 3 of 3 214,1201

Fact Iy' tuber
Division of Water Quality .
Q Division of Soil and Water Conservation
>
Q Other. -Agency
�� �'
Type of Visit 6 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l o L D Arrival Time: /0 3 a Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
�,_%IJRT iA/J MZI AL
Phone:
Title: Phone No:
Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =1 a =1 ' = Longitude: 0 ° = g 0
is
Design Current Design Current m� Design� Current
y Swine Cap city Population Wet Poultry Capacity Population Cattle C pactyPopulation,_
❑ Wean to Finish
&.Wean to Feeder
I I I Sta
9 2 �
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
JU Non -Layer I I 1
" :.
Dry,Poultry
Non -
Other F
Turke Poults
❑ Other. Other
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
"NumberYi
Discharees & Stream Ininacts
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 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
El NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes E No. ❑ NA ❑ NE
Page 1 of 3
12128104 Continued

Facility Number: 11 =0
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Z No ❑ NA ❑ NE
a, If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: t A 6r VrJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 37
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IiNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
Yes
ElL/
,�(
I No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
jNo ❑ NA ❑ NE
8. 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)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
[?(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
ElYes
Ef No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
U�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
[A No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ENo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
/ o ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
X10❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments (refer to questions#). Explain any YES'answers and/or any`recommendations or any otl er,comments
Use•drawings of,facility to.better explain sit uations.�(use.addittonal pages as necessary):
.. �.,
Reviewer/Inspector Name Jbfl,i�%� „vr` Phone: 91e) 7 1 --73!
Reviewer/Inspector Signature: Date: 6AD
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection o
freguired 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 E No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps ❑ ether
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [a No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Z"No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ck�o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3"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
[ZNo
❑ 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
MN-
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
"No
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Eff
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Lj No
❑ NA
❑ NE
Additional Comments and/or Drawings: y
3
Page 3 of 3 12128104

Division of Water QualLillity
Facility Number :3 1 in (i 1911t,
Division of Soil and Water Conservation
i. Other Agency
F
pe of Visit Co liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
eason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: q U o Arrival Time: Departure Time: County: uet=&) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: (��` ,,�� Title:
Onsite Representative: 4ja►s S- 4-I F1#1 IAM I k L
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: c = ` �" Longitude: = ° = ` = "
Swine
Design
Capacity
C*urrent
Population
Design Current Design
Wet Poultry Capacity Population Cattle Capacity
Current
Population
❑ Wean to Finish
❑ La er
❑ Daia Cow
® Wean to Feeder
y50
❑Non -La er
t ❑ Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Layers
❑ Non -Layers
❑ Beef Stocker
❑Beef Feeder
El Farrow to Finish
❑ Gilts
❑ Pullets
❑ Boars
❑ Beef Brood Co
❑ Turkeys
❑ Turkey Poults
❑ Other
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?
Page I of 3
❑ Yes L -No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
FINE
❑ Yes
❑ No
❑ Yes l_�'/No ❑ NA [I NE
ElO Yes No ❑ NA ❑ NE
12128104 Continued

acility Number:,3Date of Inspection Il
lWaste Collection & Treatment
. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: lA Cx6-4-)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 9
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
,�%
O 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
c4o ❑ 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
P�o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
L 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
,,��,,//
UNo ❑ 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?
I l . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or i 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[]'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Cj'<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ NA
[I NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�[���//fo
YIN,
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
LJ No
❑ NA
❑ NE
Reviewer/Inspector Name - Phone: `� rD "73 P
Reviewer/Inspector Signature: Date: I it o
Page 2 of 3 12128104 Continued

Facility Number: —p Date of Inspection 1d
�Reguired Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists
❑ Design El 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 V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L�(No
❑ NA
❑ NE
• 23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[R No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�&
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�(No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
C�Ko
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes
L__NO
❑ NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LyN )
❑ 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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,,�
U 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
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Zo
❑ NA
❑ NE
12128104

Type of Visit VCo lance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: a Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Cj")We.r kA.'j Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: a o = 4 =46 Longitude: = ° = , = «
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
C+attle Capacity Population
❑ an to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
�a
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
El Stocker
❑ Gilts
❑Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
-
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
dNo
❑ 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)?
71
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Cl Yes
❑ No
❑ NA
❑ NE
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
R
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Faaility Number: 31 — 5 d Date of Inspection d
*ste Collection & Treatment
4' Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PfNo ❑ NA ❑ NE
(ief large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 40 ❑ 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 thr t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes T - ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ONo, ❑ 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 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
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
❑ NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ NA ❑ NE
�r//
17. Does the facility lack adequate acreage for land application? ❑ Yes
l o ElNA ❑ NE
18. Is there a lack of properly operating waste application equipment? El Yes
No ❑ NA ❑ NE
. i ..
Comritents�(reteto,quesha�nR#) xplatna nyYESkanswersattd/or any rec_o'mtneindations or any other comments.
�., �'
Use drawings of facthty tto better tu explatn siations (nse'addtttonai�pages as necessary)
-�.a�.ert£. -
Reviewer/Inspector Name) �(,(� Phone: 0
Reviewer/Inspector Signature: Date: 9 d
Pape 2 of 3 12128104 C tdnued

