310685_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: Q Com nce Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ?n Arrival Time: Departure Time: I�_J County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:�%-
Certified Operator:
Back-up Operator:
Phone:
Phone:
Integrator:
Certification Number: ) q G Z f
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
We to Finish
Desiign Current
Csapacity op.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
can #o Feeder
INon-La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . Poultry Ca aci io ,
I Layers
Dry Cow
Non -Da'
jBecf Stocker
Gilts
Non -La ers
113eef Feeder
Boars
jPullets
Beef Broad Cow
Ot
Other
Turke s
ey Poults
eT
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenp threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No".
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ 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 [Zf o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesVNoo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes❑
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes eNoo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes Ej No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - > Date of Inspection: �o
24. Did thty facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25 7Isthe facility out of compliance with permit conditions related to sludge? Ifyes, check ❑ Yes ]o 0 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 ❑ Yes C rNo❑ 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 d 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
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
ETNo ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No NA
❑ NE
34. Does the facility require afollow-up visit by the same agency?
❑Yes
NA
❑ NE
Reviewer/Inspector Signatui
75c'/,/,7
Page 3 of 3
21412015

Type of Visit: JD Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: URoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:County: 3.LJFL__W Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 19 (.DA
Certification Number:
Longitude:
Design Current
DesigWqr
rrent
Design CurrenSwine
Capacity Pap.
Wet Poultry
Capacop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dry Piaultr,
Ca aci
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
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?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ N [:3 NA ❑ NE
❑ Yes 0/ ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
Page I of 3 21412015 Continued

Vacili Number: j - Date of Inspection- qjjk7jjp
`Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
E_Y_es­[�
�NoD
❑ 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
dNo
❑ 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 V'Ko
❑ 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 [1] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ 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 [3/No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [T No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2"'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [�o ❑ NA ❑ NE
❑ Yes 110—F—j-No❑ NA ❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ❑
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes [.-;Xo
❑ 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 E34o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes N
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes YNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

acili Number: jDate of Inspection: X 1 t (,,
�24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E2rNo
❑ 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
�o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[2"No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[�(No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
dNo
❑ NA ❑ 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
Ca�No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ 1-agoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[—]Yes ❑ No ❑ NA ❑ NE
Yes
/ No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑
Comments (refer t6;4pestion•##):;Explain anyYES answers and/or.any additionahtecoinmendations or any other eomm"ent&l '
Use drawings of facility to.better'ezplain situations (use additional pages as necessary).. ';
fjg
rL-05S
� t
S�a� Ohl - � [,)A LC
CT
i3crcn, C
R-ass
CCU r�_.
Reviewer/Inspector Name:;�.4.)
Reviewer/Inspector Signature:
Page 3 of 3
Phone:191b)
Date:
21412015

Type of Visit: U Coxbpliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:*41 Arrival Time: Departure Time: 0 0 County: D / Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
� 1
Onsite Representative: J a NA�a�l _ _ mi-j— a., Integrator:
Certified Operator: Certification Number: �� f
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current Design Current
Capacity Pop. Wet Poultry Eapscity Pop.
a er
Cattle
DairyCow
Design
Capacity
C►urrent
Pop.
Wean to Feeder
Z
Non -Layer
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
, P,ttnl Ca aci_ P,o
a ers
OTurkeys
DairyHeifer
Cow
Non -Dairy
Beef Stocker
Gilts
on -La ers
Beef Feeder
Boars
ullets
Beef Brood Cow
Other
Other
Turkey Poults
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:)Yes n/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
[:]Yes Vl�b
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Page I of 3
21412014 Continued

Facility Number: - Date of Inspection: hS
Waste Collection & Treatment
4.ils storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):i
5. Are there any immediate threats to the integrity of any of the structures observed?
El
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?
'ronmental
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or7Yes
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
[:]No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ZNo ❑ 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
2fNo ❑ 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
[ o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
];o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
t7 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fait to have the Certificate of Coverage & Permit readily available?
❑ Yes 2f o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ['No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes YNo.
❑ 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 Z�
Zo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes LJ
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Numbe 7A I - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [[J o ❑ NA ❑ NE
251s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes XNo ❑ 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: oll
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 gNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes M No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes do ❑ NA ❑ NE
❑ Yes 0No
❑ Yes EJ/No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes E�Di ❑ NA
❑ Yes �No
❑ NA
Yes ❑ NA
Comments (refer to question #):,Explain any YES'answers and/or any additional recommendations or any other "comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
�TK& IMF 06W
Reviewer/Inspector Name:
Reviewer/Inspector Signatuf
Page 3 of 3
Phoneeq10), C
Date: b
1 �- /1' �-
2;4,'2015
❑ NE
❑ NE
❑ NE

