310760_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

Type of Visit: mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: qArrival Time: Departure Time: County: 11 t7 Region:��
Farm Name: g� ' 1]L�i''_L �'� r' "ZI Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: h�� }"J,�- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I I I - _3
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish I
Design Current
Wet Poultry Capacity Pop.
I Layer I
Cattte
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
jNon-Layer I EE]
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P,oul_ Ca acit P-
,o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -La ers
Boars
Pullets
Other
Other I
urkeys
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 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 0 NA ❑ NE
[—]Yes [:]No
[—]Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili ` -Number: -11 LLD jDateof 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 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
(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
bNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [:]Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ 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 �V0 ❑ NA ❑ NE
maintenance or improvement?
Waste Api3tication '
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Yo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [�+J o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
k No
❑ NA
0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
aCNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements El Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes
ElWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers�TNO
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FaciliNNumber: 1 - n 14 n Date of Inspection: I -)l% I f rM
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ix No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes M 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 ONo
❑ 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 IXNo
❑ 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 M 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 [4No
❑ 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 Qf No
''��V9
❑ 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 a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain;any YES., answers and/or any additional recommendations,or,any other comments..
Use drawings of facility to better explain situations (use additional pages as necessary).
�- -Pew bars S� 0� Vy) AP wail
51,,E die v� d,+�' � � � o1
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
,r AMA.
Phone: f,Q-714
Date: I i
2144015

F-- }
Type of Visit: JO Com nce 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 0 Denied Access
Date of Visit: Arrival Time: © Departure Time: 39 County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: i 1 ( < ^ � Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Certification Number:/ (� 7
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Poultry C•apaeity Pop.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
W an to Feeder
Non -La er
DairyCalf
eeder to Finish (�
Farrow to Wean
{�
Design Current
Dai Heifer
D Cow
Farrow to Feeder
Dry Ploult , Ca aci P.o ,
Layers
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other T
7 MF70ther
Turkeys
Turkey Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 U_hlo ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes ❑ No
DNA ONE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �j`NoE]
❑ NA ❑ NE
El Yes NA ❑ NE
Page 1 of 3 21412015 Continued

R
1•acility Number: -76,0 Date of Inspection: 2 l
as e o ection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EErNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA 0 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
(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 10 ❑ 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 E]IN 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 ❑ N [DNA ❑ 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 0 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
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0j)
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Fj No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I ]-lqo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[3Yes
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 ❑PTO ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M.
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes r!�No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

4
Fac' ' Number: - Date of Ins ection: 2_ ar
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [. Io ❑ 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 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 Vo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes EJ446--❑ NA
❑ NE
C©mments'{refeTtoquest�©n #).EgplainanyY)rSganswers and/c►r anyaddit�onal:3recouunendations oranyother,1cornmeuts:*..
LTse�drswrn � :: .,� � >
fsci[�ty�to,�bei#er�expl�m,sitaatLons
gs of � (use�addih©naE pages�as�n�essa...
� ��
Reviewer/Inspector Name: QL' `�
P
Phone: p (0 7 73 f
Reviewer/Inspector Signature:
Date: /Z
L66
Page 3 of 3
21412015

I ype of visit: (> Co�oufine
a inspection U operation Review U Ntructure Evaluation U technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1A
( Arrival Time: �f Departure Time: J T County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
r
Region:
Facility Contact: Title: Phone:
Onsite Representative: �� ll r a L n Integrator:
Certified Operator: Certification Number: 7,7
T
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
C**specify Pop,
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
]Non -Layer
Dairy Calf
Dairy Heifer
Feeder to Finish 3 r< 7 g
Farrow to Wean
=19sin
Current
Dry Cow
Farrow to Feeder
I) , P,oultr. C•_a aci P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
01
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 EZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Qlj1,o
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili Number: V I - 7G 19 jDate of Inspection: % t
,Waste tollectio n & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ea-t-To— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L i
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 CZrNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t rest, 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 ❑ N" o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
rNo,❑
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
F NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
D 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 En"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V Rainfall Inspections ,❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes��Lj NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 1C, 0-1 Date of Inspection: tl
•24. Dia the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑<0 J NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes /❑' oo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes P'No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

6
Type of Visit: 0 Co pliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: } Arrival Time: Departure Time: Q 3C> County: k-UV Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: A u_ey 6"c t Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: I I 1 -] 3
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
I
Wet Poultry
ILayer IDairy
Design
Capacity
Current
Pop.
Design
Cattle Capacity
Cow
Current
Pop.
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
D . P,flul
Layers
Ca aci
P,o
Dry Cow
Non -Dairy
Beef Stocker
Non -Layers
1 Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 ❑ ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
[:]Yes VNo ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection: it ( r
Waste Collection & Treatment
'�. 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
Identifier: (..A0001")
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4 Structure 5 Structure 6
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
[—]Yes E2No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 D40 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1Vo ❑ 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 IFrNo
l ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ ❑ NA NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ 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?
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 E3 No
[] Yes To
❑ Yes g�N
❑ Yes
❑ Other:
21. 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 Inspectionss ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [/J o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