FAcility Number: 5— Date of Inspection 0
!jkguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes "fJ N ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes
No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes - N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
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?
❑ Yes
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
O N
❑ NA
❑ NE
El Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
❑ Yes
E>cr ❑ NA
❑ NE
❑ Yes
ONo ❑ NA
❑ NE
❑ Yes
ONo ❑ NA
❑ NE
❑ Yes
NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
Additional Comments and/or Drawings:,
Page 3 of 3 12128104

Division of Water Quality
Facility Number 31 (dSv 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
pliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
7Routine0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 1i{ p7 Arrival Time: g YS� Departure Time: County: DLPt-130 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: GCE OUTLAO
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
Other
❑ Other
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: o Longitude: =
Design Current Design Current
Capacity Population - Wet Poultry Capacity Population
❑ Layer
ss a I -rn'o 10 Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
r ,r
Design Current'.
Cattle Capacity Population;
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
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 VNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[?(]No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
12128104 Continued

i
1
Facility Number: 3 (-6g& Date of Inspection 9 dY o
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural Freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: #A&Srx)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes (" No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property 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 L' I 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 E No ❑ NA ❑ NE
maintenance or improvement?
Waste ApDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes O 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 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[IYes E(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes NN
El NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes Zo
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Zo1 01PA01Z kA* F6a 04616-E
a.c r /<(_ P of 0 E av_ kti f1
7 Au +-Al" ,.
14 co�wj'
L
er/Inspector Name G Phone: /d
er/Inspector
Signature: Date: 2 SP O
ti/LW VY l.UreN/EME

1'
Facility Number: Date of Inspection 9 u
Required Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes D'No []NA ❑ NE
20. Does the facility fail to have all om� ❑ ponents of the CAWMP readily available? If yes, check [�No ❑ NA ❑ NE
the appropirate box. .p ❑ Checklists ❑ Design El Maps El Other /
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes D o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
EJ�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Eg o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E3No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the pen -nit?
❑ Yes
D No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
Eql es
❑ No
[I NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
❑ No
,❑:/NA
E NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,��,//
EG No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L7 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
ElC1 Yes
o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[I Yes
,�
L1'No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

r Division of Water Quality
'acility Number 0 Division of Soil and Water Conservation
r' -0 Other Agency
Type of Visit <5 Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit 16
Routine O Complaint O Follow up O Re€erral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: _ J_9_04ZAi Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: (IC -Alf- 04lrL09!.,/ _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude: n c
Pbone No:
Operator Certification Number:
il
Back-up Certification Number:
Longitude: = °
Desin g .CurrentDesign"Curreni.° D-.�!CurrentK
Swine Capacity Population Wet Poultry Capacity_ Population `:. 'Cattle Capacity Populatron
❑ Wean to Finish
Wean to Feeder
5`d
d f3
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
;r
Other
❑ Layer ❑ Dairy Cow
❑ Non -Layer ❑ Dairy Calf
1 ❑ Dairy Heifer
-Dry Poultry El Dry Cow
❑ Non-Dairy
❑ La ers
El -Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
ILI Beef Feeder I I IK'-I
LJ Beef Brood Co
E ' r7,ZZa: a,
Number of Structures
Discharges & Stream Impacts
i . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes UNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
2�o
El NA
❑NE
❑ Yes
7No
❑ NA
❑ NE
12128104 Continued

Faciliy Number: - j / —
Date of Inspection I_IrPJ/Y/a(e_I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EXNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I 6 VVA
Spillway?: L
Designed Freeboard (in):
Observed Freeboard (in): C/ s ,.,�
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes 2,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 EtNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L! 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 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? Z
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L"J No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) W S``/� /3 co' SG ()
13. Soil type(s) X1"rr..ro L /C
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
JZNo
❑ NA
❑ NE
�No❑
NA
❑ NE
QNo
❑ NA
❑ NE
�o
[I NA
El NE
]'No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or°any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
aa'u wr Zc-occ -a/GVo sNAPF
fJo c'y v� ftuoGE )9#A'�c
Reviewertinspector Name F Phone: /n/ !
Reviewer/Inspector Signature: Date: 16
444
Pnoo 7 of 3 72/2RIOd rantinued

Facility Number: — $'� Date of Inspection /
'Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes I(J c ❑ NA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O/No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
[IN E
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ld NNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,E3
LNo
ElNA
❑ NE
'No
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
E'
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
VNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B 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
EKo
❑ 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
D- o
❑ 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?
El Yes
�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
T
Page 3 of 3 12128104

