310683_INSPECTIONS_20171231

NOHTH CAHOLINA
Department of Environmental Qual

Q Division of Water Resources
Facility Number - ® O Division of Soil and Water Conservation %
` O Other Agency
for Visit: ZRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1 3 11 Arrival Time: ® Departure Time: L•� County:
I Y-19
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: /I Title:
Onsite Representative: 1'c `r L G rr-` �y _ Integrator: f r
Certification Number: 9 1 rg
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region:
Phone:
Certifications Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
can to Feeder
Feeder to Finish I-z- zZTL
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -Layer
Pullets
Other
Poults
Design Current
Discharses 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 roan -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?
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 44e ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [] No
❑NA ONE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ro ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: Date of Inspection:
} X, 7
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ETNO ❑ 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): -L i Z ZS
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [21 . ❑ 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 L_I'No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes NA
❑ NE
8. Da 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 Vj No ❑ NA
❑ NE
maintenance or improvement?
Waste Aoollcation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E;I<o❑ 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 W ind 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 ffNci ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes NoNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
gt�o
❑Yes NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes D.No _❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No ❑ NA
❑ NE
the appropriate box
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? 117yes, 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 P' o ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes Io ❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: - (p fr
Date of Inspection: 7
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 es ❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
on -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 [a Now❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑] 'No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility`? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[-]Yes No ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP? ❑ 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
�o
❑ NA
❑ NE
'° ' -o
�
❑ NA
❑ NE
0-5o'—
❑ NA
❑ NE
09
Reviewerllnspector Signature: —�4Date: 3 3 r
Page 3 of 3 214,0015

F 'Facility Number I s� / - ® 0 Division of Soil and Water Conservation
`] �� v
0 Other Agency
type of Visit: U Comaii5nce Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: q� Departure Time: County: Region:
Farm Name: —i Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: / Title: Phone:
OnsiteRepresentative: Integrator:
Certified Operator: Certification Number: 1a p 'Z6 5 /
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
/ 1
Design Current Design .Current.
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
L f ��
Design Current
Wean to Finish
anto Feeder
eeder to Finish
Other
Other
Discharees and Stream Imuacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy.
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Io ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes ❑ No ❑ NA ❑ NE
[::]Yes D-1go ❑ NA ❑ NE
❑ Yes Eto- ❑ NA ❑ NE
21412015 Continued

Facili Number: ] Date of Inspection: a /
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
Identifies_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -j 9
5. Are there any immediate threats to the integrity of any of the structures observed?
[—]Yes []'g ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes 0 No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t reat notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes 0 No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [3--go ❑ 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 ffNo ❑ 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? L yes, check the appropriate box below.
❑ Yes Er<o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN? 10%or 10Ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of W ind 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 []'Flo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ❑'FTo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [;.No
❑ NA
❑ NE
acres deterntination?
17. Does the facility lack adequate acreage for land application?
❑ Yes r�J 1V°
❑ NA
❑ NE
18. Is there a lack ofproperly operating waste application equipment?
❑ Yes LJ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 0 No
❑ NA
❑ NE
20. Does the facility fail to bave 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
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 0 No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facie Number: - 6P L 3 1 Date of Inspection: Z� fb
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [/] No [] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 P' 1lo ❑ NA ❑ NE
❑ Yes 5� " ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes J2 o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 'EJN6- NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Lj 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).
S %
f"c.��/►� (P o �� 1 a �
V� 4-9 /,-- e --<-- et � ©P� a �- o �►� ,t C L­ G? .� �c ,� P G-.- �
(o 770
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
lu— �Yv---I—t
Phone: 1(0 74 G 73 c2,v
Date:
21412015

UDiv'ision of Water Resources
Facility Number - & T3 O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Carout'i
nee Inspection Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: One Q Complaint O FoIlow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
! ,
Arrival Time: —1-'-1 J
Departure Time: County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
can to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
1. Other
Title:
Integrator:
Phone:
Certification Number:
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
ury iroultry t_
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharacs 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?
Longitude:
Region:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes C No ❑ NA ❑ NI
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
[] Yes Vo ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility umber: _ Date of Inspection: Z JK
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
[-]Yes [:]No
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: -_ G 7 O
❑ NA ❑ NE
❑NA ❑NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,0 3 ( r+
5. Are there any immediate threats to the integrity of any of the structures observed?
El"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
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
15 ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ENo
❑ 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 Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZI 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/SIudge 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. o the receiving crops differ from those designated in the CAWMP?
❑ Yes ❑ No
Yes
❑ NA
LJ NE
1Q. Does the receiving crop and/or land application site need improvement?
❑ No
❑ NA
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No
❑ NA
rNE
acres determination?
f'
6NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
18. Is there a lack of pproperly operating waste application equipment?
❑ Yes VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
❑ No
❑ NA
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall
Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA rNE
Page 2 of 3 214120I5 Continued

Facility umber: I jDate of Inspection: z
T
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No
❑ NAB �NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
0'NA ❑ NE
Other Issues
I
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 [ffNo ❑ NA
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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? Vyy
s ❑ No
34. Does the facility require a follow-up visit by the same agency? s ❑ No
❑ NA
❑ NE
NE
2✓ E
❑ ZA
�NE
L�J
❑ NE
❑ NA
❑ NE
Comments `(refer'to question #):'Explain any YES answers and/or any additional recommendations or any other comments. '
Use drawings of facility to better explain situations (use additional pages as necessary).
OW4�C_or,. Q AC" F f-t lea dHy, Wt � i S sr t �, � CaIle 4- a (Lf�4�rve c !J�frw.sSo,
e^-i'e fi CGt((e 6J-k -i 4. )^ 4orn-- �F -�r� ��+s .f �o t.-' l�9ao/► yil/s,
3q. �/I I t re VW�-re- -r<? I(VI—LAQ
r,Q Qgpe.,­t.drl—t.-,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
LI�4�,_e 4
at 4A /T fly
Phone: n 77 7-7p�
Date: 40vf
21412015 P P

-s C7Division of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: erCompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
ly'ean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Wet.Poultry Capacity Pop.
Layer
Non -La er
Design Current
ury rounry t
La yers
Non -Layers
Pullets
Turkeys
Turkey Puuets
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?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes EyNo ❑ NA ❑ NE
D Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
[:]Yes
E�No
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
Page l of 3 21412015 Continued

Faciliumber: - Date of Inspection: % -Z
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: S G 7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J� _ j (9 ZD 27
5. Are there any immediate threats to the integrity of any of the structures observed? Eryes ❑ 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?
H any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes E(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
maintenance or improvement? I
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA [ZONE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA O' E
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. o the. receiving crops differ from those designated in the CAWMP?
15. oes the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &€ Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [] No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA dNE
❑ Yes ❑ No ❑ NA ff NE
❑ Yes [] No ❑ NA T[ fNE
❑ Yes [] No ❑ NA [71NE
❑ Yes ❑ No ❑ NA f NE
❑ WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [:]No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [::]Yes ❑ No
❑ NA [7FNE
❑ Weather Code
❑ Sludge SJNE
❑ NA IF
❑ NA
Page 2 of 3 21412015 Continued

Facility, Number: - Date of Inspection: -Z-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [] No ❑ NA �NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA LJ 1V E
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? []Yes ❑ No VNA
A NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA WNE
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 7 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 .
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA E�`NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No [] A ENE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? Yes ❑ No YNA ❑ NE
34. Does the facility require a follow-up visit by the same agency? EYes ❑ 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)..
pC%51 C tGt+pvf �f, Q
CGt 0. e � 9 i.��� f6 � f v [e'�`c- f �v !` n '�� �`+•c, 4 � T 'n4� i �,.f �'^' {O (� r, � �r
-- 9{i-
#
�30 Red w,'rc- 7W(at—ke
rr q t �I
� � � � I � (\[ e � wart �uL C .��. � can'�lQ
Q, kze s
105���J Soc+� �y�c o raSS + �l Gc i{Pr` I�>�Or s'lrrn cC
e �s �r � eo Gem 4D
kj rcoN,>,,S fs r�C�^ten, �„r1A ��an1
`v ^t r�
bhs k bogy'
S 4 �— np Ok �t'�l✓��� � 4 c�u c/
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
Phone: q k o 71 % 7 30
Date: 1 ` (—
214/2015

0 Division of Water Resources
i'acality Number e - �3 O Division of Soil and Water Conservation 1
O Other Agency
Type of Visit: UCompliance Inspection U Oppfation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Routine O Complaint ,+v_�,(Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: G 1/ Arrival Time: ® Departure Time: © County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Canacitr POD.
Layers
Non -Layers
Pullets
Turkeys
Turkey Pouets
Other
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q N ❑ 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)
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
❑ YesE-�O—
[:]Yes ❑ NA ❑ NE
F:rNo ❑ NA ❑ NE
Page I of 3 21412015 Continued