[Facility Number: - Date of Ins ection: l4
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes WNo
o ❑ NA ❑ NE
14
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 EfNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes j(No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [3lo
❑ Yes No
❑ Yes (.7No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [/]No ❑ NA ❑ NE
❑ Yes No
❑ Yes Fn<o
❑ Yes ;3/No
[DNA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any, YES answers7and/6r any. additional•`recommendations ©r'any.4ther comments "—
Use drawings of facility to better explain situations (use additional pages as accessary)..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone 1b -,?3 ve
Date:
2/4/2 r4

Type of Visit: 4@rCompfiance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: §2Ktoutine Q Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: #- Arrival Time: Departure Time: 3: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: Integrator: n
Certified Operator: �V�[� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
11
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
INon-Layer
I
Dairy Calf
Feeder to Finish
R5
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design t►urrent
D . Paul. Ca aci_ P,o ,
I ILayers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
Turke s
Turkey Poults
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 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 KNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:)Yes [:]No
[:]Yes O�No
❑ Yes ONO
❑ NA ❑ NE
❑NA ❑NE
❑ 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 0 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3
Identifier: W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�j
Structure 4 Structure 5 Structure 6
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
❑ Yes oNo ❑ 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 7, No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes I /I No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T'
9. Does any part of the waste management system other than the waste structures require [—]Yes VfNo ❑ 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? 10
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes rNo
o ❑ 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 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ 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 ;ZNo ❑ 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 ff No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes qNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

;i.
Facility Number: - Date of inspection: —IT 13
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes WfNo ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes K] No
❑ Yes TdN_ 0
❑ Yes [�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes VfNo ❑ NA ❑ NF
❑ Yes o No ❑ NA ❑ NE
❑ Yes 91 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes XfNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes P No ❑ NA ❑ NE
Reviewer/Inspector Name: A,,- �h�����
Reviewer/Inspector Signature:
Page 3 of 3
Phone:� vc��
Date:
21412011

Type of Visit: Acompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ] Sa County:.
Farm Name: �Ac2�1U1.(_{ �tU i c.� JAC.�56�?RNI Owner Email:
Owner Name: C� S,�,L }cal Phone: a
Mailing Address: $ �Li;�p Gl C� ��- �� , NC O 0 3 - -
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: A(,LF-A1 1RCaL1� Inte rator:
(� 301
Certified Operator: u J 12 �G� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region:
Design Current
Swine C►apacity Pop.IffPoultry
Wean to Finish
Design
Capacity
Current
Pap.
Cattle
Da' Gow
Design C•arrent
Capacity Pop.
Wean to Feeder
Feeder to Finish-3(DairyHeifer
La er
ll . P,oul
Design
Ca aci
Current
l;o ,
DairyCalf
D Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
jOther
Dischar es and Stream Impact
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 1ANo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes$:o
❑ NA ❑ NE
Page I of 3 21412011 Continued

FacilityNumber: jDate 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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t�
Spillway?: c
Designed Freeboard (in): , 7
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes A 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 ❑ NA ❑ NE
waste management or closure plan?P�_No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 4
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 ANo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
'P_
❑ 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 [Wiindow/ [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): S � \?::'ea l g) --- -- -
13. Soil Type(s):
r r
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.
D WUP ❑ Checklists Q Design ❑ Maps ❑ Lease Agreements
❑ Yes )iNo
❑ Yes No
[:]Yes {[ No
❑ Yes No
❑ Yes o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes
o
❑ NA
❑ NE
❑Yes
tNo
❑ NA
❑ NE
[3Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Waste Application 0 Weekly Freeboard [] Waste Analysis 0 Soil Analysis ❑ Ate TransaTers
[�] Rainfall [] Stocking Q Crop Yield E] 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
[DNA ❑NE
Q Weather Code
Q Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: 'RI�
\.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rNoo
❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
'VJNo
❑ NA
❑ NE
❑ Yes
❑ No
95-NA
❑ NE
❑ Yes f No
❑ Yes No
❑ Yes No
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes gNo
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: V 6 11 G-
Date: 81 MAP
21412011

r
type of visit: Compliance Inspection U Vperation Review U. Structure Evaluation U Technical Assistance I
Reason for Visit XLRoutine 0 Complaint 0 Follow-up 0 Referral , 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 Arrival Time: Departure Time: County: Region:
Farm Name: Q ►RLX-C_� PU I Ck Ji;C zSCW G42 AA:0 Owner Email:
Owner Name: CP4QS QU_ J ACIC-SCN Phone: 919 10Q
Mailing Address: 1 1 o S L-e LA, C" e 1L c2 � Cn� C� U� INC—
Physical Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Phone:
Certified Operator: er � � Ctificate 1 Number: C-41
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Prop.
Design C►urrent
Wet Poultry Capacity Pop.
Lay er
Design Current
C*attle Capacity Pop.
Dairy Cow
Wean to Feeder
]Non -Layer
Dairy Calf
Daig Heifer
Feeder to Finish
3rj
Farrow to Wean
Farrow to Feeder
Design Current
Dr. I;oul_ Ca aci P,o ,
Dry Cow
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Points
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ 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