IF
Type of Visit qfcompiiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Z Arrival Time: eparture Time: ; S Count},: Region: �P
Farm Name: Owner Email:
Owner Name: G` Phone:
Mailing Address:
Physical Address:
Facility. Contact: )Title: Phone No:
Onsite Representative: � .>^�� ��ITLI�}GL! Integrator: � %t 5;w /x*r4II
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= u [= 6 = « Longitude: = ° 0 I& 0 tl
Design
Swlne Capacity
- k , r,
Current Design Current Design Current
,P,apulatron. ... -Wet ry Ca aci Po ai►on Ca F'
Poult ul
max, -gip P,,� the �Cap.�ty Populahan
❑ Wean to Finish
❑ La er =F
I❑
Dairy Cow
Wean to Feeder
O
❑Non -La er I
❑ Dairy Calf
eeder to Finish
Dry Poultry
❑ Dairy Heifer
Farrow to Wean
El D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Layers
El Farrow to Finish
❑ Beef Stocker
❑ Non -Layers
❑ Gilts
❑ Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
�9 I
I'
Number of Structures:
❑ Turkey Poults
❑ Other
Y -
Discharaes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
jNo
❑ 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
❑JNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ONo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
0 No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number:3 — Q
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes yrNo
❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 9
Spillway?: lilt,
Designed Freeboard (in):
Observed Freeboard (in):
❑ NA ❑ NE
[I NA ❑NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VrNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ONo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require [] Yes YNo ❑ 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 VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area w .
12. Crop type(s)
60, (D,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
determination: ❑ Yes PNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ff No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;No
❑ NA
❑ NE
Comments (referto questtont#) Explamaany YESianswersand/or,any recommendatiogs or say other comments.
Use drawingssc>sty>to►better�expiamsttuabons_{use}{a�drLtional�pages as necessary):
6 6f Gl%Zy�� LC/'fO�%%s
Z�� S�/Lf O �ff� �TOCf Li✓� /4nl,O ULD1� IV;_1fe� ACp20s,
C'Y- 6q M lortol
Reviewer/Inspector Name .. ,
7� Phone: `T
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: N —Zoo Date of Inspection O�
Reduired 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 A 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. A Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall 9stocking Z Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
;dNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
to No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
toNo
VrNo
❑ 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
VfNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes YINo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report the mortality rates that were higher than normal? /
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately /
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes XNo ❑ 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 XN o ❑ NA ❑ NE
12128104

M.
Type of Visit '10 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit XRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility NumberE3TD_C=
Date of Visit: r by Time:
Q Not Operational Q Below Threshold
eriniti Certified © Conditionally Certified 13 Registered Date Last Operated or Above reshold: ........ .. _.
FarmName: .....W..._ ... D GI W,.i.... .� 5................ ............. ................ County:............ f!r. ............. ...... .._.._-------
OwnerName: ................................... Phone No: ......................................................... ...... _. .
MailingAddress:............................................••----•-............... .................... ....
_ _ �.�.__�...... _.. ..... ._ .. .
Facility Contact: .. Title :.............._. ............. ... .......... Phone No:
............................................................................ .....................
Onsite Representative: ......
.f fM- .._........................... ...... Integrato'....._.-VU. �.4:�1�1�.............-- �—
Certified Operator: ----• ...................._..........••---••--- . ..................................................... Operator Certification Number:.-----.-....--...................� .
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 94 Longitude • 4 66
to Feeder
Oo
;can
eeder to Finish
11
Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes B<O
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes B No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes io
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier: _. '........................................ ...... ............... —.... -�..... _.
Freeboard (inches):
12112103 Continued

Facility Number: — Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes [d"No
seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a waste management or ❑yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ZN
7NO
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? [:IYes Z
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes IMA
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 64 SGd
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Nq�
14. a) Does the facility lack adequate acreage for land application? [I Yes —�iV/
b) Does the facility need a wettable acre determination? El YesFNqq/
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes 2No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Ng�
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes �/N/o
Air Quality representative immediately.
:Comments (re%r to quesiron #) Explain any Yt.S answers and/or aoy z ecammendatioas or anyfot_ er comiients. = z
'Use drawrngsof faicilty to better explain �afjons {u a ad�tional pages as necessary) ❑ Field CaPY ❑ Fxnal Notes r
,,jot G,os5 GJdI iJ�R�K- 6� IJAt.(_.
rjrrslE r "tlon wr dd 4)664-5 vJ &-RW49A coAjiJ' VcA To CwTjQ&, ,
11) C C qmw•r IAC-16 Tv I',: "Xr/r
Arm
g6i J
rAl 02DE0
ReviewerlInspector Name 1`" A' fit �`r=
�_..
�f _ .$r
am.�,,� __._ n�� �:�
Reviewer/Inspector Signature: Date: G
12112103 1 Continued