Type of Visit: m Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: f -I f �Lj Arrival Time: ® Departure Time: County-, j� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: � _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
[:]Yes
Longitude:
Design Current
Swine Capacity Pap.
Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pap.
Dai Cow
Feeder
Non-La er
Dai Calf
o Finish
Dai Heifer
Dry
o Wean
r
gnCet
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood CowTurke
er
s
Turke Poults
Other
Cow
o Feeder
D ,laci,
Non-Da
o Finish
La ers
Beef Stocker
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes /No ❑ NA ❑ NE
Discharge originated at: ❑Structure ❑Application Field ❑Other:
a. Was the conveyance man-made? ❑Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
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?
❑ o ❑ NA ❑ NE
❑ Yes � ❑ NA ❑ NE
[—]Yes [1� o ❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facility Number: - Date of inspection: 'j 1H
- I r -
Waste Collection & Treatment
!�. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? cAlyes o ❑ ❑ N NA E
a. If yes, is waste level into the structural freeboard? []Yes No ❑ NA ❑ NE
Structure �I, j Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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 [21/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ YesVNo
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes E?(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes /No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
fNo
❑ 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
YNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
g �No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [:]Design [:]Maps ❑ Lease Agreements
❑ Other-
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
No
[DNA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
[]Rainfall []Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? C] Yes .�o ❑ NA ❑ NE
w
25'. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes 2(Xo ❑ NA ❑ NE
0 Yes E No ❑ NA ❑ NE
❑ Yes F No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes ❑>(� ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or.any other comments.
Use drawings of facility twbetter explain situations (use additional pages as -necessary). .
LA6� �6h s�► gl ,1. Au {EA��
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone "11 ,­11 C ��-
Date: Aq
2/4/ 01

Type of Visit: a70utine
ance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Q Complaint 0 Follow-up Q Referral O Emergency 0 Other O Denied Access
Date of Visit: I i Arrival Time: 3� Departure Timer County:l�p�� Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
OnsiteRepresentative: JoN�4�C�'q�+ �1�L,tf1rL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 1 I (a9
Certification Number:
Longitude:
Swine
to Finish
Design Current
C*apacity Pop.
ltry
fE
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity PoWean
Dai Cow
Wean to Feeder
2.6D
Z
]j
E er
Dairy Calf
Feeder to Finish
IMP P,oult .
Layers
Design
Ca aci_
Current
P,o
Da' Heifer
Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Non -Layers
I
113cef Feeder
Pullets
ef Brood Cow
Turkeys
Turkey Poults
Other
h
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Zf No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [—]Yes ❑ N ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [-]Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes rNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Fac i Number: jDate of Inspection: It a
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?
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
Structure 1 Structure 2
21-
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ YesNA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �Noo ❑ 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 [a No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Z/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
[Z 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
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes � o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �o ❑ 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 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaAlity Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes gNo
❑NA ❑ NE
25.'Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 [� To ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA, ❑ NE
❑ Yes WNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
&�No ❑ NA ❑ NE
�o ❑NA ❑NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any. additional recommendations or any other comments.
Use drawines of facility to better exvlain situations (use additional vaees as necessarv).
Reviewer/Inspector Name:Phone
Reviewer/Inspector Signature: Date: ie
a�
Page 3 of 3 21412011

Type of Visit: (>Corn ance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: 1 9/S" County: IV Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �joNaryA,��i=Q a �.iL
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
}C
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design
Cattle Capacity
Dai Cow
Current
Pop.
Wean to Feeder 7.Qa o Non -Layer
Dai Calf
Feeder to Finish
Farrow to Wean Design Current
Farrow to Feeder D p Ploul Ca aci P,o ,
Farrow to Finish Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
01 Other ill
Turke s
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No [] NA [] NE
❑ Yes �No ❑ NA ❑ NE
[:]Yes CyNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of —inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA&60J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 b
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ 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 21/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment l threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [ 40 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ 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 CNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes E? No ❑ 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
o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
[rl o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
YNo ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
N ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
To ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
do ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�WNo ❑ 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 0 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 N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - &I 5 Date of Inspection: ^ 3
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes d
25. Is'the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? [] Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
Do
❑ NA
❑ NE
[—]Yes
No ❑ NA ❑ NE
❑ Yes []YNo ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
do
❑ NA
❑ NE
No
❑ NA
❑ NE
RNo
❑ NA
❑ NE
VNo
❑ 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). .�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: — 3�0
Date: V 42'L
214720111

0
+Type of Visit: (2j �toutlne
fiance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: $ t Arrival Time: Departure Time: r.5� ,County: 1-
Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: N Aid AX.) t • rjL(_Z JL
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Wean to Finish I ILayer I I Dairy Cow
Wean to Feeder UD 3 vvt Non -La er I Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Current D Cow
Farrow to Feeder Dr, P, Itry Ca acity P,o , on -Dairy
Farrow Farrow to Finish La ers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number:
Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure
�. j�(..J
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 S
Structure 2 Structure 3 Structure 4 Structure 5
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?
�No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes �No ❑ 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 � o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑Yes f o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes 1[
/NNo
❑ 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?
/No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP [:]Checklists [:]Design ❑ Maps [—]Lease Agreements
[:]Yes Q o ❑ NA ❑ NE
❑ YesrNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
[-]Yes [�No
❑ NA
❑ NE
❑ Yes EjN�o
❑ NA
❑ NE
❑ Yes �
[DNA
❑ NE
❑ Yes rN
❑ NA
❑ NE
❑ 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 d_NN0
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes "J
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ Nan -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 E5 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [.%f 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 dNo ❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
❑ Yes
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
M/No
❑ NA
❑ NE
Zoo
❑ NA
❑ NE
N
❑ NA
❑ 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)."
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
�o -- LL Phone:��'j
Date: { 1
21412011

's
Facility Number
ion of WWater Qual.ty ,
ion of Soil and Water Conservation ,,,,,,,_
Type of Visit rRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 9 q Arrival Time: Departure Time: County: r Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailino Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: tjjpj At) (Am L( Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= o = i = LI Longitude: = o =1 =
Design» ,Current 4 -1
5wuie Capacity :Population Wet""Poultry : C
a
,
] Wean to Finish
10 Layer
S] Wean to Feeder
3
7 ao
❑ Non -La er
] Feeder to Finish,
] Farrow to Wean
Dry Poultrv��
Farrow to Feeder
] Farrow to Finish
] Gilts
] Boars
)thee
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
I❑ Turkey Poults
D -Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
Beef Brood
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ICJ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
El Yes 7No
❑ NA
❑ NE
❑ Yes ;No
❑ NA
❑ NE
12128104 Continued