Fa ,ill ,Alj4mber: - 1 Date of Inspection:
Waste Collection & Treatment
�[
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
T❑
❑ 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
(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
[XNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
N[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 Manurc/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
&
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? [:]Yes UA No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists 0 Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 0 No
❑ NA
❑ NE
❑ Waste Application 0 Weekly Freeboard Q Waste Analysis Q Soil Analysis
❑ Vste Transfers
❑ Weather Code
Q Rainfall ❑ Stocking Q Crop Yield 0120 Minute Inspections Q Monthly and V Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Fa - Number: { - i= I Date of Inspection: 9 111
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes C'6,No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes rjNo ❑ 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 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
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 M No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
0 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
kfNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [Z No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments:
Use drawings of facility to better explain situations (use additional pages as necessary).
w• A.
C�
DC)N 7-
�1 Sv1 L S�MP�E
_._
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
ES
s��ma,
Phone: c)-'�5a�3��
Date:I/d/i
21412011

�. � Division of Water Quality
FaciHU".UM1xerjI'3 `� O Division of Soil and Water Conservation
Q Other Agency
Type of Visit A
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival
�Time: ® Departure Time: �� County: U N Region:
Farm Name: Ci ►WOLL 4- ��t�t '�L` ``,Pr5� 1{`AQftX# Q Owner Email:
Owner Name: CAQ 0�_ �adcsdV Phone: 919"I 35- ILI&O
Mailing Address: 1 tS &-EEP�_ ��Q �u� � �`y1 AC ��13 Is
Physical Address:
Facility Contact: ,,�� �} Title:
Onsite Representative: H �C—.A/ Ego C.v�
Certified Operator: • ?., (LpCIC
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
16
OperaorCertification Number:
Back-up Certification Number:
Latitude: = o = i = Longitude: = ° 0 4
Design Current Iesign
Swine Capacity Population Wet Poultry acity
❑ Wean to Finish ❑ La er
Current
Population C►attle
❑ Dai Cow
Design
Capacity
C►urgent
Population
❑ Wean to Feeder
❑ Non -Layer
❑ Dair Calf
Feeder to Finish L4
Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers
❑ Gilts Non -Layers
❑ Daia Heifer
❑ Dry Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
❑ Beef Brood Coixi
El Pullets
❑ Boars
❑ Turke s
Other ❑Turke Poults
❑ Other ❑Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes x No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
No
❑NA
[I NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes YNo
❑ Yes ANo
12128104
❑ NA ❑ NE
❑ NA ❑ NE
Continued

Facil41 Number: 3 1 Date of Inspection LyQ
Waste Collection &Treatment �..,(
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes �J No ❑ NA , ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes /❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier: G A AGO AI
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 KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 9
9. Does any part of the waste management system other than the waste structures require ❑ Yes XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 4No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) NA0tF0C4C- CL&CN
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
XNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES 1. answers and/or any recomtnendation&or any other comments_
Use drawings of facility to better explain situations. (use additional pages. as necessary) a
Reviewer/Inspector Name iJ 1cF(o-130
(Yl ,��� Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Faei'.ity Number: 3 1 Date of Inspection luwil
Required
Records & Documents
i9.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box. 0 WUP ❑ Checklists 0 Design 0 Maps El Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑)/aste Transfers ❑/nual Certification
El Rainfall 0 Stocking 0 Crop Yield ED 120 Minute Inspections [] Monthly and I"
Rain Inspections El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
;gNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ANo
❑ NA
[INE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El
No
4
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes]
No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Qualirv.
Fac�I�ty Number' 0biAsion of Soil and`Water„Conservafton� i 4
. .�., her Agency x
Ot � I
Type of Visit 'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit tKRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: `l___.� Departure Time: County: k Q/{� Region:
Farm Name: �e(LOL L q- A U I CE _ fiCIC S OV_ i4� l�� Owner Email:
OwnerName: <!AaaCy{-L JgGC Soar Phone:
MailingAddress: ®2 �L5-- `� • / u C
Physical Address:
Facility Contact: Title:
,/�
Onsite Representative: 'E 1L � G (� n Al L cr—, C
Certified Operator: ,
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: -!
Back-up Certification Number:
Latitude: = o = I Longitude: = ° = 1
Design-- Cnrrerit• = ©esi
Swine Capacity Population Wet PoultryCapac
❑ Wean to Finish ❑ La er
El Wean to Feeder ❑Non -Layer
Feeder to Finish
...�
Farrow to Wean
Dry Poultry
h:: ❑ Farrow to Feeder g° "
❑ Farrow to Finish
❑ Gilts
❑ Boars
.Other
❑ Other r
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischartles & 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)?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood {
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 X No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
x No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Niimber: 3
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 1q.
Observed Freeboard (in): 3
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 XfNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes ANo ❑ 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 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes )I No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes kNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes No El NA El NE
maintenance/improvement? 16
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes A 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 Windo/w., ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)�(�
13.
Soil type(s) /VQ (twtx CpLpS(3gF_4 LL4cLA,
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Pq No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
)Q No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
JQ No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
9-No
❑ NA
❑ NE
J'F 1 Gi J. a
LjoT10 • �
Reviewer/Inspector Name (�'?A j�(a� C�1111 f g T —_^ Phone: 11d �q(p=3ol T
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: 3 f Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
ElYes
XNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropirate box. 0 W UP ❑ Checklists 0 Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[ No
❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑/aste Transfers
❑)(nnual Certification
O Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
J�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
y No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
yf No
❑ 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
.0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
N NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
10No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
91 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
jo 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
1KNo
❑ 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
EfNo
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality`
Facility Number L�—� 0 Division of Soil and Water Conservation
--- --- Other Agency
Type of Visit ) jxxCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Y� Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: %� Region:
Farm Name:
Owner Email:
Owner Name: C A Q-(IOL L '�, R CY-- SON Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = o = Longitude: = o =, =
Desi n Current`' Desi n CurrentDesi�n"#�Cu rr enter
g g . �� g s
Swine " ` Capacity',Population Wet Poultry :.Capacity Population Cattle:Capacity: Population.
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder JEJ Non -Layer
%Fee to Finish :
❑ Farrow to Wean Dry Poultry.
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other.-
[] Other
❑ Da4y Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cod
I
Number of strudtures [
-- - - - —.
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
0
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�io
El NA
El NE
❑ Yes
❑i'l�li o
❑ NA
❑ NE
12128104
Continued