FneiG Number: jDate of Inspection:
Waite C-Alection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ITO
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? E f 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 ENo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the strictures need maintenance or improvement? [Yes ❑ No DNA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes fNo ❑ 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 �io ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ENE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > lo% or 10 lbs. ❑ TotaI 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):
I . Soil Type(s):
14. o the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
. Does the receiving crop and/or land application site need improvement?
ErYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NAE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
ONE
18. Is there a Iack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
0 Yes
❑ No
❑ NA
,-�
[] Tq- -.
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
NE
the appropriate box.
❑WLTP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
divE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
Page 2 of 3
21412015 Continued

Facility Number: j (p`t( Date of Inspection:
24. bid the facility fail to calibrate waste application equipment as required by the permit?'
❑ Yes ❑ No
❑ NA [�N/E
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes ❑ No
❑ NA
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes ❑ No
❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
[/f NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAV"?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA E NE
❑ Yes 01No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA E f NE
❑ Yes ❑ No ❑ NA [�NE
❑ Yes [:]No
❑ Ye ❑ No
Yes [:]No
❑ NA [fNE
Q-NA- ❑ NE
❑ NA ❑ NE
::omments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Jse drawings of facility to better explain situations (use additional pages as necessary).
la((f� C^ rftlf.td--Pe/y5ira {� ( ltP/�arti t efore
4>Lf v- 4-k, v, 51 y-- t_A-'C d'01 S.
-�-2 '— CS• rd�..��1 a_bFJ d 5kP4�
4, PSouSS ;c Ids u-^dl'fre_ k,-'
5�f.
�e( "e fr",��ovl�P 1+r)tl
G9ronoM/S/-
�t(1OAr-'d"/Te-4."�lS
014 So efl') is
�Lre, 3,an,
()asl(.y F,e/�S
V" I ( (7C V "" -e, iW." P
5vr. Ye Pu�/c/t vrft �oc�ky
Reviewer/Inspector Name: 01� IG 09 It Phone: (Q 7? 7
Reviewerflnspector Signature: 62 Date: 7/c./1 S
Page 3 of 3 21412015

Division of Water Resources
Facility Number j - 0 Division of Soil and Water Conservation \ 1'
41 0 Other Agency •J
Type of visit: Com nce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: CrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L7/2V IhJ Arrival Time: Departure Time: 2A County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 0 o r 1, L ft �e (l Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Van to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pap.
Layer
Non -La er
Design Current
Dr` Poultry Capacity Po .
Layers
Non -Layers
Pullets
Turkeys
Turkey Pouets
Other
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
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 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
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[E `No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[jNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: '5 jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ,S
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 Zv
5. Are there any immediate threats to the integrity of any of the structures observed? Yes [RNo ❑ NA ❑ NE
(Le., large trees, severe erosion, seepage, etc.) DO
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes []'No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
- No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[f]No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ONo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
El a
❑ NA
❑ NE
maintenance or improvement?
11 s there evidence of incorrect land application? If yes, check. the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ SP
Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) t_
❑ 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. SoiI Type(s):
I4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D—No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
E31'es
❑ No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
M-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E5No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑/ N�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE.
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes F�rNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other•
21. Does record keeping need i rovement? If yes, check 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 Judge Survey
22. Did the facility fail to install and maintain a rain gauge? [] Yes aNCO ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Fj"No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: '?f jDate of Inspection: 2
24. id the facility fail to calibrate waste application equipment as required by the peanut? Yes ❑ No ❑ NA ❑ NE
s the facility out of compliance with permit conditions related to sludge? If yes, check 6/Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Faihtre to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Q VAA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
�fer to question #): Explain any YES answers and/or any adds
of facility to better ex[)lain situations fuse additional oases as
❑ Yes No ❑ NA ❑ NE
❑ Yes [/�No ❑ NA ❑ NE
❑ Yes MIN. ❑ NA ❑ NE
❑ Yes Z'No ❑ NA ❑ NE
❑ Yes [:(No ❑ NA ❑ NE
❑ Yes [!No ❑ NA ❑ NE
❑ Yes L3 to ❑ NA ❑ NE
ons or any other comments. A
y crod<� CPI« Sir r,.�+ �as1 sac
(e Jtc.Q cr'-Sin,
'SC—d k-, T� /✓t 5 �ntI5Sa7 �/ 2v���0/f
s
��. A3r°^a�..3f w• �( Sri (�f6i
Vs nee 1" OP
6i • fl recQaDn,
/r 1 e' o �e��( C�f��' �� ((7'I� G f ion -F-•`e ��5/pk i%S a^�
J`e Q p(ea,`X,
12-7 Ck- P-4l L-��L end r�eebor✓1�Aa`'^ c�P'Ps �`�MZ�ty/���s
ce �I
106 ZP 74q 7
Reviewer/Inspector Name: 06 — t / , G ( Phone: I o 74 6 73v y
Reviewer/Inspector Signature: Date: 2 5
Page 3 of 3 21412015

I a
«-Hivision of Water Resources r;
Facility Number 7 - 0 Division of Soil and Water Conservation 4�1
0 Other Agency
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine C) Complaint ollow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Lj rr Arrival Time: Z 1 Departure Time: o D County: Region:
Farm Name: Owner Email:
Owner Nance: Phone:
Mailing Address:
Physical Address:
Facility Contact: �} Title: Phone:
Onsite Representative: Pa `' ~ a L lr Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
EELayer
Non -Layer
Non-L
Pullets
Other
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Q No ❑ NA ❑ NF
[:]Yes
[:]No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
[DNo
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
Page I of 3
21412015 Continued

Fac'ii Number: 3 - Fs Date of Ins ection: 2
r Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes ua< ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 ` 2.10
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes [2-No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[a'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E"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
❑/ NNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
[:3<E
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Za, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ 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
EINE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
E Z
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
ff RE
acres determination?
17. Does the facility lack.adequate acreage for land application?
❑ Yes
❑ No
❑ NA
aNE
1:8. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
aNE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
[2'1iE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
/❑TNE
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
0N-E
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey _
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
�NE
�
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[] NA
L _I
Page 2 of 3 214120,15 Continued

IFacUity Number: - & jDate of Inspection: / S—
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes ❑ No ❑ NA 1J KE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] No ❑ NA J_,VNE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes ❑ No ❑ NA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [:]No e'-NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA DNE
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? 0 Yes �o ❑ 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 ❑ NAE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
E qE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ENo
❑ 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❑
VNo
NA
❑ NE
Comments (refer to question 4): 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).
can -b, -Q,�e P 4V.'P I!, ye
C� n T f 14r, 4.0 ^_. ,_ - O�L) e �-'f P S
N:'�" e I d s (V'V k) 00j
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

Q�rDivision of Water Resources
.Facility Number - L d� O Division of Soil and Water Conservation r
e O Other Agency
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Q Routine Q Complaint ollow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Qu rf L !ih{ / Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boar
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
El I Non -La er I F:�
Nan-L
Pullets
Other
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes C3'Nlo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes [�
❑ Yes No
❑NA ONE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste`Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q N ❑ 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
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):S~
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
[2-11-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 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
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
IJ''l"o
❑ 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
❑ No
❑ NA
QNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ 111E
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
�E
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
TE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
[3'NF
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
[� NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
Ef N_ E
the appropriate box.
❑ Wi1P ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA 0-11'E
❑ Weather Code
❑ Sludge S3<�
y
❑ NA
❑ NA
Page 2 of 3 214120-15 Continued

Facili Number: ? ir jDateof1hospection: it,
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [-]No ❑ NA L�_J 4
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [-]No ❑ NA -NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA U "E
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No I _t N-A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of thepermit or CAW W?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [:]No ❑ NA [2] 9
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [I NE
[-]Yes ❑ No ❑ NA LJ Ni
❑ Yes ON. ❑ NA ❑ NE
❑Yes ❑NA ❑NE
❑ Yes ffNo ❑ 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).
0/'kc- � // s ; h ,-eL
'— Con- ins e/o5,n C'.on �r
0
co Ve.7��.ce
Reviewer/Inspector Name: 9ti- � E9--' V Phone: I P/7 G 1S,7
Reviewer/Inspector Signature: Les 1� ` Date: 0) Z t 7L
Page 3 oj3 21412015

E
Facility Number ©- 0 Division of Soil and Water Conservation.
0 Other Agency
Type of Visit: .J�;Mompliance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine OComplaint 0 Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: %GQ Departure Time: County: A't / Region:
Farm Name: f 2 `f a-- Owner Email:
I Owner Name: Phone:
f ►Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:�r��11 '^
Certified Operator:
Back-up Operator:
ILocation of Farm:
Design Current
Swine Capacity . Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator: A-, 1.e5
Certification Number:
Certification Number:
Design
Current
Wet:Poultry
Capacity
Pop. .
La er
Non -La er
Design
Current
Drv'Poultry '
Canadty
Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Puults
Other
Discharges and Stream Imtaacts
t. 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)
1. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle . Capacity Pop.;
Dany Cow
D iCalf
Da'Daig Heifer
Dry Cow
Non-Dafty
Beef Stocker
Beef Feeder
Beef Brood Cow
)eYes ❑ No ❑ NA ❑ NE
k-] Yes
❑ No
❑ NA
❑ NE
0 Yes
No
❑ NA
❑ NE
X Yes
❑ No
❑ NA
[] NE
[:]Yes
%�No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