L.
Facility Number: 3 — 9 Date of Inspection 4 9 !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
Identifier: (AC�N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ENo ❑ NA ❑ NE
(iel 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 th5eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 7No
El NA [I NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. El Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V15 ❑ NA
[INE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
dN ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
i.d No ❑ NA
❑ NE
Comments (refer to question #O: Explain any YES answersandlor any -recommendations or•:any other comlii_ents
Use drawings of facility to better explain situations. (use additional pages -as necessary):..vv
a
Reviewer/Inspector Name l _ Phone 714 —
I
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

1_
Facility Number: '31 - Date of Inspection a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2 N El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes CJ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain InspectioVNo
Weather
Code
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
U No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
t�vo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ef'Nd
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ENo
❑ 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?
ElLQ Yes
�'
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
LEI No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
/o
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
Additional Comments and/6i,Drawingsi
Page 3 of 3 12128104

Type of Visit rRoutine
pliance Inspection Operation ReviewStructure Evaluation Technical Assistance
Reason for Visit 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 7 b Arrival Time: qOb Departure Time: County: bLAMIQ_ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: JwAimo n4TLA__
Owner Email:
Phone:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = I = i! Longitude: = ° = 6 0
fg
Design
Current
Design
Current
Design
Current
Swine
Capacity
Papulation
Wet Poultry
Capacity
Population
Cattle Capacity
Population
❑ Wean to Finish
10 Layer I
i Cow
R1 Wean to Feeder
176ZD
ILI Non -Layer I
i Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Da Cow
ElNon-Dairy
❑ Farrow to Feeder
El Farrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
El Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
IF —Other
❑ Turkey Poults
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ N El NA
El NE
❑ Yes
El Yes
p ElNA
ElNE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure] l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (6(1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ENo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ONo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes LA�o ❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes WNo
o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require D Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo
El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[2rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Y
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
7�40
❑ NA
[I NE
17. Does the facility lack adequate acreage for land application?
❑Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
6/No
❑ NA
❑ NE
Comments(referitoiquestion�.#)-Explamtany YE5&answerand/or anyl ommendat�ons or any o#her comments:
+E'd".�s ..i.- y 4"sr.ry..— ... mm f.:;a,
Use drawings;qf facility to betti rQxpiaw srtnahons :{use additional;pages asynecessa17
Reviewer/Inspector Name Phone: 0 7
Reviewertinspector Signature: Date:
Pape 2 of 3 12/2RA4 I tonfinued

r
t
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Lf No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropriate box. ❑ W'UP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
9<0
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
[:]Yes
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Cl YesBNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O No
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
ETN' o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9 o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
3'"Ko
❑ 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
U No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElQ Yes
o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
<o
❑ NA
❑ NE
Additional-:Gommeo
12128104

r
C�
` ==1i=tyN
r-
(M
Type of Visit C
Reason for Visit
Date of Visit:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
a 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Arrival Time: Departure Time: County:
Owner Email:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: [= o = f Longitude: = ° =1
Design Current Design Current
Design Current
Swine
Capacity Population Wet Poultry Capacity Population Cattle
Capacity Population
Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
I 7.aS
2M
JE] Non -Layer I
❑ Daia Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Pullets El Beef Feeder
❑ Beef Brood Co
El Boars
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes d/No []NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[--]Yes
[]No
❑ NA
❑ NE
❑ NA
❑ NE
[]Yes
❑ No
❑ Yes 3 o El NA El NE
❑ Yes�'No ❑ NA ❑ NE
12178104 Continued

Facility Number: 31 —
Date of inspection
�. Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure,I Structure 2 Structure 3 Structure 4
Identifier: U�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 0</0 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNNo90
El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes El 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 No El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo
[I NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes 7NNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
�Comments�(refer�t"o�%questEon #) ,�Eplamtany i�ES�answers`and/or�.ad �,y recommendattops-or any oche"r coruments.
• fig" � �t �z. ,a:'�" .�, r h .
�Use�tlrawrngs of facilrty to�better°explain situahonss�(use'iaddtttoual pagesas ne`� a nary}": ' _ s
�
Reviewer/Inspector Name Phone: 9/6
Reviewer/Inspector Signature: Date: 7 d
A .,o ? _F 2 1217R/OQ C'nntinuod

Facility Number: 31— ,� Date of Inspection a
N` Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ Zo
El NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [I Yes ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design
g p 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 i" Rain Inspectio;/No
Weather Code
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
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 'No ElNA ElNE
26. Did the facility fail to have an actively certified operator in charge? ElYes ICJ No El NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes L1 No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,�,/
L� No
❑ NA ❑ NE
29. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
LI 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
R No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31, Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2"No
❑ NA ❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
ElYes
u4
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
[IYes
LEINA
❑ NE
Additional Co in anrllor Drgwings: _ < 4,�' " �`
Page 3 of 3 12128104

Division of Water Quality
Facility Number ��E
O DiN7sion of Soil and Water Conservation
_ Q Other Agency
Type of VisitC
mpliance 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 Time: 13 u Departure Time: County: �Upl Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 156NATi4A,J iW_rt t k4_
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o =' � " Longitude: = ° 0' "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
® Wean to Feeder I 31-o ?fly
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Capacity Population
❑ Dairy Cow
E]Dairy Calf
❑ Dai Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
M
❑ Yes LI No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o El NA
El NE
❑ Yes
El Yes
❑ NA
❑ NE
❑ Yes
LJ No ❑ NA
❑ NE
12128104 Continued