Date of Inspection
Facility Number--3 j (��
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
WNo
❑ 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
II
Identifier: LA GCXQPI
Spillway?:
Designed Freeboard (in):
n
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
WNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
IM No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
.0 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
q No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
ElNA ElNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ 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):
Reviewer/Inspector Name I AI!;:5 Phone:
Reviewer/Inspector Signature: Date: �- d
Page 2 of 3 12178104 Continued

Facility Number: 3 1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ANo ❑ 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Dd No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑Yes "No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[gNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[KNo
❑ 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
MNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
N No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[XNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[$ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
IkNo
❑ 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
[ANo
❑ 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
[KNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[XNo
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12129104

Division
Facility Number 3 +
of Water Quality
Q Division of Soil and Water Conservation
R
- -- — -
0 Other Agency
Type of Visit Q,.,00mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit t0 Routine 0 Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Q 5 a Arrival Time: / Departure Time: �] County: Avp&� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: �1 ' ,, Title: Phone No:
Onsite Representative: A Wes/1 �Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o Longitude: = ° = A
Design 'Current: Design Current;; _ `Design
Swine Capacity Population Wet Poultry Capacity Population Cattle --.:Capacity
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -Layer �a
® Feeder to Finish 3e✓7 +� �.
v
❑ Farrow to Wean D Poultry ,
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars77
i
- — — — - —�
J Other
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number. of Structure
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 l of 3
❑ Yes Cl/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[�] No
❑ Yes
L1N
❑ NA
ElNE
ElYes
No
❑ NA
❑ NE
12128104 Continued

Facilify Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[I'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: CA 61"N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):9
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2 No
❑ NA
❑ NE
(iet 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?
El Yes
� No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
11 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
ElLI Yes
��
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ldNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 136,4) � c d
13. Soil type(s) Wd-&-ra L K LucV 64L0JA60A-0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Ej-'No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question ft Explain any. YES answers and/or any: recomrAendations.or.any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I Phone: Y 8) /7b S X
or
Reviewer/Inspector Signature: Date: 0
Page 2 of 3 if12128104 Continued

%0
Facility Number: I— Date of Inspection a
-Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ W`UP ❑ Checklists ❑ Desi gn ❑Maps El Other
❑ Yes ;No
N ❑ NA El NE
❑ Yes ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
2 No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B No ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VW0 ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ICI ❑ NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
No ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I4 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
UK
❑ 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
EJ-14o
❑ 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
20IN5o
❑ 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
ICJ5 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
U�<
❑ NA
❑ NE
Additional Comments and/or Drawings:
z
Page 3 of 3 12128104

IType of Visit f0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f!7 / Q Arrival Time: �,'� Departure Time: 3; ounty:
Farm Name: B nj2— Owner Email:
Owner Name: PLG f T ✓yL'/'y e'�,�nJ Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: f�LLf / lZolCl;
Certified Operator: _ 1 4 do / QGL^%
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
�o
Latitude:
0/1) Region: WA20
one No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La ei
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Longitude: 0
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
EFDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: F/11
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 YfNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
- ❑ NA
❑ NE
❑,Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
AxNo
El NA
❑ NE
El Yes
❑ 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 PNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No •
❑ NA ❑ NE
St rµcture l 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
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
'VNo
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 oft he structures need maintenance or improvement?
❑ Yes No
❑ NA ❑ NE
/0
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes [�No
❑ NA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA ❑ NE
maintenance/improvement?
`
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes XNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [I Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop W* do ❑ Evidennci
e of Elind Drift pplication Outside of Area
Z �i m',e6
12. Crop type(s) - A16! V.640'
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 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
/0
El Yes ANo
❑ 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
Comrrents (refer to question Explam,any YES answersand/or any recommendationsr any�Cotercomments
Ukse drawmgs:of facility to better ezplam situattonsl (use addthonal pages as necessary)`Rc`'.''�sxa'
20 �� L•or Fs C��.o�r.�, �,�.��
7 ; .f�.�Ro
n
Reviewer/Inspector Name �/ Phone
Reviewer/Inspector Signature: Date: /� B
12128104 Continued