IT
lFafflityNuritber: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes 'Vo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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 [;�o
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes JNo
❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA ❑ NE
S. 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
es ZrNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application - �5
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ EJ
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 Ibs. ❑ 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 ILI No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Z(Yes ❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ❑ No
❑ NA
(ZNE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
❑ NA
0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No
❑ NA
tjNE
Reaufred Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ❑ No
❑ NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ❑ No
❑ NA
NE
the appropriate box.
❑WUP []Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA
] Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis
❑Waste Transfers
❑ Wea
?NE
r Code
] Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
❑ NA
NE
23. If selected, did the facility fail, to install and maintain rainbreakers on irrigation equipment?
[:]Yes [-]No
❑ NA
ril' NE
Page 2 of 3
21412011 Continued

r
Facility Nnruber: - Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes [] No ❑ NA
. NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [:]No ❑ NA
NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating [ton -compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [] No ❑ NA
0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA
dNE
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
VNE
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 0 Yes [:]No ❑ NA
NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA
ONE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes []No ❑ NA
NE
gNE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA
34. Does the facility require a follow-up visit by the same agency? [] Yes [—]No ❑ NA
' NE
7`
Comments (refer to question #): Explain any YES answers andlor any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional as necessary)).
/pages
XL�"��` /�-�.:.�L i
f
C � 8r .Z l�.J �G r^ rr- -5
GA
Tf
erf?�' k�C� �`C
/ C& 7-1f J � cIF f.�C��t !s i2a !sz
I� 'L V L
Reviewer/Inspector Name: ,- ' r �r '-' .' r Phone:
Reviewer/Inspector Signature: ��f.. Date:
Page 3of3 ,��4.,. ,. - %:., ./ram` ; .�rfa ,� �F- e' 214,6011

41C.4

vision of Water Quality
Facifity Number - 0 Division of Soil and Water Conservation
4
0 Other Agency
Type of visit: CMompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: I d County: Region: 61
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ZM l
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
can to Finish
can to Feeder
seder to Finish
irrow to Wean
irrow to Feeder
arrow to Finish
Other
Other
Title:
Latitude:
Phone:
Integrator: An /
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop,
[TLayer
Non -Layer
Dry rouirry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure OApplication Field ❑ Other:
a. Was the conveyance man-made?
Longitude:
Design . Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
)eyes [] No ❑ NA ❑ NE
W1 Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
;ff No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gaIlons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
X Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[4�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
0 No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of inspection:
Wade Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o
a. If yes, is waste level into the structural freeboard? ❑ Yes 6/No
Structure I Structure 2 Structure 3
Identifier:
Spillway?:
❑ NA ❑ NE
❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
Designed Freeboard (in): —
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 'L2'Tlo ❑ NA ❑ NE
❑ Yes le
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
;0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z 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
es
eNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2n 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
[a No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
&Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
�ZN
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[] No
❑ NA
tINE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
NE
the appropriate box.
[]WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of 3
❑ Yes ❑ No
❑ Yes ❑ N
❑ NA NB
ElWea r Code
❑ Sludge Survey
❑ NA Ff NE
o ❑ NA Ftinued
NE
21412011 Co

IFaciUty Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes ❑ No
❑ NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes ❑ No
❑ NA NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes ❑ No
❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
❑ NA YYY"VNE
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
��rppp
❑ NA 1 �{ NE
If yes, contact a regional Air Quality representative immediately.
r
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ❑ No
❑ NA NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA I A NE
El Application Field ElLagoon/Storage Pond El Other:
/
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ No
E
❑ NA 9NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ No
❑ NA
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No
❑ NA 1❑ NE
`A0 CGI+Qryr
Q� mil/ 5
6,�Ile-
474
Arc Z' re�'/L- d� /&J ll /.' 6
1� �2 T/ pr7 �%/�'� �%4�'%�► .� �lNOirT Gt/GJ /La T- OfJS�/��
cprJ�ei�,s� 4c00 4,C-1 /s 170
A I&C'j M/cra s r<<. Y/� /,t/GU /�/C! 1 - r /ztrt
Reviewer/Insoector Name:
Reviewer/Inspector Signature: /L
Page 3of3 /�iPl�/i%, fCOGc��Q/1�";7Co /%%' 'j-Qi-
Phone:lCr! "y'_7
Date: ZZ+
214 011

vLir�siuum rr xier Vuuuiy
Fatility Number � .I - (p ,� 0 Division of Soil and Water Conservation V/{
0 Other Agency
Type of Visit: om lance Inspection Operation Review Structure Evaluation 0 Technical Assistance
Reason for Visit: oudne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 3 Departure Time: Z $ County: OUP ( Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: /� Title: Phone:
Onsite Representative: 1� RT�7cy �E(\, Integrator: I I
iG Certified Operator: Certification Number: t-l7 t 6
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Wean to Finish
I
ILayer
Wean to Feeder
I
lNon-Laver
Feeder to Finish
Farrow to Wean
Design
Current
Farrow to Feeder
Dry Poultry Capacity Pop.
Farrow to Finish
Layers
Gilts
Non -Layers
Boars
Pullets
Turkeys
Other
Turkey Pouets
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?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes VVO
❑ NA ❑ NE
❑ Yes CJ ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3
21412011 Continued

Facili jNumber: Date of Inspection: A Lom 117--
Waste Collection & Treatment
4. A 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
Stmc e l S cture 2 Struc e 3 Structure 4
Identifier:
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r 32 ZZ
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
❑ 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
El 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?
E(Yes ❑ No
❑ NA
❑ NE
g. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [�rNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes Ej`No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes a<o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 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
❑ NA
❑ NE
ro
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes No
❑ NA
❑ NE
acres determination? /
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes E(No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[-]Yes o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
L
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Ins ection:
Z I1
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
2 Np NA NE
i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
=�N
o NA NE
the appropriate box(es) below.
Failure to complete annual sludge survey Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
Yes
NA NE
No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
L_I ❑ 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)
No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes [2
NA
NE
El Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes �I jo
NA
NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes —Vi/ o
NA
NE
34. Does the facility require a follow-up visit by the same agency?
Yes No
NA
NE
Comments (refer to question li): 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).
7.) 1_Dsk_C- w0, L-A&---C/'J ( 0(-- �-'3, (� fLP, ss W(' r'�<_.
Reviewer/Inspector Name: p p p-_lJ (�, �.� Phone:(-1I6 b 3
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/201

FacilityNumber O Division of Soil and Water Conservation J
O Other Agency
Type of Visit: C�o/qtpliance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 6d Routine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: 1 Arrival Time: Departure Time: ? Z County: DUPLXV Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: has Qrefc gE.Ly Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Design Current
Design
Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Wean to Finish
Layer
Wean to Feeder
I
INon-Layer
Feeder to Finish
Farrow to Wean
Design
Current
Farrow to Feeder
Dry Poultry
Capacity
Pop.
Farrow to Finish
Layers
Gilts
Non -Layers
Boars
Pullets
Turkeys
Other
Turkey Poults
Otber I I
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy CaLf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ['NNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑No ❑ NA ❑ NE
❑ Yes gt
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Pagel of3 21412011 Cominued

Facility Number: Date of Inspection:
Waste 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
o ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: ( C&itdj Z [ w w�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N ❑ 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?
tf any of questions 4-6 were answered yes, and the situation poses an immediate public health or en ' onmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Ycs
E(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 94,o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ 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/SIudge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
. No❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
6<o ❑ NA
❑ NE
acres determination?
`
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑' I o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El�10 YesE
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ff-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Rio ❑ 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 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Condnued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the petmi ?
❑ Yes L Q a ❑ 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 fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes�YN. ❑ NA ❑ NE
Other Issues
;N�.
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑ 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 o ❑ 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 do ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes U 1VO ❑ NA ❑ NE
33. Did the Reviewer/mspector fail to discuss review/inspection with an on -site representative?
❑ Yes � ❑ NA ❑ NE
go
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ NA ❑ NE
Comments (refer to question Il): 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).
`7.) k � w o r t k O t-' O (: o w"W"' 7
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Ph..(( 9(Dp 31f
Date: L L
21412011

1011)ivision of Water Quality
Facility Number Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit �Coommpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
t�J Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: �ounty: l� Region(^-L4�
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
— 4— Owner Email:
Phone:
Facility Contact: Title: Phone No:
01
Onsite Representative: r Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o = 1 = u Longitude: ❑ ° ❑ ❑ u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -Laver
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turke s
❑ Turkey Paults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
] Dairy Coati
] Dairy Calf
] Dairy Heifer
] Dry Cow
] Non -Dairy
] Beef Stocker
] Beef Feeder
Beef Brood
Design Current
Capacity Population
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0`No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
�-,Ko
❑ Yes
2Ko
❑ NA
❑ NE
❑ Yes
Ply o
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Ins ection:
/
24. id the facility fail to calibrate waste application equipment as required by the pe ' ?
Yes ❑ No
❑ NA ❑ NE
5. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[—]Yes ❑j 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?
02Kcs- V'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
❑ 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 eNo
❑ 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 ZrNo
❑ 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 P-No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes P No
❑ NA ❑ NE
33. Did the ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes ONo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes gNo
❑ NA ❑ NE
Comments,(refer to. question 4): 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).
'I/ee'0�17 % IZ/�rl�f14!�7
Aj -T `t
y�� tks
t� N V
heel- c®umn pll
Reviewer/Inspector Name: V U-L Vnjsl Phone: �✓6 ^ 77C--
nX
Reviewer/Inspector Signature: Date: U l/ (/
Page 3 of 3 2/4 0I1
--I.