Facility Number: '3 —Gg5 Date of Inspection �S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
r l 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: LAy-zr1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3i
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
CdNo ❑ 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
environmenta7theat, notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yes
[�/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
,. /
L'J 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 [ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes N
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes 7No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes d o
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes u No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name cr-p J�Ar21J .� Phone: f1 6 . 3
Reviewer/Inspector Signature: 9 Date: y
12128104 ` Continued

Facility Number: Date of Inspection I to 1r o
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ENo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes El'�o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
EfNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El"No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[114o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
M-NO
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[]-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
21NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
a[,' +l�'to
[INA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[l Yes
E No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[Ylo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
�,/
L� No
[:3 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
E] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or
12128104

ivision.of Water Quality
Facility Number 3 6 g O Division of Soil and Water Conservation
. Q Other Agency -
Type of Visit Q Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ORoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: a y Arrival Time: Departure Time: �� County: Region: r �/
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �7,oh Cj �Zaz/ .a �'J�—f _
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: r,
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ 0 0' ❑ Longitude: [� o [= i
Design Current Design Current' ;'Design.
Swine Capacity, Population - :Wet Poultry Capacity Population Cattle Capacity` Po
❑ Wean to Finish Layer
Wean to Feeder ❑ Non-Laye
Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish '
El Gilts
El Boars
Other -
❑ Other
❑ Layers
ElNon-Layers
El Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field ❑ Other
a. Was the conveyance man-made?
lon I
El Dairy Cow
El Dairy Calf
ElDai Heifer
El Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 ❑ No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Apiplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu., Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C �% J
13. Soil type(s)
0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ 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?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better.explain situations. (use additional pages as necessary):
a8 6� 3.0
Z/76� o' 0)
ic✓ o 6(114 (4�j dcn wa-.
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: j dG
Pa,ee 2 of 12 8104 Continued

S
Type of Visit Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: $ oS Arrival Time: 30y S Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: i Title:
Onsite Representative:
Certified Operator: ►.1jlj H;.M1rt_T�6
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o [= 6 0 Longitude: = o= t 0 u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Wean to Feeder ZA a 1.d'a
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ D Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑Yes
Y,o
El NA
El NE
El Yes
1 No
❑ NA
❑ NE
11/18104 Continued

Facility Number: 3 — ` Date of Inspection 3
Waste Collection & Treatment
/No
4. A storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): t 9
Observed Freeboard (in): 44
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes L'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 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. Downy of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ 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 dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s) C S W
13. Soil type(s) AA3 o�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
U6 o
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
[IYes
o
El NA
El 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
[d] o
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
[ No
❑ NA
❑ NE
ia.) i(rE P C4Q-? of cxn.Tx F.Z(_Aix&J L)F wuLA r ijNb Pc_P-mxx kk:m I KC.woj,
(_aGtAYZ;-o dLA=j1FAL4_ AN O 1" L►-SSPELTs
ate.} =4JsT LL, R.Amr-� 6AJ&E,
ReviewerlInspectorName - ,z; zti. ` a Phone�%C)?i5-3`ia0 xz.y3
Reviewerlinspector Signature: WA. jAZn Date: 3 ��5
12128104 Continued

Facility Number: 31 — GiFsiDate of Inspection 3 $ US
Required Records & Documents Zyes
19_ bid the facility fail to have Certificate of Coverage & Permit readily available? ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E(No ❑ NA ❑ NE
the appropirate box. ❑ W-Up 0 Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
ElYes
❑ No
❑ NA
❑ NE
El Waste Application El Weekly Freeboard ❑ Waste Analysis ❑ Soil/Analysis El Waste Transfers
❑ Annual Certification
L�f Rainfall El Stocking El Crop Yield El120 Minute inspections 1/J Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El"Yes
El No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
D No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
E,3 NNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
❑ No
LYNA
❑ 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
❑ No
[2NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
21 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
[I"No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
��,,��
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
[2'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
1X0
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

(Type of Visit 9�Compliance Inspection O Operation Review O Lagoon Evaluabon I
Reason for Visit `Routine Q Complaint Q Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: Time:
/
0 Not O erational 0 Below Threshold
Permitted [3 Certified ©/jConditionally Certified 13 Registered Date Last Operated or AINve Threshold:
Farm Name: -- •.Xtfe r i �M;.......................... County:'�` ..........
Owner Name:
Mailing Address:
..............�_,...._.... ......... Phone No: ..........� . — ---
FacilitvContact: -----._ ............. -................................. ....................Title:......................................... .............. Phone No:
Onsite Representative: •._.----_L�-------------------- --------
Integrator:
Certified Operator....................................................•--................ _................... .................... Operator Certification Number:.... - ..................._.. .
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • ' 46
3
Design Current D6Qn
Swine Cap-dtv Population. ..'Poultry Capacity
Wean to Feeder
Z
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
El Boars
❑ Non-Uj
- ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [] Yes [:]No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ❑ No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: . _._........... ....-- -- -- ......... _._.
Freeboard (inches): Z-7
12112103 Continued