Facility Number:
Date of Inspection
Required Records & Document.~
21. Fail to have Certificate of Coverage &. General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
Yes ❑ No
❑ Yes ZNj
❑ Yes o
❑ Yes IVNfl❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes o
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Type of Visit $0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit o Routine O Complaint O FOlaow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
[Permitted 0 Certified D Conditionally Certified D Registered
Farm Name: 6ZWI-e-12�2
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
Time:
Date Last Operated o bove Threshold:
County: �L elv
Phone No:
No:
Integrator:
Operator Certification Number:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 IJ { C� a Longitude ' G u
Feeder to Finish &Oth,,
ayer
Farrow to Wean �,:4 _ }: ;:�.- .
Farrow to Feeder
Farrow to Finish Tntnl i?Pc:an lCan
Boars
Subsurface Drains Present
No Liquid W.
Discharges &c Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Laizoon ❑ 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?
Area III Spray Field Area I
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 30
05103101
❑ Yes ❑ No
❑ Yes ;;�No
❑ Yes XNo
❑ Yes X
No
Structure b
Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
[�(No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
dNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
ElYes
VNO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid levelXNo
elevation markings?
ElYes
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
0No
11. Is there evidence of over applicatiroe. Excessive Ponding ❑ N ❑ 1Hy lic Overlo
dwv
//P Yes
]No
12. Crop type /�il/1� �/V ILL SL',EU
(�/l r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (AWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
N0
b) Does the facility need a wettable acre determination?
❑ Yes`
o
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
XfYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
)dNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
o
7-",
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?(ie/
WUP, checklists, design, maps, etc.)
ElYes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
V No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
El Yes
91
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
ElYes
7No
113 No violations or deficiencies were noted during this visit. You wilt receive no further correspondence about this visit.
Commentsr(refer'to:question i } .::Explain any YES answers aad/oi-any r commendations'!or a y of ei comments: '
., - -
Usedrawings of facihty to -better -`explain situations. (use:additional pages as necessary) Field Covv El FinalNotes ;
0
FE60S
�% O L i " ,CFO
ukED 00Aj-
&"�"nq zz s r7
w
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: ✓� OZ
05103101 Continued

y \L
Facility Number: — Date of Inspection
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes 7NO
o
❑ Yes
❑ Yes 1E No
❑ Yes ;d� o
❑ Yes No
❑ Yes ❑ No
Additioua_I Com0eota anM)e:Drawmgs4` '
-
D
05103101

of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
!Reason for Visit) Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
L_�Faci�lityNuw�ber 31 ti50 Hate of Visit: Time: 100D Printed on: 11/612001
Not O erational Below Threshold
Permitted IN Certified E3 Conditionally Certified E3 Registered Date Last Operated or Above Threshold:
Farm Name: Quflaw.Fa]Cw....................................................................... County: D-UPI l--•--.-......_._..--•--.._.._.._.._. 7MQ--•---
OwnerName: .fie--------•----------- Q1tti------------•-------------- Phone No:(4�9.CZS$�IR4------•---------------------
Mailing Address: 554.Scolt7x51or.c.Iiaad...................................................................... Mt..Oli AAC........................................................ 283b5..............
FacilityContact: ................................................. .......... Title: ............................................... Phone No:......................................
OnsiteRepresentative:Integrator: P-mmimm.StandarAFArmsAiNorttt_.
Certified Operator: GMC.Q.................................. .Qud aw ... Operator Certification Number: a,7,Z6 J.
Location of Farm:
Southwest of Herrings Crossroads. On Southeast side of SR 1521 approx. 0.5 mile West of SR 1306.
®Swine []Poultry ❑ Cattle []Horse Latitude E 35 • 06 - `44� i� Longitude — 77 . • F53 00
Desegn... =s Current ....::.:::.:.. ........ g .......
..:.::
... Desi n Curren#..:........ .
etlation.......Poult... Ca.acit _. Po ulatLon `'.`Cable
.............:.
❑ Wean to Feeder
3950
❑ Feeder to Finish
1350
❑ Farrow to Wean
❑ Farrow to Feeder
® Farrow to Finish
250
❑ Gilts
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other I-
'.. T6M D6ikh.:C crty.. r—
:: :_:Total: SS.LW
250
354,250
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes ' ®No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
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?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
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):............31._........_...._........_.....- - .... ._. - - - - ...... _....... _ _ ...
n tin ain r ............... �,.,.�:......a