Facili Number: DateofIns lion: /
Waite Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes E3"No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Strums- Structure 2 Structure 3 Structure
Structure 5 Structure
6
Identifier.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):� L ��
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [rNo
❑ 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 VrNo
❑ 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 ,ffNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes LZNo
❑ 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 [2rNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ONo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes m No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes oWo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Ej No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes Z No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes JZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes Z No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes Z No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes E�rNo
❑ 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 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3
214/2011 Condn

vision of Water Quality
Facility, Number 0 Division of Soil and Water Conservation
0 Other Agency
r
Type of Visit Compliance Inspection
0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit__(?rftoutine O Complaint
O Follow up O Referral O Emergency 0 Other ❑ Denied Access
S
�Q' Time: County: Region: ` ' /�
Date of Visit: / Arrival Time:
.Departure
Farm Name:
— Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact,
T' le: Phone No:
Onsite Representative:
Integrator:
Certified Operator:
Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm:
Latitude: o [71' =" Longitude: [�e
Swine
Design Current Design- Current
Capacity Population Wet Poultry, Capacity Population
❑ Laver
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boar,
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
Design , Current.
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ BcefBrood CONY
❑ Turkeys
Other ❑ Turkey Poults
❑ other ❑ Other Number of Structures:
Discharges & 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?
El Yes �o
❑ 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)?
0
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes P'No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes ZNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes PTNo
❑ NA
❑ NE
other than from a discharge?
12128104 Condnued

Facility Number: Date of Inspection UA4r
W s#e Coil ti & T tm t
a ecyn _ rea en
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElYes No [I 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: L^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0 C7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �no ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes gNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes "'o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 7No ❑ 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 XNo ❑ 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 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
La"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
O No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
d o
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
L/I No
❑ NA
❑ NE
Comments (refer to question 4). Evplain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary)-
Reviewer/Inspector Name C Phone-
Reviewer/Inspector Signature: Date: 4
12/28/04 Continued

Facility Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage &Permit readily available? ❑ Yes No ❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes PNo ❑ NA ❑ NE
the appropiate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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 ANo
El NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ZNo
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ?fNo
❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes gNo
❑ 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 VfNo
❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes YTNo
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes PrNo
❑ 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 El NE
Ifyes, contact a regional Air Quality representative immediately
'A
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes o
[INA [INE
General Permit? (ie/ discharge, freeboard problems, over application)
(((
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes dN
El NA ❑ NE
33. Does facility require a follow-up visit by same agency?
[IYes VNo
❑ NA ❑ NE
Additional Comments and/or Drawings:
(::!Agc's -�� Y�f
�(,t��"�-eve��s l
Page 3 of 3 12128104

,Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
i�i n�uai
0 Other Agency LZ
Type of Visit j2rCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason forvisit 0 Routine OComplaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: i Departure Time: County:
Farm Name: FCG �s✓ GlI�l12.5v�5 J'8 Owner Email:
Owner Name: Af'LL 6j/zxZ 5� Phone: _
Mailing Address:
Physical Address:
Facility Contact: 9 Title:
Onsite Representative: ' Q- 7_C fC CJF—LL
Region: �KO
Phone No:
Integrator: ,Z2&'ezV,y—��+��✓
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = I = 11 Longitude: = o =
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: `-
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 XNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ Yes ❑ No
❑ NA
❑ NE
❑ YesxNo
❑ NA
❑ NE
❑ Yes oNo
❑ NA
❑ NE
12128104
Condnued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ONE
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
Id tiff '¢
en er.
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'0 NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
❑ No ❑ NA [�NE
through a waste management or closure plan?
/
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
[I No ❑ NA P
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
,(,NE
El No ❑ NA L� 1 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 )ZfNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
�/
El No El NA YJ NE
maintenance/improvement?
/
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No ❑ NA NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
/
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[--]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA /I�NE
15. Does the receiving crop and/or land application site need improvement? ElYes ElNo ElNA �NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes ❑ No ❑ NA NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA 'NE
18. Is there a lack of properly operating waste application equipment? El Yes ❑ No El NA �NE
IComments (refer to question ft Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
- A'& we,.-, /,2 m fz /, e�u Alllxcll- o 2
'V
Reviewer/Inspector Name IA49& Phone:
Reviewer/Inspector Signature: p %y l Date:

Facility Number: — Date of Inspection�h/i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes ❑ No ❑ NA gNE
❑ Yes ❑ No ❑ NA [�NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA / ENE
❑ Waste Application El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [I Waste Transfers Elfi Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require follow-up visit by same agency?
❑ Yes ❑ No ❑ NA EJ NE
❑ Yes ❑ No ❑ NA m NE
El Yes [I No El NA �NE
❑ Yes ❑ No ❑ NA 1ONE
❑ Yes ❑ No ❑ NA JYNE
❑ Yes ❑ No ❑ NA 10 NE
❑ Yes PYNo
❑ NA ❑ NE
❑ Yes �&
❑ NA ❑ NE
❑ Yes PNo
❑ NA ❑ NE
❑ Yes i`-' No
❑ NA ❑ NE
❑ Yes ON.
❑ NA ❑ NE
❑ Yes ZNo
❑ NA ❑ NE
Additional Comments and/or Drawmings: ee�
4'V'V �oB m 5 op i' /vv J`P�i✓O -=n _ �47r</�
Page 3 of 3 12128104

discharged to stream
N35 00 466 in woods here
W077 56 108
1 /12/07
Untreated animal
waste sprayed here

7
Division of Water Quality
lty Number 3 �,� 0 Division of Soil and Water Conservation
0 Other Agency
_73Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time1: ©�"' pD�eparture Time: County: t,2 C- n//L'l Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: _
Facility Contact: _
Onsite Representative:
Certified Operator: _
Back-up Operator: _
Location of Farm:
Swine
Title:
Latitude:
Phone No:
Integrator: �L
Operator Certification Number:
Back-up Certification Number:
o Q' = Longitude: =10
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -Laves
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Rocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Dischar¢es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Ely. EN.
❑ 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)?
0
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 0'No
❑ 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 — Date of Inspection,
_Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes PJo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
[]Yes JRNo
❑ NA ❑ NE
Structy 1 Structure 2 Structure
Identifier. S
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes J"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 eNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes JUN.
❑ NA ❑ NE
8. Do any of the strictures lack adequate markers as required by the permit?
❑ Yes ,ETN-
❑ 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 ZNO
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [J.Jo
❑ NA ❑ NE
maintenance/improvement?
/
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes PVo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10% or l0lbs ❑ 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. Soiltype(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0-NO
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes EFNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes . fNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes In -No
❑ NA ❑ NE
IS. Is there a lack of properly operating waste application equipment?
❑ Yes JU o
❑ 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):
gyre ,S Ct Q Sc//
No ieca�✓ �
(
F
Reviewer/inspectorName / / Phone: 6!
Reviewer/Inspector Signature: Date:
tL/Ld/U4 Continued

Q Division of Water Quality
FAility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: / Arrival Time: 00 Departure Time: County: 4 Region:
Farm Name: ! O Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative:
Integrator:
Certified Operator:
Operator Certification Number: _
Back-up Operator:
Back-up Certification Number: _
Location of Farm:
Latitude: E—] o [--] ' F7" Longitude: F7
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Q Feeder to Finish
y
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacitv Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 ON. ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0
❑ No
❑ NA
❑ NE
❑ Yes
�TNo
❑ NA
❑ NE
❑ Yes
E2(No
❑ NA
❑ NE
12128104 Continued