[ . ,r
Facility Number: Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes rONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El,IGI Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 XNo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 17No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes Jam-' No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 0No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ON
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes )ZNo
❑ NA
❑ NE
Other Issues
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes YJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ;dNo
❑ 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 XN.
❑ 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 VNo
❑ NA
❑ NE
32.
General Permit? (iel discharge, freeboard problems, over application)
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes /No
❑ NA
❑ NE
12128/04

.f
Type of Visit C5 C pliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
Q Not Operational Q Below Threshold
Permitted dCerdfied [a Conditionally Certified' © Registered Date Last Operated or A.boove} Threshold: ... _ __.. ..
Farm Name: ...... ..Awl�.... -... County: .
OwnerName: ........ . . . . . . . ......................... . . .. ................. . . ................. .............. ................. Phone No: ............................. ... . __................._.
Madmg Address:
FacilityContact: ...... ................ ................................ ........ - ....... ..... Title: ... ................................ ................ ......... Phone No: ......
Onsite Representative:.. Z i CIUR?C, .�--•-.----,�.._..._ .. Integrator•.
Certified Operator:....._................................................. ........ _ .................... Operator Certification Number:..........................................
Location of Farm:
❑ Swine 0 Poultry ❑ Cattle ❑ Horse Latitude • & " Longitude • 6 44
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes
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? El Spillway ❑ Yes LTNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... .._._.j...................... ................... ... .... ... ................ ............... _.. ............ .............. ..... ........................... ....... .......... .......................
Freeboard (inches): CJ
12112103 Continued

Facility Number.-31-701 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 ❑ Yes S/No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmentaI threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes [3 No
8. Does any part of the waste management system other than waste structures require maintenance./improvement? ❑ Yes ❑0No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes Nv
elevation markings?
Waste A heation
10. Are there any buffers that need maintenance improvement? ❑ Yes [TNo
I I- Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes Erf4o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type &"_ Mu.A l_'i, ) S C,o
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes OWo
14. a) Does the facility lack adequate acreage for land application? El yes ;�;
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes r rlNo
16. Is there a lack of adequate waste application equipment? ❑ Yes L-�'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 CJ No
liquid level of lagoon or storage pond with no agitation?
IS. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes '1�10 2
19. Is there any evidence of wind drift daring land application? (i.e. residue on neighboring vegetation, asphalt, [IM
Yes - o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 2o
Air Quality representative immediately.
�LS.�tiBQRllin'�11y 8i�5W:5 BOTIfyl a_ Vr.
1<3se drawings of sty to better txpi-fin iitfi� % F8 13' Field Copy l N Fina
l Notes
35� L)FbA76 CLOQ ''=c t,D F`0C-rvr
Reviewer/Inspector Named} t Ql i a"
Reviewer/Inspector Signature: Date: O
il./!l/U.f LOnA�uea

Facility Number: Date of Inspection a
.! Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? --/
(iel WUP, checklists, design, maps, etc.) ❑ Yes E N
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 Ll
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes u �O
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes N
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 ETNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes L; o
1 'PDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) Yes ❑ No
No
31. I€ selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes <o
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes U Ko
34. Did the facility fail to calibrate waste application equipment? ❑ Y s Imo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. E'Yes ❑ No
❑ Stocking Form OKrop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Facility Number Date of Visit: � Time: O - O
Orati nat Below Threshold
Permitted 13 Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: �_ ,, e-a kC e;--r_ ! ;_ - -i -k 2, - County:
Owner Name: CA'- I � Ja GPhone No:
Mailing Address:
Facility Contact: 1 �j Title: Phone No:
Onsite Representative: � I f e+�l i-vc " Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine []Poultry ❑ Gattle ❑Horse Latitude ' 6 Du Longitude ' f
Design Current
Design Current
Design Current
Swine
Ga aci P,o ulation
Poultry Ca aci l?o ulation Cattle Ca aci P.o ulation
to Feeder
❑ La er DairyFeeder
rElWean
to Finish
❑ Non -La er ❑ Non -Dairy I
❑ Other
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Total Design Capacity
❑ Boars
Total SSLW
Number of Lagoons
❑ Subsurface Drains Present ❑ La oon Area
El
Spray Field Area
Bolding Ponds /Solid Traps
❑I No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ZrNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes -ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ YesJ2No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes/!TNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 4 Z
05103101 Continued