VJ/ VJi V;
Facility Number: 31-650 1 Date of Inspection 11-b-2001
Printed on: 11/62001
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 maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed Corn, Soybeans, Wheat
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes N No
b) Does the facility need a wettable acre determination? N Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reuuired 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/ WllP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
@[] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
❑ Field Copy ❑ Final Notes
due to age of operation, the sludge level in the lagoon should be measured for possible reduction if needed.
4. Facility was pended for Wetted Acres, but missed deadline. Now full Determination needed. Have completed ASAP. If
elds across the State Road are needed, then permanent pipe will need to be installed.
9. Need to document any nitrogen applied to row crops other than from lagoon liquid and deduct from PAN. Consult with
firmer tending the land for info regarding this.
Cont. on Page 3
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

05103101
Vacility Number: 31--650
Date of Inspection 1 11-6-2001
Continued
Printed on: 11/812001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
Farm was retrofitted in 2000 from Independent sow operation to contract grower for Premium Standard. Has 3950
ry and 1350 finishing animals. I talked with District office and they submitted info about this to Raleigh twice.
cted them to send me 3 copies of the complete package including new Wetted Acres WUP to me and.I will send to
Permitting.

0
= Ihvrsion of Water.Q'rah
•fy
%Drvisaon o#Soil and Walei Conservation Y ,
iLe `u 3
W v
k x
�- rAgencyr�
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: 1 Time: OGU Printed (oil: 7/21/2000
EFacility Number
FO Not Operational Q Below Threshold
[] Permitted ❑ Certified ❑ Conditionally Certified [3 Registered Date bast Operated or Above Threshold: .............
Farm Name: ��Q. � w Count: �A'--'.' .................................
OwnerName:................................................................................. Phone No: .......................................................................................
FacilityContact: ...............—Title:.....................................................-.......... Phone N'o....................................................
MailingAddress:....................................................... I.......... ............ ...................... ..............---.-................. .... ...
Onsite Representative: ....... ................ ............
---1-..1... ......... Integrator:
Certified Operator: ................................................... ..... .................. . ....... ........................... Operator Certification Number: ...................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� 0°° Longitude h� • �� ���
Design Curreint Design Current Design Current
S ep -'Ca Po nllation Poultry Ca aci Po ulatiorr CattleCappiaty, P66utation
Wean to Feeder SC) ❑ Layer ❑ Dairy
Feeder to Finish p ❑Non -Layer L
1 10Non-Dairy
Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish Total Design Capacity
Gilts
Boars Total'SSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes )<No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min`?
d. Dees discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any pan of the operation? ❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes (,N(No
Structure 6
Identifier: ........................................... .............
Freeboard (inches): 3`
5100
Continued on back

2scility, Nymber:�` — Q Date of inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
�No
seepage, etc-)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
A 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
KNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
)dNo
12. Crop type b� t� e asv
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
_
XNo
14- a) Does the facility lack adequate acreage for land application?
❑ Yes
KNo
b) Does the facility need a wettable acre determination?
XYes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
Wo
16. Is there a lack of adequate waste application equipment?
[I Yes
Wo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Cl Yes
D<No
(ie/ WUP, checklists, design, maps, etc_)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Jet No
20_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Mo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
C&No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 9No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes UNo
24. Does facility require a follow-up visit by same agency? ❑ Yes XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? N�Yes ❑ No
�:viQiatigris oT di f cietni es *(ere noted- during this'visit'. - Yoir will f&d*6 no fuirther - : -
comes oindeii& about: this visit_ -' - ' - '
YFS answers and/or' -any recommendatie
w�o�s wee
P qst 4 .
Reviewer/Inspector Name ►.�, 4.:, <:pi
Reviewer/Inspector Signature: Date: — —Q 5100

a I Facility Number V Date of Inspection 11 110 jV(
�rT
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below Ky
es ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes )�No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes .*No
❑ Yes XNO
Additional omments and/or Drawings:
AL
cue ��y:c a►�- _ spy
h Qv�r— v�CL;?5—�� sue— ►-'e— � ,
S ('