Facility Nurn6er: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
5. 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 maintenanceCmprovement?
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?
I I . Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. 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)
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 queshan #) �Explarn any�YFS�airswers_ dLorip��ecam�eadatious ar aiey3othei comments. a
Use drangs a�f fsc�ity to�be�tte ��x�p'l n simat ons. (use�addit:onW_a_I pages as necessary) � ❑Field Copy ❑Final Notes �
-- �(tet � •(,� �'/QL� f '�` W ��I�CS' ✓d �o�l � DCj G� � �
�r� �' �ecQ� �f� �d�•
k
Reviewer Inspector Name =" F -om--
ReviewerAhspector Signature: Date: `2

Facility Nurter. _7/ - 1,;6n Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WLTP, checklists, design, maps, etc.)
❑ Yes
❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
Cl No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

em'�,,M.
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH:1V
Lagoon Dike Inspection Report
31� �
7
Z
Names of Inspectors Alx�r�
Freeboard, Feet Z
l Top Width, Feet
3; ( Downstream Slope, xH:1V
Embankment Sliding?
Yes
No
(Check One, Describe if Yes)
i
Seepage?
Yes
No
(Check One, Describe if Yes)
Erosion?
Yes
/ No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Yes
""No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed?
Yes No
E
Engineering Study Needed?
Yes "No
Is Data Jurisdictional to the Dam
Safety Law of 1967? -Yes -No
Other Comments

Facility Number Date of Visit: "5F-`s'-'�� Time:
Not O erational Q Below Threshold
®-Permitted ISCertified 0 Conditionally Certified 0 Registered Date Last Operated or hove Threshold:
!Th Farm Name: /1 7�C/yi�t ��* County 14
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
On site Representative: Integrator:
Certified Operators Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a ° " Longitude ' °
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
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 CollertiQn & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
identifier: I
Freeboard (inches): 3 /r
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 'KI No
❑ Yes $A -No
❑ Yes KNo
Structure 6
Continued

:' - t
Facility Number:
. �t3' 31 —6SDate of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XrNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes MNo
(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 9q No
$. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes kNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNo
Waste Application ,tom,
10. Are there any buffers that need maintenancelimprovement? ❑ Yes ,k No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �o
12. Crop type (npnq /, /,4p5- I~ _>Qy
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 29No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
KI No
16.
is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
&No
19.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
JFCtNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
K] No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RjNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
M No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
X,No
(ie/ discharge, freeboard problems, over application)
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
,N No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
W No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
k No
19 No violations or deficiencies were noted during this visit. You will receiveno further correspondence about this visit.
Comments (. [ 9. �a d _.,y�' 4
eefer to question #) Explain iiii (ES answers;andlor any recommendattans orsany ether coMmmenta.,
Usedrawrngs of faeilityto better ezplainsituahon(use additional pages as necessary)❑ Field Copy ❑Final Nc
nsi
Nil i Aee I&A odam° 4keA
Reviewer/Inspector Name r lC
Reviewer/Inspector Signature: Date:
05103101 v Continued

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 attor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes OqNo
❑ Yes Q_No
❑ Yes PSNo
❑ Yes PtNo
❑ Yes A!SNo
❑ Yes KNo
❑ Yes JJ!qNo
O5103101

' 4 von of Water Qushty a
Either A n . F
cY"
z
Type of Visit - f Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit A Routine, O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
F_ Facility Number 5r Date of Visit:
Permitted 13 Certified © Con 'tionally Certified 0 Registered
FarmName: ..... n.................... P%!l.................:...........................................
Owner Name:................. K.............................. 1.
FacilityContact:.............................................................................. Title:..........................
MailingAddress:................................................................................
..........................
Onsite Representative: .-
Certified Operator:
Location of Farm:
El i Time:
Not Operational O Below Threshold
Date Last Oper2tedAr Above Threshold : .............. ..
County:......... Ite... :.....
PhoneNo:.......................................................................................
................................. Phone No:....................................
............................................................................. ........... I..............
Integrator: ......... .ad) d
Operator Certification Number:. ........................................
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• ��°� Longitude �• ����,
Design Current Design Current Design' ni t Curren
Swine Poultry . Cattle
Ca cPo illata. on
Wean to Feeder 0o ❑ Layer ❑ Dairy =
El Feeder to Finish ❑ Non -Layer I I❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other -
❑ Farrow to Finish Total Design Capacity
❑ Gilts
El Boars Tt►taI �SSLW
Number of Lagoons ❑ 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?
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. ............... 13.11� ............................................. ........ ... ........................ .................................... .............................
Freeboard (inches):
5100
❑ Yes PNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
&0
❑ Yes
N0
❑ Yes
A No
Structure 6
Continued on back

Facility Number:?] Date of Inspection Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures obse e ? (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 IgNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes X[No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes KNo
11. Is there evidence of over a3plication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 14No
12. Crop type k, ' L" _23
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes o
14. a Y 9 g PP Does the�facili[ lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination?
❑ Yes
[VNo
c) This facility is pended for a wettable acre determination?
❑ Yes
PNo
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. Fain to have Certificate of Coverage & General Permit readily available?
❑ Yes
r,No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WCJP, checklists, design, maps, etc.)
❑ Yes
VNo
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
PfNo
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
JqNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�ZNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
PrNa
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0 No
Q.tiOlaiigns•ot d�fc!6ncie5 -w' ngted d4rrin ' th�s;*jt; Yo> i'<iil seeeiye Rio flqfthoe
comes atidence: aboiiti this 'visit:. . • .... ... .
'Comments (refer.t�_question #). M Explaui arty YES answers and/or atiy _r�eco uuieudatlons or`any 'otliet com w-v F
_ �.:
Use drawrngs of facility to -better ezpiairi situations (use addrti pages as neresisaiy}�
a
Ul) 40 4
Reviewer/InspectorName
Reviewer/Inspector Signature: ` _ (� % Date: :7_ II _ /}� SAa0