'Facility Number: 3) — %D Date of Inspection 3D O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type �e�"'� �d� �ti , SY44Iq Grn ve✓seed
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 or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss 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?
❑ Yes _'io
❑ Yes EfNo
❑ Yes -&No
❑ Yes 'PrNo
❑ Yes _5'No
❑ Yes �No
❑ Yes J'No
❑ Yes _ErNo
❑ Yes _Z(No
❑ Yes _0"No
❑ Yes ONo
❑ Yes ❑ No
Cl Yes XNo
❑ Yes. ,'No
❑ Yes El'No
❑ Yes V No
❑ Yes j2vo
❑ Yes J:?No
❑ Yes j2No
❑ Yes ErNo
❑ Yes -EI'No
❑ Yes -JZNo
0 No violations or deficiencies were noted during this visit, You will receive no further correspondence_ about this visit.
Gantments;(refer,to:.question )_ .Explain any, YES anweW,anwou,anyreconimewdations or anv other edm_inents:
_
[}se:drawins of fa i 7ity to;betterezplaursituahons, (nse addtttonal pages as deressary) ❑Field Conv❑Final Notes
J;.-r-incre s eA rleed -la co �-a1 n6r►beryv.vd,9, ve�eta�;drti an
-3-64.
Pulls
6 1-1a,1) ) 4 h :.s 4a r w. ; s w e. l l wza f •-.-�q ,'� eo[ , The "c,,_d s Are v e r
well kv(l , —r1ge be,-r►tddz, tsar avi +ke Kgzta del�7 or
The l agao•-, a k-,d Sw >,ve k6ase area � s well "+nan; e, Lw f .
Reviewer/Inspector Name e c1 w
Reviewer/Inspector Signature: Date: 3 O o L
0510310l Continued

Facility Dumber: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of 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 permanentitemporary cover?
05103101
,Q'Yes ❑ No
❑ Yes ZNo
❑ Yes Z No
❑ Yes 0 No
❑ Yes OQ No
❑ Yes ;'No
❑ Yes ❑ No

=�I?rvrsioa of Water Quahty
4
t
y �, Dirision of Soit and Water Conservation
0 Oiher Agency
Type of Visit OCompliance inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit:
Facility Number 31
Permitted E3 Certified [3 Conditionally Certified Q Registered
cot", -at( ksaM ram- r, 4 L
FarmName: ............................................................................................................................
0 Time: I is. 5- 1 Printed on: 7/21/2000
0 Not -Operational Q Below Threshold
Date Last Operated or Above Threshold: .......................
County: !�...� +-x..................".".
OwnerName: tro [ r...Y.....�� x......................................... Phone No:................................... ...................................................................................
Facility Contact: .............................................................................. Title:................................................................ Phone No:
...................................................
Mailing Address:
Onsite Representative: .... ,f`f�.�L� .....P.r.afrl......................................................... Integrator:... G
CertifiedOperator: .......................................................................... ............................... Operator Certification Number: ..........................................
Location 'of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse
Design Curr,
Swine Ca act Po ula
Wean to Feeder
Feeder to Finish
ILI
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Latitude • 4 r----�61 Longitude ' 9 «
Design Current Design . Current
Poultry Capacity Population Cattle. aG P60tillation
❑ Layer F[]Dairy
❑ Non -Layer Non -Dairy
❑ Other
Total Design Capacity
Total S$ W
Ntta�beit of Lagoons �f L� 1 Q Subsurface Drains Present JE❑ Laywm Area❑ Spray Field Area 1
�$%gMPontis/Sold Traps . ❑ No Liquid Waste Management System
Discharxes & 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: ........... .......................I...................... + ............................................. .................................... ........ 11...................
.....
Freeboard (inches): 1 -3
5100
❑ Yes ONo
❑ Yes ❑-No
❑ Yes / No
?7 1A
❑ YesNo
❑ Yes ZNo
❑ Yes zNo
❑ Yes No
Structurt' 6
Continued on back

FacilityNmnber: 31 — 7(-A Date of Inspection I Printed on: 7/21/2000
5_ Are there any immediate threats to the integrity of any of the structures observed? (ie/(ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ 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?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type �� �015 111A,X4 , �wtc.lt' 6rn,n
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?
❑ Yes )2! No
❑ Yes)no
❑ Yes (rNo .
❑ Yes No
❑ Yes
❑ Yes No
❑ Yes ❑ No
❑ Yes JNo
❑ Yes 'VNo
❑ Yes XNo
❑ Yes .,"No
❑ Yes XNo
❑ Yes No
❑ Yes No
❑ Yes �&No
❑ Yes ONO
❑ Yes IdNo
❑ Yes'�TNo
❑ Yes �o
ElYesoo
0' Rio violatigris :or ... c..... were noted during this visit: • Y;ou will •feeeiye lid futc 4h .
• : • cor'res�oridenee: abauti this :visit~ � : � :.:.. .. .. ... ..
- • - ' • ' • ' - ' -
Comments (refer to: tjuestiorf ft . Explain any YES answers and/or any recommendations orjhj other io' minents 7
Ilse dra wings of facili.4y- to better explarn-situations (use addrponal pages as�nec --
-- A e -rSm-^ c "I � 4� i c r%er r) q,q4 re cov-A s q re tre r � welly k ef' . �Nee,Of
G
70 tk+ A//grotV'Y1 o p,rev<n4 S ,Adib en
"j opp n�e��'+-��-Wgde>/'
AL
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
5/00