}' Division of Water uahty .
Q
,-
O ivision of Sorl an&Water Consetrvatiori
0 Other Agency 0
Type of Visit V16ompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit (Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3/ 6So Datc of Visit: /a Zi 20'VTime: Z : /.S Printed on: 7/21/2000
Not O erational O Below Threshold
14 Permitted JoCertified 13 Conditionally Certified [:]Registered Date Last Operated or Above Threshold. .........................
Farm Name: Q{! jZ�W ��4�eNS I ...... County:.... D.v.PU
Owner Name: (;&Ia 00TeR A.) 97B
................................................................................................................. Phone No: J 9 6�8 -
FacilityContact: ........ SR...'td...................................................Title:................................................................ Phone No:..........:........................................
Mailing Address:...- ?l.,'�.5....�S OR£ - /ep .... T O` ivE/ M G p365
.......................... ...... .............................. .......................
OnsiteRepresentative: ........ r%�.�.....evT'Aw.............................................. Integrator: .... DD�S't.t�oeD ��9•� 5
Certified Operator: ....6LN�.......VTLIt .
p .Q .............. ....................................... Operator Certification Numher:,.........72. 60...........
Location of Farm:
C
Wesr of 5Q 13o6
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude & ° °& Longitude ' 4 C cc
Design Current
Swine Capacity Ponulation
KI Wean to Feeder
9-570
3 5-0
Feeder to Finish
1350
1350
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I ❑ Dairy
❑ Non -Layer I I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons Subsurface Drains Present I ❑ Lagoon Area pray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste 'Management System .
Discharges & Stream impacts
I. Is any discharge observed from any part of the operation?
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 & 'rreatnient
4. Is storage capacity (freeboard Pius storm storage) less than adequate? ❑ Spillway
StructLirc I Structure 2 Structure Structure 4 Structure 5
Identifier: !.........................................................................................................
Freeboard (inches):
5100
❑ Yes b(No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes OkNo
❑ Yes *0
[]Yes kNo
Structure 6
Continued on back

Facility Number: Date of Inspection IO 2 Gp Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Vi No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes J�rNo
(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? J'Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes bPo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes )�TNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Pondinhg ❑ PAN ❑ Hydraulic Overload ❑ Yes AkNo
12. Crop type C, 5 B, WF} a- CAWaSrt.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: �1+ViWhtipris:or defeiencies •were nirtea• iiuring this'visit'. - Y:oi� will-i•&d-061 rurther :
Torre ondetzce about this .visit... :::::::: : ::::::::: :
❑ Yes ❑ No
❑ Yes JgNo
❑ Yes *No
❑ Yes kN*
❑ Yes X No
❑ Yes kNo
❑ Yes JXNo
❑ Yes r,
o
❑ Yes kIo
[—]Yes .�No
R'SCes ❑ No
B45;cew
Comments (refer to question #)- Explain any YES answers and/or any recommendations or any other_ comments:
Use drawings of facility to better explain situations. (use additional pages as necessary):
'�L�4tJ M U s T g E ►Hold r FaED TO f lc -AZ- 0 T7
PLC GN S ! 7V - J u s 7' D r D t G ar ! ru bf_C. 79 COO2,p 6C_7- T 7/?6 a 0AS024TT14
y.! o G Sots DS
LflG Ro�N Fq 5 iaCE cr �w rya �Fo ��9N4 B �2 u l�s 4..t c 6AJ� - M 4V 7e4P
3�4-SA4 , cp av-,+-� t ,sue •t-nv�
Reviewer/Inspector Name
Reviewer/Inspector Signature:
J,w
Date: 1,0124 &t7 s/oo

Facijity Number: 3 — Date of Imspection 10 Z.(r Printed ore: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge aYor below ❑ Yes WNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes > No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes *No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes VNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (Le. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes J 'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes VNo
32. Do the flush tanks lack a submerged fill pipe or a pefmanendtemporary cover? ❑ Yes J)(No
5100

\f
0 Division of Soil andsWater"Conseivation - Operatipn Review -
w
w 13 Division of Soil and Water." Conservation- Compliance Inspection ,.
Division of Water Quality - Cou�plianee Inspection -�
-
_� Other Agency Operation -Review - -
='
10,Routine Q Complaint Q Follow-up of DW_ Q inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection �I, —
'ime of Inspection ® 24 hr. (hh:mm)
)
),Permitted [3 CCeer"ttiified, 0 Conditionally Certified Q Registered JE3 Not O erational Date Last Operated:
Farm Name:�`^!�..�'~4-e..t.. County:......p .11..1�, �.....................................:....
Owner Name ....................... Phone No:
FacilityContact:.............................................................................. Title:.................................-.....--••---•--.......... Phone No: •..................................................
MailingAddress: .......................................................... ......................................................... I ........ ...................................................................... I...... ............... I..........
Onsite Representative:.. �!- Q...�t?- �..... Integrator:...... ............................
Certified Operator: ................................................... ............................................................. Operator Certification Number:.................. .................
Location of Farm:
i
........................................................... I .................. ..-...-............................................ -............... ........ ............................. ........ ...................-....... .................................
Latitude • 6 i Longitude • ' "
Design
Current 'Design Current.. Design Current _
Saline Capacity
Populaton , Ca on ateacity. Po ula6.Ca acity Pop'
❑ Wean to Feeder
❑ Layer = ❑ Dairy
❑ Feeder to Finish
„ ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
_ = -
❑ Farrow to Feeder
❑Other
Farrow to Finishd
Total Design Capacity
❑ Gilts,
Boars
T61tA[SSLW
jNumbeiof Lagoons.
❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holdtug-Ponds I Solid -Traps
E=- - - ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes gNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes jRrNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes t�'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 54 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, ❑ Yes WINO
seepage, etc.)
3/23/99 Continued on back