Facility No Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ETNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Struc e l Shycture 2 S 3 Ste 4
t
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 ZNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �0 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 0 No
❑ NA ❑ NE
8. Do any of the stuchues lack adequate markers as required by the permit?
❑ Yes �No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ONo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Z No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes 6No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10°/u or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate ManurelSludge into Bare Soil
❑ Outside of Acceptable Winnddow% ❑ Evidence of Wind Drift ❑ Application Outside
of Area
.Crop
12. Crop type(s)�i
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ;�N0
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes V No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes rj No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �TNo
❑ 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):
ov 2 3` 3 �f fir�itlr�tt i ��z -
6 GaLj­1 ,J - 8
/ease
Reviewer/Inspector Name Phone: �-7,W
Reviewer/Inspector Signature: L /�L Date: ,j
Pare 2 of 3 12,28104 Continued

FacilityNNumber: — Date of Inspection
Reunited Records &Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ON. ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes qNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes J2 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JONo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes F1 No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes EINo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? []Yes O No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes UNo
❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance ofthe permit or CAWMP?
❑ Yes O/�No
❑ NA [I NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes 7J 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 E No
ET
❑ 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 YJ 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 0
r�No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA ❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

0 Division of Water Quality _
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Coompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit JO Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 9C
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
�a Arrival Time: �O Departure Time:
QCounty:
a 5r U Owner Email:
Facility Contact: Title:
Onsite Representative: CA
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Phone:
Phone No:
Integrator: 42 f�
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: o = t ❑,, Longitude: = ° E::] ' I=] "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
Pullets
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Daia Cmk
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:1 Yes El No El NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes No ElNA ElNE
❑ Yes ZNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ❑ No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Stm ture 1 Structure 2 Structure 3 Structure 4
Identifier.
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): jj"_
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes ❑ No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ❑ No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes j2rNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes �No
[I NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ,ONo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes J2rNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ,ONo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10"/0 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 E No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes PIo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes Z No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes JZ-No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes P No
❑ NA ❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/InspectorName /je' PhoneYlO— l'�"---'
Reviewer/Inspector Signature: le ---7 _ Date: i 10,
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
/
Required Records & Documents r
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes ONo
❑ 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 El Design El Maps El Other
521. oes record keeping need improvement? If yes, check the appropriate box below.
El Yes El No
El 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 P No
❑ 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 YJ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
)z Yes ❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes Ej No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes P No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ff No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes d No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes AEfNo
❑ 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
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
jVNo
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 'PNo
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes P'No
❑ NA ❑ NE
All z 2
°llo - 3 Sty d /
I,J0Jor Cade- 4✓� SoM � 2n�l�S
a /Vo jw — w (�h -e c-o�
Na s1 u 3e S v f �iPQ3Q � czS Sa�,'t
GZS Ssl
Page 3 of 3 121-'NIU4

Di,ision of Water Quality j
Facility Number J O Division of Soil and Water Conservation L/
O Other Agency
Type of Visit 0,Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q'Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 6 Arrival Timms � Departure Time: � County: Region: L�
Farm Name: /(SO�/ �Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: /�/� Integrator: V5s-AOL
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: �o = ' = Longitude: = o
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Cifeeder to Finish
/ l2
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
❑ Turke s
Other ❑ Turkey Poults
❑ Other ❑ Other Number of Structures:
Discharges & 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)?
0
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
12128104 Condnued

Facility Numb er:71 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes tJ No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes 9 No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Stru�e 4
Structure 5
Structure 6
Identifier:_
Spillway?:
/ ty
Designed Freeboard (in):( -
Observed Freeboard (in): _26— .3 K
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 2Mo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ yes ,ram 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 stucmres lack adequate markers as required by the permit?
❑ yes ZrNo
❑ 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 0 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
Rf Area
12. Crop type(s)
13. Soil types) �j Z ��
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes _4�:rNo
❑ 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 j2 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes P-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [),woo
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: I
Reviewer/Inspector Signature: Date: t7

Facility Number: Date of Inspection G Z
Reaut"red 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 [2rNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Oyes ❑ No ❑ NA ❑ NE
❑ Waste Application ,Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
,ZfRainfall ❑ Stocking )2116rop Yield ❑ 120 Minute Inspections Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
O No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Jr.} No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
; No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Callo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E'NO
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[_—I*o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance ofthe permit or CAWMP?
❑ Yes
PKo
[--].NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
F'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
�'�io
El NA
El NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
j j;l<
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,�
-E5 o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes ­n No
❑ NA
❑ NE
Additional Comments and/or Drawings:
7r�ae��
a J
/ t, rQ'ffry
�l �1 sic ch
I2/28/04

ualty
Division of Water;.Q
Division of foil Arid Water Conservation
.0 Other Agency
Type of Visit JD Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Qf Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
a Bate of Visit: Time: t
4 Facility Number
0 Nat O erational Q Below Threshold
Ef Permitted 13Certified [] Conditfonall - Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ....................
................................. .......fu ......... County:.... .,.. �i�1:6`(.`.J........................... .
Owner Name: 65/ I�ieZ -Phone No:
---•--.......'...............................................�...............---.----..........----...... - •.................................................... .................................
Mailing Address:
Facility Contact: ...... Title; ................................ ......... ...... Phone No: . .......... . . .............. .........
Onsite Representative: - /_�.....� Integrator: co:QP ..................._......
__._f _._�.._.,���................................
Certified Operator: ---......... ...................................... ............................. .......................... Operator Certification Number:........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° 44 Longitude • 6 't
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer F013airy
Feeder to Finish / ❑ Non -Layer Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ GiIts
❑ Boars Total_SSLW
Number of Lagoons
jj21djnEjoDd§/SgljdTLaDs
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0"No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) El Yes ❑ No
c. If discharge is observed, what is the estimated 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? El Yes �o
3. Were there any adverse impacts or potential adverse impacts
to the Waters of the State other than from a discharge?
❑ Yes 'Q_Ko
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Spillway
❑ Yes ,B�fo
5trPcture l Structure 2
Structure 3
Structure 4 Structure 5
Structure 6
Identifier: ..._..... .. .............. ............--- .......... ...--
..- .........
........... ................... .................
Freeboard (inches): j Z_
12112103
Continued

Facility Number: — c3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes '2-f4o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yeso
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 EY&O
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes i?T'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level El Yes EVNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes .CNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 0110
❑ Excessive Ponding ❑ PAN HydrauIi Overload ❑Frozen Ground ❑ opper and/or Zinc
12. Crop type t �.�1�1C/.��� �UEi�EQ
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVvW)? ❑ Yes E/ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes PrNo
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 'P 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 �D No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes PCNo
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 �No
Air Quality representative immediately.
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): ❑ Field Copy ❑ Final Notes
F7
e) Z-OVY koe �,crj -r A) 9 AA-A0 S _70- 84- f
AIV F[vGfnrDS !� FFQ rC=i ✓G L�G � ��r
Reviewer/Inspector Name
Reviewer/Inspector Signature: ` Date:
12112103 v1 v a Continued

Facility NuDate of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ZNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes UNo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes �3to
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes EfrNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes �No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes j'No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes Ej'No
28. Does facility require a follow-up visit by same agency?
❑ Yes AjNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes .r1 No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
ffYes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes VNo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ffNo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes )2fNo
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
dtiitiomai Commea&andlorl)mwin g :
8S & 54191 % dS,E /OTC
Alf'-
12112103

r0 Division of Water Quality
0 Division of Soil and Water Conservation
Other Agency
Type of Visit T Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
10 Not Operational 0 Below Threshold
Permitted 0 Certified 0 Coondition ly Certified [3 Registered Date Last Operat r Above Threshold:
Farm Name: k;—r�--G�rl SI.J�f•IE County: _U0*9 2d
Owner Name: 1 ft�{�L'� .�t.t�GIJ�%�C_ Phone No:
Mailing Address:
Facility Contact: ^ Title: Phone No:
OnsiteRepresentative: Y���R.C�25�r� Integrator: I, 1Fr
Certified Operator: Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 1 .1 L_J.. Longitude I . I . I
Design Current Design Current Design Current
Swinc Capacity Population Poultry Capacity Po ulation Cattle Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Lavcr ❑ Dairy'
❑Nun -Laver ❑ Non -Dairy
❑ Other
Total Design Capacity
.na
Total SSLW
Number of Lagoons JL Subsurface Drains Present IL Lagoon Area JL Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream [acts
I. Is any discharge observed from any part of the operation?
❑ Yes
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
/PlNo
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 Bow in gal/min?
d. Does discharge bypass a lagoon system? (Ifyes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
Yf'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
y.J No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
P(No
Structure I Structure 2 S Wcmre 3 Structure 4 Structure 5
Identifier: pi,L1 pF) 2 tJ OI-Rr10
Structure 6
Freeboard (inches): Z 'f - GZ 2 3
05103101
Continued