Facility,.Number: / — PI Date of Inspection Printed on: 10/26/2000
08or 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
,,4TNo
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J21 0
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ YesPrNo _
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes dNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments -an or, rawinp: -
5100

iU enC Other�A .; Q Oration:Kevlewl x - �. `• r s
g- y 7
ne 0 Complaint 0 Follow-up of DWO i
Facility NumberEZTJ_7�
ection 0 Follow-up of DSWC review 0 Other
Date of Inspection LLP Lai 01
Time of Inspection 24 hr. (hh:mm)
Permitted (3 Ce ' led 1[3]C/onnditio� Certtifif ed 0 Registered Not Operational Date Last Operated:
Farm Name: ( l �J�►'i .. County... 1-4 �..i � ........,. ". 9.......
OwnerName: .... Phone No:.......................................................................................
Facility Contact: ...: A!?%...t.............: �CSw- Title: �Phone No:
MailingAddress:......................../.......................................................................................... .1...................................................................... ..........................
Onsite Representative: ............ 1. Integrator:......T...............................
I.......
►� Z s
Certified Operator: ................................................. ; . ............................................................. Operator Certification Number:..........................................
Location of Farm:
e-.. ......................................................... ................. ........... ............. ...... ........... ...
Latitude 46 Longitude 46
.'Design,' Current Design
Current Deslgn Current
:Swine
-Ca acity Po elation Poultry Ca acity Population Cattle _ ,:Ca acity "Po "ulat<on
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish (,75 ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other =
❑ Farrow to Finish -_Total;Design, Capacity r
❑ Gilts
❑ Boars ,ToW SSLW-,
'Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ID Spray Field Area
Holding Ponds/ Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 4
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min`?—
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes VONo
I\
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 21
1!
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: K
Freeboard (inches):
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
3/23/99 Continued on back

f
• Facility Number: — Q Date of Inspection / Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obs ed. (icl 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 �Qo
(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 ;R240
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 1;�Io
Waste application
I0. Are there any buffers that need maintenance/improvement? ❑ Yes $(No
11. Is there evidence o1p5r anlication?� ❑ Excessive Ponding ❑ PAN []Hydraulic Overload ❑ Yes QNo
12. Crop type J J-YC ,—) �
13. Do the receiving crops differ wA those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes J7 No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Q:No
b) Does the facility need a wettable acre determination?
❑ Yes
VNo
c) This facility is pended for a wettable acre determination?
❑ Yes
N�No
15, Does the receiving crop need improvement?
❑ Yes
62�No
16. Is there a lack of adequate waste application equipment?
❑ Yes
Id No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes Ql No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? \
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ((No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes RNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONO
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes QNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes fi�No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes W40
,r
24. Does facility require a follow-up visit by same agency? ❑ Yes KNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ONO
N-0 •YiolaiiQnjs'oe- dgficieitcies were pb. fp# during this;visit; • Y;oit :will -receive 00 fufther .
....rres� oiideince. about this visit
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
Ail
� .
L j_
Ntu a-ay-vv�
E
wer/Inspector Name e ewer inspector Signature• Date: d

Facility Number: — G Bate of inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
( No
liquid level of lagoon or storage pond with no agitation?
27,
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
)No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
[(No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
Wio
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
,kN\
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
o
Addition7mxnents an or rawmgs
_ � . _.
A
3123/99

13 Division of Soil andeWater; Conservation-- Operation Review W
i s y-[3-Division of Soil ancE=Water-Conservatyon'-.Compliance Inspection
'3Division of Water Qualify :Compliancevlispecteon $ r
-: FQ Otl►erAgency Operatao�i°Review'
0 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number Date of Inspection / 511
Time of Inspectiou 3 24 hr. (hh:mm)
13 Permitted [3 Certified 13 Conditionally Certified Registered JE3 Not O erational Date Last Operated:
Farm Name: ........... . r._..........._ ........ ..........---......--- County: ........ ,c!/ `
Owner Name:........ . e, a.?.1... .............
at GksO
.... . ................................................
Phone No: ...............
................
FacilityContact............................................................................... Title: .............................
MailingAddress: ................................................. .......................................... .......................... .
Onsite Representative: 4 f G.n .....'9 r.�.G
...................... ..................................................................
Certified Operator: ................................................... ....
Location of Farm:
......_.. Phone No:
.............................................................................
Integratar:........ f.,,,. e
�rt
Operator Certification Number:.......
A
................... ................. .................................... ........ ........................................................................................................................................................... ..........•---•.........
Latitude Longitude �•°°
Design Current Design Curreat Design Current
:'Swine - Capacity Population Poultry =--Capacity ,Population ,-: Cattle Capacity Population
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
�Neimber.of Lagoons © ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
HoldirigPonds %Solid Traps �` ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElLagoon ❑ 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. Dues 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: 1
Freeboard(inches): .......:35..............................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
Structure 6
[]Yes jo No
Continued on back
3/23/99

Facility Number: r% Date of Inspection !
6. °Are there structures on -site which are not properly addressed and/or managed through a waste management or '�fw
��-'-�
closure plan? ❑ Yes 0 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ;0 No
$. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes $9 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes JZj No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
15No
11.
Is there evidence of over[]Excessive Ponding ❑ PAN
❑ Yes
® No
12.
/application?
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
)9 Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
29 No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
1$.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
] No
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(iel discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted.which cause noncompliance of the Certified AWMP?
❑ Yes
153 No
0: �'Vo yiolati6iis:or defciern es wzere h6fea• dirrtlig this'visit' • Y:oik Will•reeeipe fib Irui-th&
correso6fideirce. ahout this visit. .
.. .. ...... .
Conunents'(refer:to question #) $ieplaiir any YES answers and/or any.recommendationsorany othei: comini is
Use.drawings of €acilrtytci:better explain situations (use additional pages as necessary)
I S . Go ✓l� ; In U O#Wq P C V6g eaf,l
Reviewer/Inspector Name .0.
Reviewer/Inspector Signature: Date:
3/23/99