Facility Numlfer: — Date of Inspection 1 aj Printed on: 1/9/2001
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 (�io
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes FTo
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 PO
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 PiNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 9No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNO
h = omments an or rawm
5100

IDivision of Water Quality
p Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection O Operation Review p Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Nunnber mate of Visit: iine: Printed on: 7/21/2000
Q Not Operational Q Below Threshold
© Permitted Certified © Conditionally Certified Registered Date Last Operated Above Threshold: ........
Farm Name: ...................................i�.uK............ County:......-.. �............... .._.....
Owner Name:......... ![..� .......................... ll........................... Phone No:
............ ..........
4
Facility Contact: ... �fYo.................. ...... Title:.... ! ................................. Phone No:...............................
................ ................... ............. 4-N ....... �i ...................... ...........
Mailing Address: ............. ............................................... `..................
Onsite Representat....Q. ......,..`............ ... Integrator:
� 1
Certified Operator:........, .. .
Operator Certification Number: ..........................................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude •° 14 Longitude • 6 «
Design Current Design Current Design Current
Swine Ca aci Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder
❑ Feeder to Finish
❑ FarroW to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer I ❑ Dairy
❑ Non -Layer I I[] Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lajnon Area 10 Spray Field Area I i
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
Identifier: ........... ............................... ......... .............................
Freeboard (inches):
5100
❑ Yes [No
�� a
❑ Yes ❑ No
[]Yes
❑ No
❑ No
❑ Yes
❑ Yes
[!;�TIo
❑ Yes
*Io
❑ Yes Yo
Structure 6 �\
Continued on back

Facility Number: Date of Inspection0�20W
Printed on: 7/21/2000
r Are there any immediate threats to the integrity of any of the structures obs ved {iel trees, severe erosion, El Yes KNO
seepage, etc-}
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ONO
(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 pyer application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMPV
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination'?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available'?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
13: No-061'atidtis of deficiencies were noted during 4his'visit: - Y.
*Will-Teeeive Rio fut her • : •'
corres oridence: ab'tit: 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):
16P
N
❑ Yes - ((No
[:]Yes AfNo
❑ Yes g(No
❑ Yes K$No
❑ Yes ,;t10
❑ Yes No
❑ Yes XNo
❑ Yes gNo
❑ Yes KNo
❑ Yes XNo
❑ Yes VNNo
❑ Yes KNO
❑ Yes No
❑ Yes No
❑ Yes (� No
❑ Yes P(No
❑ Yes. Ix No
❑ Yes % No
❑ Yes XNo
❑ Yes kNo
A.
1 f U' l /r r / Udl/r- _� L %X/GI. - 1 w 1
3
Reviewer/Inspector Name N oer I Y ! / / e
Reviewer/Inspector Signature: Date: 3 (100

Facility Number: Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge AL/or helow ❑ Yes x
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 [XNo
28. Is there any evidence of wind drift during Iand application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes4No
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 PkNo
Additional Comments and/or raMngs:
AL
5100

EM
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH:IV
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Lagoon Dike Inspection Report
KV, 10s, &aLa31-
4-6 2aZ Y31LL Sfil1014 0
51'so" l y\c_ IZ- 8i o t
C�IJ Names of Inspectors
r
Freeboard, Feet z
Jz. Top Width, Feet
3; ( Downstream Slope, xH:1V
Yes `_ No
i
Yes No
Erosion? Yes No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Follow -Up Inspection Needed?
6 as s-& d� _ -
Yes �No If Yes, Depth of Overtopping, Feet
Yes No
r
Engineering Study Needed? Yes -,"No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes ,-----No

Facility Number
Date of Inspection
Time of Inspection 0 24 hr. (hh:mm)
p Permitted M Certified p Conditionally Certified 13 Registered 113 Not Operahona Date Last Operated:
Farm Nante: ............. __........................................................... County: Duplin WIRO
Owner 1\Tame: Attp.Id-.. Herring ................................ ........... ..... ...... Phone No: 919_56B 3989..............................................-----.......
Facility Contact: ................................................ .Title:........................... . Phone No:.............:...
Mailing Address: 292.B&S:utton.Road......................................................................... Albertson..N.G....................................................... 285OX ..............
Onsile Representative:
................. Integrator: Goldsbnru.Hog.Farms.......................................
Certified Operator: Marshall.S........................... Rritt................................................... Operator Certification Number:19.629.....................
Location of Farm:
a,Ete.H . Q ;r axtbl.lrotn.Ker�axts�ille,...)CIx m,lri, b� am; Q Sr.a ....
:: arml,is,Q�7,.mAl s;,an;s uth it ;oaf: �a:::::::::::::::::::::::::::::......:: —
w
Latitude ©• ®° ©�� Longitude ©• ®� ®i�
esign Current ... esign Current-_ esign Current
Swine _ Capacity Population- - Poultry Capacit} 'Population --Cattle _ Capacity Population-
.N Wean to Feeder
3200
❑ Feeder to tuts
p Farrow to Wean
❑ Farrow to Feeder
p Farrow to Finish
❑ Gifts
Boars
f L❑u surface Drain Lagoon Area ❑ PrayField AreaNumber o
Holding.Ponds I Solid_Tra;s ❑ o Liquid Waste Management System -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon p Spray Field p Other
a- If discharge is observed, was the conveyance man-made? ❑ Yes © No
b- If discharge is observed, did it reach Water of the State? (If _yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes []No
2. Is there evidence of past discharge from any part of the operation? p 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 p No
Structure I Structure 2 Structure 3 Structure 4 Structure 3 Structure 6
Identifier:
Freeboard(inches): ...24...............................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes p No
seepage, etc.}
3/23/99 Continued on back