l
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?
El Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
�f
IQ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
YNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
//
elevation markings?
❑ Yes
P No
Waste Application
l
10. Are there any buffers that need maintenance/improvement?
❑ Yes
11. Is there evidence of over application? ❑ Excessive Pending ❑ P El Hydra ul' Overload
❑ Yes
..�///No
/{p No
12. Crop type lJ`-1t1'I�III �PrZ �`l �fl�(�ZL Ri�z/�oUEkS�EEO\
/ _
13. Do the receiving crops differ with those designated in th Certified Animal Waste Management Plan (CAWMP)? /?
❑ Yes
o
14. a) Does the facility lack adequate acreage for land application?
❑ Yesfo
o
b) Does the facility need a wettable acre determination?
❑ Yeso
c) This facility is pended for a wettable acre determination?
❑ Yes
15. Does the receiving crop need improvement?
El Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
;No
RRe uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
El� Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Q
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
,LJ 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
o
21. Did the facility fail to have a actively certified operator in charge?
ElYes
ONo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
XNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Of No
24. Does facility require a follow-up visit by same agency?
❑ Yes
0, j�Io
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question 0): Explain any YES answers and/or any recommendations or any o er comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): Field Coov ElFinal Notes
r4) Rk ©N �5tR8Lts1+7 Ne- e)ET-70_=2 6-9 55
CO
-GSOprDJ—T,5RoLONTR1, F�oE-ooSr� AWP�Ar �� S FGo,�rto.(t��Bz>JZ�. �� COJE21}GC
_�lr0� �TRHF./ DlZEE
C^otJ �zNU� DN NF_Xr 10
Reviewer/Inspector Name -_ K
Reviewer/Inspector Signature: L&I&EI 1z Date: .5 2
05103101 Continued

Facility Number: — Date of Inspection �2
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes � No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes #No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes dNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
I ) DwN r_R H,�o A j tu)o np W4s,, a (0o F Fc-o C 1
yw�T11 A+7vrt+8/_ L"b [)a90E�R-
NF LNPa t..DF, p k 140'lsF -r- ek
F�ELO,i 1 IAt. c+� l,Js %Pant OFp 141.131.
" CJ�11C(Z -�5 �RJ2l�(r- �Ol"� � L (fir' p C L1� At2ED i0 11 EPLflE1
f r4z� F2F_�p� �P�s�C pC�q�l 11�yLc NF t_D to J3E
15) SumE�7►iFoN 1�) V-"'PerPLcx
FVo,-r SroE flF a Rl�o Fr��'r �FF���&��zy
®OE.RRLl SZ:�7E LooK► 8 0-00P. KE-CORpS
OR,DER. KEC40MMEAD PK nP-ZI�C- tkO-0605
Ldit ER. (o �T � �AS7 �QOcrt)V�o ��t:�clR2�Ci
raE✓pt.Jz1J� 211—
�F (�Sn[ �oR s�i{nuPfl• s�oP
�rcmP L.EJEL5 r-o2 k- LA-&O-N5 L�RS ��cow'fS�r
05103101

0 Division of Water Quality -
Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0• Routine O Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 (83 Date of Visit: 1 3/22/2001 1 Time: 8:05
_ ..._ - Not Operational Q Below Threshold
® Permitted ® Certified E3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold_
Farm Name:.l?&R-Fax'CIO.#:1.Br:2.......................... ........................ County: Vm4diu......... ............ ............. WIR,O......
Owner Name: 121?naltl ---------------- ----------- lieellisuu... .......... —...................... Phone No: 410 4(r1.125------------------------•-- _.
Facility Contact: _ Title: — — Phone No:
Mailing Address:.1.8.4..L?[._YlalAiaxt!.s..Rd.......................................................................... KwansvilIRLINC........... _...................................... 2834-9 ...........
Onsite Representative: A eU_IiortlJSno .......... Integrator: Integrator: MjpxV4•-f-'FjalnthX.faJCttla.--------._................
Certified Operator: Jeffery_ _ IleflilSQtt_ Operator Certification Number:779-3Z
Location of Farm:
South of Westbrook Crossroads. On East side of SR 1381 approx. 0.3 miles North of SR 1380. Office in cedar building on +
left
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 35 • 00 11 F-35-111Longitude 77 • F56 46
Design Current
Swine r'A...it. P... a..ti....
❑ Wean to Feeder
® Feeder to Finish
9792
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Po ulation Cattle Caaci Popmlation
❑ Layer ❑ Dairy
][IN n-Layer 10 Non -Dairy
❑ Other
Total Design Capacity 9,792
Total SSLW 1,321,920
Number of Lagoons 10 Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ®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 D WQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min? n/a
d. Does discharge bypass a lagoon system? (lfyes, notify DWQ) ❑ Yes ® No
2. Is there evidence ofpast discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ®No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes N No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier: ............. 1DB.1............. ............ .DB2............. .................................... ........ _.... _................... .................................. .............. ......................
Freeboard (inches): 19 19

5100 Continued on back
Facility Number: 31-683 Date of Inspection 3/ZZ/2001 Printed on: 3/26/2001
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 ® No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes ®No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes ®No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ®No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ®No
11. Is there evidence of over application? ❑ Excessive Ponding ® PAN ® Hydraulic Overload
® Yes ❑ No
12. Crop type Coastal Bermuda (Graze) Rye Graze
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ®No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ®No
b) Does the facility need a wettable acre determination?
❑ Yes N No
c) This facility is pended for a wettable acre determination?
❑ Yes ®No
15. Does the receiving crop need improvement?
❑ Yes ®No
16. Is there a lack of adequate waste application equipment? ❑ Yes ® No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes ®No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes ® 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 ®No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes 10 No
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 ®No
25. Were any additional problems noted which cause noncompliance ofthe Certified AWMP?
❑ Yes ®No
No violations or deficiencies were noted during this visit. You will receive no further
corresnondence about this visit.
(Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
This facility is being operated under the same waste plan with 31-684 and 31-807.
11. Hydraulic overloading and Plant Available Nitrogen (PAN) overapplication occurred on Field 4 Hydrant 14 on the 2000-2001
small grain crop. PAN application occurred on other spray areas as well.
15. Apply lime according to soil test recommendations.
18. The owner needs to sign and date the new waste plan. Hydrant 27 in the wetted acres design appears to be 2.36 acres instead of the
1.6 acres shown; contact the technical specialist to have this reviewed and necessary changes made to waste plan and wetted acres.
19. Be sure to use a waste analysis dated within 60 days of application on the IRR-2 forms. (cont)
Reviewer/Inspector Name Stonewall Mathis

Reviewer/inspector Signature:
Date: Q I '0
Facility ;umber: 31-683 Date of Inspection 3/22/2001 Printed on: 3/26/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below []Yes []No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ®No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ®No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes []No
Additional Comments and/or Drawings:
19. (cont) Updated I RR-2 forms for the 2000-2001 small grain crop were not available_ Representative had field notes of where he �►
had sprayed. While reviewing the field notes it was indicated that applications which had occurred on one spray area were recorded
as having taken place on another spray area. Be cautious and record application events properly.
I, the crops are in good condition.
J

Facility Number 31� 683
Date of Visit 2/162000 Printed on: 3/23/2000
O Not O erational O Below Threshold
Permitted H Certified ® Conditionally Certified a Registered Date Last Operated or Above Threshold: ..............
Farm Name: D&H.Farm.#.1&2..................... ... ...... ......... ........ _............ _..... _................ County: D.aplin............................... -........... . R!1R0.........
OwnerName: Rama).d.................................... Daxdlaoln.................. _................................ Phone No: 2?fr4195........................................ ........................
....
FacilityContact . .......................... ................... ..... ........... ... _..... Title :.._............................................................ Phone No: ._........... __...............................
Mailing Address: 11t4.Rr.�1'.i1)iaxmtRd.......... ............ ...................... _......... ...... .._.... 1KemmaviUe..NC_....................................... _........ 7AJ.49 ............
Onsite Representative: ......................................... ...... . ........ ...... .. ................... Integrator: Murphy.Family.F.arena.... .................. ............
Certified Operator.,Ieffcxy:.11......................._._... Hartlisan... _.................................... Operator Certification Number: .179..3.7..................... _......
Location of Farm:
f]nSB.13R1,.east.slde..apRxoa..a.,S.oilirs..xuutL.atintcrarspian.xritb.SR1�0lt...Appens.0.,3.miawxth.af.SB.13BD...LID'xce.in.xzdax...... �
wilding.on.lett................................................................................ ...... _......... ........._.._._............. .......... .
® Swine ❑ Poultry ❑ Cattle Latitude 35 • 00 35 Longitude 77 • 56 46
Discharges & Stream bonnets
1. is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ lagoon 0 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 Q No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (Ifyes, notify DWQ) ❑ Yes O No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes []No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................................... .................. _............... ... _...............
Freeboard(inches):. ....... ..... 23................ ............... 25................ ............... 23.... ....... .................. 24._............. ._._.............................. ....................................