Facr ity Number: — jd Date of I11spection
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 maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidenep of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
FJ_ o vio�aiicjns:©� d.iffi. cie asps -were po(ea• OtWihd this:visit: • Yott will receive Rio further
correspondence: about: this visit. :.... :::: ::::::::::.::.. .
❑ Yes VNo
❑ Yes Wo
❑ Yes allo
❑ Yes gNo
❑ Yes t'No
[]Yes ["'No
❑ Yes NNo
❑ Yes 4No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes gNo
❑ Yes XNo
❑ Yes kNo
❑ Yes ,M No
❑ Yes C3No
❑ Yes N(No
❑ Yes XNo
❑ Yes 'M No
❑ Yes No
❑ Yes No
❑ Yes % No
Comments (refer-to:questi"4): F.�cplain;ariy -YES answers and/or an yreeoinmendatrons or any other comments.
Use',drawings of facility to better explarnrsituatrotis (use additional-pagesas neeessary) �
- z.�
AL
sr+_
Reviewer/Inspector Name c
Reviewer/Inspector Signature: Date:
3/23/99

�f EFacility Number: 1zDate of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes b(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ((No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes KNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 4No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes PNO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes )`No
[��dditional Comments and/or rawings - _
ALI
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
13 Division of Water Quality
+sutine O Complaint O Follow-ue of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection © 24 hr. (hh:mm}
[Q Registered Certified Applied for Permit E3 Permitted [] Not Operational Date Last Operated:
d
Farm Name: ...... 5--.,...... Count,�t'1�j_............................. ...................
*--�
�...... ( c
Owner Name: .......... i"....... �.................................................... Phone No: 1..^ R��....1............-----.----
Facility Contact: .......................................... Title: ................................................................ Phone No:
�j �Q j� j�, \fir
Mailing Address:..... ....... L ."F..,1 fu' .1.`.................!...........�..........�.................`............ 5....
G 4i tr . 2.�
Onsite Re resentative:..................
p Integrator:..... ....1....................
Certified Operator: .................................................. ....................... ................ ............ ........... Operator Certification Number-,
I-ootip of farnN
....................... ..A .......... ... ...... .. ...... ^.... i! ...... ......
.ls .... jjr .............. ......... I.n.4.
Latitude 0 4 46 Longitude • 6 4g
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
O
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance improvement?
Yes
❑ No
2. Is any discharge observed from any part of the operation?
❑ Yes
XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
qNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (if yes, notify DWQ)
❑ Yes
�,,,,N""o
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
O //No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
( No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
C�No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
A No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
KNo
7/25/97

s Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes kNo
Structures (LagoonsAolding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes PfNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft): .........a:G ....................................................
10. Is seepage observed from any of the structures? ❑ Yes E�No
11. is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes JdNo
12. Do any of the structures need maintenance/improvement? ❑ Yes [�No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes No
Waste Application
14. Is there physical evidence of over application? ❑ Yes No
(If in excess of WMP, or runoff enterrinng- waters of the State, notify DWQ)
15. Crop type .......
.I!?..,`.(.......'.1......................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes KNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
CXNo
18.
Does the receiving crop need improvement?
❑ Yes
VNo
19.
Is there a lack of available waste application equipment?
❑ Yes
tqNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
ONO
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
P No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted_ Facilities Qn11•
ONO
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONO
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
P�No
0� No.vio'i tions-or. ddkieneies.werenoted-during this.visiL- You.�vi11 re �enti,ftirtliei~.
:. corresp�tideitce atiouE -this:visit:: ; :.:::: _ . ' ..: ; :::: ::.:...
5�
7/25/97

f.
�'�'y: � to '.;'�::_�'�,_ ;,"t.,d�„ �.,-:-..•, a:'+.7.,. his'" ,.. �_;,., -:.<;: qua,.... m.i�; .. � f�3 a � °°zv
YY 0 Division of Soil and Water Conservation ❑ Other Agency
'� LL ® Division of Water Quality
Routine O Com laint O Folks►►•-u of DWins ection O Follow-u of I}SWC review O Other
Date of Inspection it e
Facility Number
Time of Inspection '+gyp 24 hr. (hh:mm)
© Registered ;l�Ceyrjtified © Applied for Permit 13 Permitted Q ional Not O erat, Date Last Operated:
FarmName: ....... SOLO.........rwrM� ............................. ............. ......... County:.....)"114................................. .............................
Owner Name:.........6G> .............0...0.4 bt......................................................................... Phone No: C�41 �...�. � q7,1 ...............
Facility Contact: &v'k...... bu. t .. Title: OWtuY .... Phone No:.�.�!,1.g�
Mailing Address:......5.?..U..ball.
�.,�R ..... IGY't ...... �1......................................... ...... " r....�lvt�...(.1G.......11......L......................
b..........................
� laS........
Onsite Representative:........ll........�ttt1a.l��Attu .................. .......... ...... ... Integrator: �C at�n�l.Pa.�.... .............
Certified Operator ...... ��1 ....... ...............0.i!`3L.Lqtl Operator Certification Number;..4..421a-0.......
Location of Farm:
TU r.n... x.... ....a.�n.S.ifa...Urr.........ara.._R�..IL.I.....w nn....i.......P.............
Latitude Longitude`
General
I. Are there any buffers that need maintenance improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes UNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If.discharge is observed, was the conveyance man-made? ❑ Yes [P No
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ) ❑ Yes 1P No
c. If discharge is observed, what is the estimated flow in gaUmin? NJA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑yes ®No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes M No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 0 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ® Yes ❑ No
maintenance/improvement?
5. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes N No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes lj� No
7/25/97 '
- Continued on back