Facility Number: 31-685 Date of Inspection
6- Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
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?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
a • N0:viditatiorts:or. rlaficieicies.were.t �nte'di.duringA' is visit..You: wvill:recervir na further- ::::
.. ....... ... ... ... .. .. ...
:-:��or'xes�viideuce.aboir�this:visit:•:�:-:•:•:�:•:•:•:•:•:•:•:�:�:•:•:•:•:�:�:�:�:•:•:•:•:•:•:�:�:•:•:�:�:•:
urrrcane
w
ient freeboard available. No problems observed.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes p No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[]Yes ❑ No
[]Yes ❑ No
❑ Yes p No
❑ Yes [:]No
p Yes p No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes p No
[]Yes ❑ No
❑ Yes ❑ No
[:]Yes [:]No
p Yes ❑ No
Reviewer/Inspector Name Fatrick:Eussell Richard ]Vloore (DLQ) - = _
Reviewer/Inspector Signature: Date:

Division of Soil and Water Conservation - Operation Reviews
- _ E Division of Soil and Water Conservation -Compliance Inspection
- Division of Water Quality - Compliance'Inspection
--Other Agency - Operation Review k
Routine 0 Complaint 0 Follow-up of DWQ ins ection 0 Follow-up of DSWC review Q Other
S Date of Inspection G
Facility Number is Time of Inspection 1117() 24 hr. (hh:mm)
0 Permitted Certified 13 Conditionally Certified Registered Not O erational Date Last Operated:
n` [
Farm Name: .....e1't c ... \+tL�G............. County:... l l
j...........................................................
Owner Name:-....��!'�...... Phone No:
!^'.� �.............................................................. ...........................
Facility Contact : ............ .. Title: ................................................................ Phone No:................. .... ... ....-.............
MailingAddress: ........................................................................................................................... .......................... ..............................
Onsite Representative:. ................... lntehrator !...............................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude ' 4 64 Longitude ' 4 "
Swine Capacity Population
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry Capacity Population Cattle Capacity Population
❑ Layer I ❑ Dairy
❑ Non -Layer I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
bsurface Drains Present ❑ Lagoon Area ❑ Spray Fi
Number of Lagoons ❑Sueld Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If dischar-c is observed, was the conveyance ratan -made?
h. If discharge is observed. slid it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any 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?
Structure I Structure 2 Structure 3 Structure 4
Identifier: AR�5'
Freeboard (inches): ..........
❑ Yes CYNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes NNo
❑ Yes tgNo
❑ Yes XNo
Structure 5 Structure 6
.................................................................
116/99 Continued on back

Facility Number: — S 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? 4 ❑ Yes O 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 f No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
❑ Yes
JYNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
gNo
11.
Is there evidence of over application? ❑ Ponding ❑ NiErogen
❑ Yes
No
12.
Crop CSr
a
type ...........t `'1��.
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
( No
14.
Does the facility lack wettable acreage for land application? (footprint)
❑ Yes
"No
15.
Does the receiving crop need improvement?
❑ Yes
XNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
VNo
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
O No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
J'No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
JONo
21.
Did the facility fail to have a certified operator in responsible charge?
ElYes
W No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
IgNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes allo
24. Does facility require a follow-up visit by same agency? ❑ Yes ['No
No
XD'violations ar. deficiencies .were noted d'uA'ng .tliis.visit:. You will.re�ceive na further.
etirrespo�.... . a.. . .this v.: ; ; _ _ . • :...:. . ...:.: .
Comments (refer to question #): Explain any YES answers and/or anyrecommendations;or any other comments.. x1
Use drawings of facilityto better explain situations. (use additional pages as.necessary)
`� t-t� tie►-st CA-� tt� c�ao—,
Reviewer/Inspector Name
Reviewer/Ins ector Signature: Date:
P g - G 1/6/99

0 Division of Soil and Water Conservation ❑ Other Agency
0 Division of Water Quality
10 Routine O Comnlaint O Follow -Up of DWO inspection O Follow-up of DSWC review Q Other 1
Facility Number 3 S
©Registered M Certified 13 Applied for Permit U Permitted
Farm Name: �\.. of e
.....................................
OwnerName: ...... ................\..............................................
Date of Inspection
I Time of Inspection Ems_ 24 hr. (hh:mm)
© Not O erational Date Last Operated: ..........................
County:....... ........ p�)...................................................
......... Phone No:.... �`�a.:... 56 B _'.: 9 0 1
...........................................
Facility Contact: ..................................................................... Title• . Phone No:
.. n q
Mailing Address: ...0�a ....1.L`................... ............ °`......c.4..4.1�........................................ ................
Onsite Representative:....0!�c....!~?.... ........... Integrator:... Q�d bC ±rq..." ...................
Certified Operator................................................................................................................ Operator Certification Number .........................................
Locati of F
U..........ii...................................``..._.._........_...........�3....... ........................... !^ ►�-+' t1.............. �............... .... ......... ....... .
,.�•....� �.6........ .................................................. ....................... ,
Latitude 9 1 46 Longitude • 0` 64
General
1. Are there any buffers that need maintenancetimprovement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes t4 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes U(No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑Yes (No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes UrNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 14 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes t4 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [.. 4 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes [X No
7/25197