Facility Number: 31-693 Date of Inspection 2/16/2000 Printed on: 3/23/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
0 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
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenanee/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
[l No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
I0. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
[].No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes C. No
b) Does the facility need a wettable acre determination? El 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?
Re uired 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(uispection 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?
-No-yi;olaiiirns. ar:cfefir iencies-ivere.u:oieA.dui'iilg Aiiy0iit:: Vki-val:reeeiv'e no fiiri ie'r
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes 0 No
0 Yes ❑ No
[j Yes ❑ No
❑ Yes [l No
Yes ❑ No
j Yes ❑ No
0 Yes [l No
Yes ❑ No
eboard check with farm owner on site (Dean Hardison). I did advice Mr. Hardison not to spray on front left field (small acreage)
at least a couple of days until field dries out. Pull made earlier in the day did cause light ponding in field. Field does have a
sl crop stand and waste has not ran off. Ditches are clear.
Reviewerlinspector Name

If
0 Division of Soil and Water Conservation - Operation Review
0 Division of Soil and Water Conservation - Compliance Inspection
Division of Water Quality - Compliance Inspection
0 Other Agency - Operation Review
Routine O Cam faint O Follow-up of DWQ inspection O Follow-u of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection S 124 hr. (hh:mm)
Permitted 0 Certified 0 Conditionally Certified 0 Registered 10 Not Operational I Date Last Operated:
.��1��.. Coun :. �'`1 .............................. Farm Name: ................ .............................. .......... t3
OwnerName:......................................................................................._.._..........._..........._........ Phone No: ........ ...............................................................................
Facility Contact:
Title:
Phone No:
Mailing Address:. .................... ............
Onsite Representative:.2f!�!'\!-��, !Su4..................... Integrator: .. .................
Certified Operator: ....................... ........... .........
Location of Farm:
Operator Certification Number:
r` -...........................................................................................................................................................................................................................................
fF
Latitude 0 6 « Longitude ' 4 "
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer I I ❑ Dairy
Feeder to Finish 9T7,9,a JEI Non -Layer I JE1 Non -Dairy
Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ANo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ,KNo
❑ Yes NrNo
❑ Yes 'PkNo
Structure 6
Identifier:
Freeboard (inches): ........... : d" .......
..
........................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �(No
seepage, etc.)
3/23/99 Continued on back

c Fac[Yky Number:31 — 3 Date of Inspection
u
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
gNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
Yes
❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
MNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
V No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
NNo
12. Crop type U_� I W 0"
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
Nf No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
14 No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This "facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
D(No
16. Is there a lack of adequate waste application equipment?
❑ Yes
Wo
Reauired Records & Documents
17.
Fait to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have aft components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Wo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
jgNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
VNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes XNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 9No
24. Does facility require a follow-up visit by same agency? ❑ Yes D�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes b4No
Io aiionis'oii deficier�cie5 •mere nbted during t;his'visit: - :Y;oti will-feerive iio further ; -
corvesO oridence: about: this visit.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary):
hwajz'�,
Reviewer/Inspector Name ]
ReviewerAnspector Signature:
q(o _-39 S 390C
Date: ,[---

FaMity Number: 3l — g3 Date of Inspection OG
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below KYes [:]No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes O�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 �fNo
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 kl-No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes C�'No
Additional Comments and/or ravings:

Division of Soil and Water"Conservation - Operation Review,
0 Division of Soil and Water -Conservation - Compliance Inspection:,:
Division of Water duty = C®tx►plia»ce Iuspection
9Other Agency - Operation Rivi"ew
'
IV,Routine O Complaint Q Follow-up of DWQ inspection O Follow -tip of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
l$Fermitted [] Certified © Conditionally Certified E3 Registered JE3 Not Operational Date Last Operated:
FarmName: ..-. �........ . 1................................................................................. County:.............I,1.�....................... .......................
Owner Name:. ..................... ...................
Facility Contact: ..
.......................... Title:
Phone No:.. ................
Phone No:
MailingAddress : ........... ............................. ........................................................................ .......... ......................
.-.-.... ..........................
Dnsite Representative:—�.. �sv....................... lrrtegrator:......,�
............... ............ ..... ..
Certified Operator................................................................................................................. Operator Certification Number:..........................................
Latitude ' •1 Longitude E__10 ° 4�
Design Current
Swine . Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts i
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I FEEJ
Dairy
❑ Non -Layer Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present IF0 Lagoon Area JE1 Spray Field Area
Holding Ponds / Solid Traps 0 ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: Wr�_ N*-_a
Freeboard(inches): c� ..............................................................................•--.......................... ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc-)
3/23/99
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes (' No
❑ Yes UrNo
❑ Yes RNo
Structure 6
❑ Yes [YNo
Continued on bar' -

Facility Number: Data of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
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
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?
Reguired 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?
:: N6-- ibl:ati6iis:or deficiencies mere hied• during #jiis:visit: - Yoi# will-reeeiye iid Mi-ther
.. correspondeirce. aboutk this visit. . . . ... .. . .. ... .....
❑ Yes ;I No
❑ Yes CKNo
❑ Yes [XNo
❑ Yes ff No
❑ Yes 0No
❑ Yes N No
❑ Yes No
❑ Yes No
Yes ❑ No
❑ Yes [9No
Yes ❑ No
❑ Yes allo
❑ Yes [W No
❑ Yes [1 No
❑ Yes PINo
❑ Yes Wo
❑ Yes qNo
❑ Yes J� No
❑ Yes No
❑ Yes j No
❑ Yes No
Comments (refer to question #) ` Explain any YESanswers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):.
fv�� —�►� �� � kleols cam,
ti)
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below "Yes ❑ No
liquid Ievel of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
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 fc`No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken -fan belts, missing or `` 11
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes N No
rvr
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes q No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? XYes ❑ No
Additional omments and/or Drawings:
i
3/23/99

❑ DSWC Animal Feedlot Operation Review
®DWQ Animal Feedlot Operation Site Inspection
0 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number r �-,r�
Time of Inspection I oj;) 24 hr. (hh:mm)
Total Tune (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex: t.25 for 1 hr 15 min)) Spent on Review l�
❑X. Certified ERPermitted or Inspection includes travel and processing)
[I Not Operational Date Last Operated: ............. . . ....... . ..... . ..... . ...... ................... .._......
Farm Name:... sC+ s_ ......i ti..�.3.. �... �_.._.....:r county: ......... ......... .............. .�. �
Land Owner Name:Phone
Facility Conctact:.............. _....... ................. ........... Title: .._ Phone No:
� 7 L
MailingAddress: ` .....�..�......:......D r.:.....l�L}..6..L.Is...t� sr.�^s.......�:..rl:..........................�...�:�s.� u..�.i.�,.e..r...�..L........_.....�:.�'..�...l.....
Onsite Representative:.. ..^, _ ._.. �. ..S3..+� .... _... ...... Integrator:... %j i--. ,.ki _ ............p
Certified Operator:.. ��Q1�.........i ..................HaX.A , KDA..................... Operator Certification Number:. ].U.71......................
Location of Farm:
e?.�....�..n.�.f.......Ss. ..�.._..a ._.....5�.1..$.�.y.....�,._�..�..L-�.�.�..r,�+..a.��.........:.........w...i,.�..�.�a.[.....5.�.!s.�:.�.....�.......t.v.�... ..........
................ ro
...
Latitude '`) • ' it Longitude 1 ®4.
type of Vperation and Insign capacity
Design Current Design Current Design Current
Swine CapacityC.apicity Population. Poultry Ca achy Po ulatiari` Cattle Ca aci Po elation
❑ Wean to Feeder 1El Layer ❑ Dairy
® Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder Dotal Diisign Capacity
Farrow to Finish
❑ 'dotal SSLW 1
Other
Number of Lagoons. / Holding Ponds ? JE1 Subsurface Drains Present
❑ Lagoon Area 10 Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. 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 Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
JZ Yes ❑ No
❑ Yes 0 No
❑ Yes ® No
❑ Yes P No
❑ Yes
El No
❑ Yes
19 No
❑ Yes
® No
❑ Yes
E[No
Continued
on back