1 Facility Number: 31-
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (Lagoons,11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes (A No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft): ...........g.............. ........................ I...... ...................................................................................................................
.........
...........................
W.
Is seepage observed from any of the structures?
ElYes
RNo
11.
Is erosion, or any other threats to the integrity of,any of the structures observed?
❑ Yes
'0 No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered ves, 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
RNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
Q,No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type 'S4.1T_.............. �.Qr.h............ wkwk............... b eirrhu C& .................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
M Yes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
❑ Yes
MNo
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[ No
22-
Does record Keeping need improvement'?
®Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
®,No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
No.vioWions or. defciencies.wer'enoted during this.visit. You.will receive -no further;
correspondence about this'.visit:
Coiiiments [refer to question #i}: Explain any YES answers and/or any recommendations or any other comtnents
Use drawings of facility tobetter explain situations (use additional pages as:necessa�y) F
w r
113 M.
s R �Qr ar. a�nOvla b� bu► �� . a�u�id 11-graSse}}� wctCl``-uyJc°.�. -
IL. �iro5?oh Ct� ov1- 1r�V117' r�evL Walt S,.kO i� b� �(c Wt'N� G11( q,,,0 tKS�cOflU. E'oSTOM
ourb Lf Y uA G1 �Ut i r�0.G�iV 1 in f7 US G S npUt [� 6 e i iiJ ri. G �,y Cw.t) S2 p d ed. S Yee%
e.,�•� bru5j� s�.0vit} a iavrtOvea �'ron. icn n wr,(). Govt{ti. `� �i`ra LoOJW-1)"Oo' Co.
Car o.sS,c ,,ue . MarVkr f)4 ftsfj&c3 for auvracy. . VxcycU i.i,L s6A3 6e-
c-o v" . (o-�-1
lo. 5oybe��s �An[�
Z• So�j�ec,^ rn n� S�d� ba �iz
*4sG3 5koLAJ11 7/25/97
t inn rr� r•
, w_..
Reviewer/Inspector Name r
Reviewer/Inspector Signature: Date: 1

Site Requires Immediate Attention:
Facility No.3
DIVISION OF ENVIRONMENTAL MANAGE?4IENT
A,INTAAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: ^7 " O 1995
Time: Z = YS
Far, Name/Owner: 00TL A
Mailing Address: -S- /4( 5 c S a t .Q _ _ i -�2 Z-S,G,c_
County: (, "q
Inte?rator: Phone:
On Site Representative: G R • Phone:
Physical Address/Locadon: A rp nt; SQL j3d�
Type of Operation: Swine C/ Poultry Cattle
Design Capacity- ✓ Number of Animals on Site:
DEM Certification Number: ACE DEM Certincaron Number: ACNEW
Latitude: o ' S7_ " Longitude: —71 ' Sz ' 61 Elevation: FeP:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot _ 25 year 24 hour storm event
(auoroximately 1 Foot + 7 inches) Yes 00 Actual Freeboard: —LFt. _ Inches
Was any seepage observed from the laaoon(s)? Yes o t o 'as `_v erosion observed? do or No
Is adequate land available for spray? Ye or No Is the cover c:oo adequate? s r No
Crop(s) being udEzed: ('04/0 „,.4 c_ H -a c,
Does the facility mee. SCS minimum setback cr_teria? 200 Fee: =o n Dw Dwellings? gs? - r No
100 Feet :Torn Wells? �s No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Scream? Yes or of
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o
Is animal waste discharged into waters of the state by man-made ditch, flushing syste:n, or other
similar man-made devices? Yes or 1/ 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
Additional Comme:its: �r�?�'[xon' �e� �7�I��R !7 . j '►[��,
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PIC -
Insnzctor Name
cc: Facility Assess-m`nt Unit
ianature
_-- __ _____ � •-- _�•__t;s;-:�#tta.�i�n-sents if Needed.