1
Z
Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes A No
Structures (Lagoonsfflolding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 12INo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
.................................................................................................................................................................................................................
Freeboard(ft):...........................................................................................................................................
..... a ...................................................
10. Is seepage observed from any of the structures? ❑ Yes [XNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 09 No
12. Do any of the structures need maintenance/improvement? P4 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 M No
Waste Application
14. Is there physical evidence of over application? ❑ Yes (9 No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop typewf.S........................................................................................................................................ ..................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 9No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes [2fNo
18.
Does the receiving crop need improvement?
❑ Yes
UNo
19.
Is there a lack of available waste application equipment?
❑ Yes
14 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
[N�No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
D<No
22.
Does record Keeping need improvement?
MYes
❑ 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
IgNo
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
KNo
0 • No.viQlatiorts°or deficiencies: were -noted during this:visit.- You:Will recei've-no further
.•correspondence abouE�this:visit:�::•.�:-:-:�: . : ..-:;: :•; .-:•:•;-:•:-:•:: . :•::•:�: .. :•
12� Cues ►- e,�
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

DSWC Animal Feedlot Operation Review'
DWQ Animal Feedlot Operation Site Inspection r
Q Routine 0 Complaint 0 Follow-up of DWO inspection 0 Follow-un of DSWC review 0 Other
Facility Number �
Registered 03 Certified 0 Applied for Permit E3 Permitted
FarmName: ........ ......................................................
Date of Inspection L4
Time of Inspection Q_!G 24 hr. (hh:mm}
113 Not Operational Date Last Operated
Cou ntv:........R.tt!ijfn.............................................................
Owner Name:....... Irte�!r1r1r�................................................ Phone No:..��1�Q.}..'i.:.��.Il.............................................
A- ...........(..-. ...... .....
Facility Contact: ....L`W!t�....1'k Y........................................ Title: ........Ay,In„ Ar....................................... Phone NO: ... .........�. t .' .�i�ti..........
1[ailing Address:... L..... iti ...... st1}�ix�.. ................... l�te S ....i..l.J.t.......... nm. .........
f' ....................................... .
Onsite Representative:......W.Wyw........ A.f: i'ver................................................ Integrator6,t!
Certified Operator;................................................................................................................ Operator Certification Number ........... 19...............................
Location of Farm.
Ta...............�(....� e.......+sac............ .... i)..... wy.S ..:rurn.... �rtr�........OA ......SSA ..! ...(o. �..... cur,,,......;...... a.. i ....+!►t....S-
e+ ... ... dc.... (r►...\41........................................ .....
Latitude Longitude
Design Current
Swine Capacity Population
Wean to Feeder
7,7
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
.Design Current Design.. Current;;.::
Poultry Capacity Population Cattle Capacity, Population
❑ Layer 10 Dairy
❑ Non -Layer 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW L
Number of Lagoons / Holding Ponds ❑ Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
[[]No Liquid Waste ?Management System
General
I. Are there any buffers that need maintenance/improvement?
❑ Yes
[%No
2. Is any discharge observed from any part of the operation?
❑ Yes
10 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 Surface Water'? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in �'Tal/min?
N
d. Does discharge bypass a lagoon system? (If yes. notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
( No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
[9 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
mai ntenancelimprovement`?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
{ No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
C9 No
7/25/97
Continued
on back

Facib!y Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 9No
Structures_(Lagoons,Holding Ponds, Flush Pits, etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes [d No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard .........'.......................
(ft):..................... ................................... .................................... ... ... ............ .................. ....... I ........ .—................
.....
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? ElYes [ANo
12. Do any of the structures need maintenance/improvement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes ® No
Waste Application
14. Is there physical evidence of over application? ❑ Yes H No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ................ ...............:............. ............ .Y.& .............. ...................................................... 4......................... .......................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? t@ 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 5 No
19. Is there a lack of available waste application equipment? ❑ Yes 91 No
20. Does facility require a follow-up visit by same agency? $Yes 19 No
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes IC 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
2�Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ❑ No
0 No.violations or deficiencies were-note'd du' ring this:visit.- Nou.will receive no fort er
correspondence about this:visit:-
Co invents (riifer to,question #) ;Explain any'YES..answeis and/or any rer6mme6dattons or any other co' nments
Use drawings of facility t6better explain:srtuations (use additional pagesas
t�
V. 1,%V r 9 oue�te (cLgorr. ,,a4(fs skodij W-4A. AL !
I (o• S�es�S ta3elrt. � �G.�.l-C� i r 5� h � l�S b uT �� � i s�•ta (+� �ax�i {�i <� `� �ah . Caron c�'
bilk J So.1 &J 004tv or Go( s boCo { kS f r
zz--. Sit" r [iGr-jjOS
t�t-ob��1ra aS� sesri�l�S -.W3 6-p-, �61
�(�isee Vi�her, a*[P Nlumber .v +r4h61ancurS
k0tm p�}hdA t) »0Ci(AZ St±h0 tole 41 Rz l� ItJ
lvwl� 1t'+n sketjtir —TXy AH19 &4 io cah cr
of ,�Sset s sfiovld be in �. rr ii,l 1
Z4. hJo sprm ceG�� Or\ sih ar �i" Of it'ifrc,C &V- StP4 ('LCU k SWbe �71125107
Reviewer/Inspector Name rs
Reviewer/Inspector Signature :���� Date: A !i'1 / 7h -7