Facility Number:
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 9No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ® No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 19No
Structures (LaQoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 0 No
Freeboard (11): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
10. Is seepage observed from any of the structures? ❑ Yes ® No
11. Is erosion, or any other threats to the integrity of any of the structures observed? Yes ❑ No
12. Do any of the structures need maintenance/improvement? ® Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes tzNo
Waste Application
14. Is there physical evidence of over application? ❑ Yes 91 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type.tri.c.,r.!o..ual.p......_.......... m.a-A.�..q.�aa.�a........_-...._..... ...... e.....-..._......
_........_....-_....._......_
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes [&No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes ®,No
18. Does the receiving crop need improvement? ❑ Yes 0.No
19. Is there a lack of available waste application equipment? ❑ Yes ELNo
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 E[No
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ® No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ® Yes ❑ No
24. Does record keeping need improvement? EN Yes ❑ No
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):
\. v-e o f . t I a a..1 t o f b y a u..w-c _ W o Oct i e1 4
i'o �cli.
\1-/IZ• E"L*10 X c-fi ova b0ft, ( oar. walls Sk4vl.o� b2 �rfly� -
ci.
v-e.vc,,.e1 a{o, few. C_o.•ec� eaosi v` cawded J, 5(orw wa��r dr. iv�elC
0" �'6-q o o vc 4f 1. Pr 1 S o i r v i h- e e S o K o v 4-e r w a l l e F l e a ..� i1 f u,-r--d-
Y-c 34 C. of e b r. S p i leg. 1 ri 0.d i. i f i o vt' w.. o �.J L d� D o h l 1 S w k e-o—
h e e. cl v,cf.. r
3. c—file need fo be Ye—ov ^� SP "`/ �e4fS of i cOY�ory
IL4
Fe p l o�.n . R c c 1 c v to 14_ fJ - 1, a l o-.•.- Lj_ {-o (y c c o v E } r-P (, } d �-ct c e t+i n v w. L e, s o �'• S p r r e cc
8
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 7 3
cc: Division of Water Vitality, Water Quatu), Section, Facility Assessment Unit 4/30/97

[3Division of Sail and Water Conservation 0 Other Agency
P Division of Water Quality
10 Routine 0 Complaint O Follow-up of DWO inspection O Follow-up cif DSWC review O Other
Facility Number 1 5 1
Registered P Certified [3 Applied for Permit WRermitted
Date of Inspection
Time of inspection L) 0: to 24 hr. (hh:mm)
113 Not Operational I Date Last Operated:....,,,,,.
Farm Name:
........... T.. ... aY.tr�..... ...�..f. f y Z............................................ County: _./h..........................................
Owner Name ............... D.UM�� ...................``......1' .i a3y`................................---...... Phone No: ,..4 �d. . Z t!e.-� ^ ...........................................
Facility Contact: ....... .............. {:iWi i5nkL .................... Title:................................................................. Phone No:.............................. .. ..................
Mailing Address:.. .s p ...... :.... � i..� �.... .s............ ......................... `..11i G!�...�1iL................................ ....�.
Onsite Representative:..,...-9+�...._i4.ad.W........................ .... Integrator:......k(vq�
Certified Operator,____..._.-.....__...._------ --------- --- ....... I ............. -- - ----- Operator Certification Numbers..__._._•------ ---
Location of Farm:
...... .t1.... P...t.......R.... 5......13E�1...�.�._S..t+tilt....!!�?a'�r... a.......... E.�r... - ..............................................»»................................._........ #
......................................................................................................................................................................-..................................................._..............................................
Latitude • ° 046 Longitude • ' 0"
Design. `Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
R 2
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Ocher
Total Design Capacity
Total SSLW
Number of Lagoons I Holding Ponds ID Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. 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 Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes M No
❑ Yes M No
❑ Yes M No
❑ Yes m No
❑ Yes No
❑ Yes (d' No
❑ Yes (9 No
❑ Yes Wo
❑ Yes No
❑ Yes No
Continued on back

Facility Number: 31 —& $3
8. Are there lagoons or storage ponds on site which need to he properly closed?
❑ Yes P1 No
Structures fLagoons.11oldine Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes (A No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: I 2;_.........
Freeboard (ft): .......... Z I Z• Z.
................. ..... ......................... .......... ... ................. .........._.....-......... _......................
....................................
10. Is seepage observed from any of the structures?
O Yes CA No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes ® No
12. Do any of the structures need maintenance/improvement?
tO 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 Q!7 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
-
15. Crop type ......... _.... K f.h J1 ............ ea l..V�^............................................................................................ .......................................................
...
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes ® No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes No
18. Does the receiving crop need improvement?
[J Yes ❑ No
19. Is there a lack of available waste application equipment?
❑ Yes DM 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
Q No violations or deficiencies were noted during this. visit. You Wlll receive no farther
correspondence about this visit.
Comments (refer to question #):, Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as'necessary):
.,
ll• �vOS 16�� urt�S Ord i /1ntr(6uiry t� i �tt t„�w� I Op �A�PC^ Yf "L 9 v d l0e Fj �,.,1 j,� (• Ur+q .'LSC f�•
Lcarvut o� 4, o,4- d16 wall of lag dE 2 s(,ou� �x n rwee� ga.e ttytgs
ova bof(�
vcVjmy\- att`tlt Walls' S'� J4- be � lwjutr�e�{�I II
�. perMA", Ske'lt) lop lh."lyOv ' M.r- ty&W t'sor. �S SClntuJtAr/ is hu3QY�1`� bermJo,"h
C I
pvu,
( 1 I,,�. pp r 1
z2 • gekmud0. �ic`p jj' S�au« �� in Mwl- kt. ' yi4 L ?"_rsw ih q,,,_
WO,
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: %�q�_ / / _ _ Date: (( h 6 14s,

Site Requires Immediate Attention.:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 'z — 02 7 , 1995 �g
Time: S i /�
Farm Name/Owner:T__ta� ( 1 �-ti' FA-f-AA �
Mailing Address:
County. 42 I t -v
Integrator: f YV Phone:
On Site Representative: c c, Q_ 0ti Phone: - 9,1d t' /
Physical Address/Location:
Mml
1 3 '3�-b
Type of Operation: q wine '� Poultry Cattle t'L�
Design Capacity: :3 7� Number of Animals on Site: -7 ;2,
DEM Certification Number: ACE DEM Certification Number. ACNEW
Latitude: 5 ° 0 Longitude: _77 ° ,�a_' 3�6 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (9 or No Actual Freeboard: __;_ Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes or Was any erosion observed? Yes or �o
Is adequate land available for spray? 0orN0 Is the cover crop adequate? (De or No
Crop(s) being utilized: oQq 'j= m k �( c�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? e or No
100 Feet from Wells? Gbr No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or1
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes Oro
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes �0 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)? es r No
Additional Comments: l off-
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

0
•
Site Requires Immediate Attention:
' Facility No_ __31_= fo"
DIVISION OF ENVIRONRIVIENTAL MANA GEMEti"T
ANRY AL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1 +' ? , 1995
r Time: _ 3' q S
Farm Name/ Owner: ✓� �.tr°rit D S [9n l�
Mailing Address: IcK44 UI ; ,-y f{]r, - 0Gg&"s✓•!Le z d �Tf_
County: �✓ 1 �"'
Integator. - MWi� v► _ _ Phone:
On Site Representative: _ ( /� f Sy►�r Phone:
Physical Address/Locadon: � � �35�1 nn�< r�u.I,c AJ)ayfk Sk OF a
Type of Operation: Swine
qAl i Cattle e Poultry Cat
Design Ca�acity* Number of Animals on
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ' CAD ' '75 " Longitude: -71 ° Siy ' 43 " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lazoon have sufficitm freeboard of 1 Foot _ 25 year 2" hotLr storm event
(approximately 1 Foot - 7,inches) es r No Actual Freeboard: Ft_ Inches
Was any seapage observed from the lagoon(s)? Yes ocp Was anv erosion obse,-ved? e0por No
Is adecuate land available for spry,.-?
Crops) being udhzed:
or No Is the cover crop adequate? nor No
I—, _ d, .
Does the facility meet SCS minimum sezbac cri-te:ia? 200 Feet Lor i Dwe:l�=i�s or No
100 Feet frdrn Wells? �r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Sueam? Yes oreff)
Is animal waste land applied or sprav iligated w-idiin 25 Feet of a LSGS pia + Blue Line
Is animal waste discharged into waters of the statc by man-made d::ch, ushing sys:tm. or oche:
similar man-made devices? Yes or If Yes, Please Explain_
Does the facility maintain adequate waste rnnnagement records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? 0)or No
Additional Comments?
���� � _fed ��- . �•�� ��-, � S-��
Insuector NFL �n:iture
cc: Facility Assessment Unit
Use _ uachmcnts if Needed.

•
s
Site Requires Immediate Attention:
Facility No. 1
DrVISION OF ENVIRONMENTAL MANAGEMENT
ANIlVIAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: % ` �-� , 1995
Time:
Farm M
Mailing
County:
Integrat,
On Site
Physical r,uui--��/Lu�.aukiii.
Type of Operation: Swine Poultry Cattle{
Design Capacity: �% _ _ Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW�
Latitude: ��' &0 ' 26 " Longitude: ��° 5' `J 7 " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 01
or No Actual Freeboard: -3--Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or(9 Was any erosion observed? Yes or o�
Is adequate land available for
Crop(s) being utilized:
No Is the cover crop
No
Does the facility meet SCS minimum setback criteriaT' 200 Feet from Dwellings? es r No
100 Feet from Wells? Ze br No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(&-)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or o
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other �C
similar man-made devices? Yes or , J If Yes, Please Explain.
Does the facility maintain adequate wa management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)I
es far No
Additional Comments: '3 ?�'_ / -Z 2 V �
Inspecto e
fgnature
cc: Facility Assessment Unit Use Attachments if Needed.