Facility Number: 3 - Q Date of Inspection
i
Od6r Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes IN 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 Z No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes] No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes NJ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Al No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes f g No
v e.
..._Additional Com6ien&and/or.Drawihgs
w
3/23/99

tr
13 Division of Soil and Water Conservation [3 other Agency
0 Division of Water Quality
JqRoutine OComplaint 0 Follow-up of DW2 inspection OFoHow-upofDSWC review 00ther I
Facility Number
E3 Registered 13 Certified E3 Applied for Permit 1*rmitted
Farm Name. . ....... -.11 ......................
Owner:a� ......................................
Facility Contact: .............................................................................. Title:....
Mailing Address-
.......... ...... ...................... I ........
Onsite Representative%&,�.,E .. ... .............
Certified Operator
Location of Fa
Date of Inspection
Time of Inspection 24 hr. (hh:mm)
0 Not Operational Date Last Operated:......
County:....D .. 4 ..... ................ .............
....... Phone No: ..... cl C
��- IT35 - .... ............. I ................
......................... Phone No:...
WC a7 ?33
Integrator: ... !j �t. ) - U' .........................
Operator Certification Number;
.... Mb
. .......................................................................................... 'W
Latitude 0 1 46 Longitude 0 6 4(
General
1. Are there any buffers that need maintenance/improvement? El Yes &0
2. Is any discharge observed from any part of the operation? 0 Yes dNo
Discharge originated at: El Lagoon 0 Spray Field 0 Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes., notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system! (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes No
❑ Yes No
(0
El Yes P No
0 Yes NNo
El Yes No
❑ Yes No
❑ Yes ONo
El Yes 0 No

acility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes KNo
Structures La oons oldie Ponds Flush Pits etc.
9. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 0No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: JL
...................................................................................................................................................................................................................
Freeboard(ft): 3.1................................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12. Do any of the structures need maintenancelimprovement? ❑ Yes [Vo
(If any of questions 9-12 was answered yes, and the situation poses
an innuediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ---- ......................................... ......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
NO.VIQlBtions'ar, deficiencies.w' e're"noted-during this.visiit.- Yodwill recei've•noltirtheir
c6rrOs066denci A out this.visit.:.:
❑ Yes -P No
❑ Yes KNo
❑ Yes KNo
❑ Yes allo
❑ Yes �No
❑ Yes O�No
❑ Yes RNo
❑ Yes q No
❑ Yes R No
❑ Yes No
❑ Yes No
❑ Yes No
7/25/97

_:
[] DSWC Animal Feedlot Operation Review
u
DWQ Animal Feedlot Operation Site Inspection r � .
Q Routine O Complaint Q Follow-up of DIVQ inspection Q Follow-up of DSWC review 0 Other
Facility Number fl
[3 Registered ® Certified [3 Applied for Permit U Permitted
Farm Name:.-.�u�r�A..ft r....- #�
Owner Name:...... ..�r1r ...�.5.................... o..L.I S.0... '.:"............
Facility Contact: .............................................................................. Title:..
Mailing Address: ... JA.g.......S.L.. Iry c.Rr�......DY-
Onsite Representative:... :�..[..e. �. ...�,.- -----------------------
Certified Operator:......t{....... A................... --------------
Locatton of Farm. I
Date of Inspection
Time of Inspection 114 : 2-S 124 hr. (hh:mm)
113 Not O erational Date Last Operated: ..........................
County:.. V.�..t..........................................t..1 -�..
Phone
.................. Phone No:...................................................
............ bud'. ... t....M.. �................................... Z &.3'
Integrator:...-P..h2.z... q ,.......................
........ Operator Certification\�umber:... L_.1.1...3.............
. ........�.�r...'�'�.%X&..a. ........&i............A.o f...... I T......a�.jr.'rm.Jl4f.m.�. Q.:... ....ln
R. .�.� ...S�..v.� ln..�..a.l... �
.... �..............-.v �- W.x,.....s..1.3.5.."7.r................................................................... ..................................-..----------...............................
Latitude • ®I El�]« Longitude ' ®='
Design Current
Design Current
Design , Current
Swine ;; Capacity Population
Poultry
Capacity .Population Cattle
Capacity Population -
❑ Wean to Feeder
JE1 Layer
❑Dairy
Feeder to Finish
3
❑ Non -Layer 1
10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
JEI Other
❑ Farrow to Finish
Total Design Capacity
3
❑ Gilts
Total SSLW
R (�
❑ Boars
Number of Lagoons /Holding Ponds'. ❑Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 2No
2. Is any discharge observed from any part of the operation? ❑ Yes RNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes IR No
b. If discharge is observed, did it roach Surface WateO (If ves, notify DWQ) ❑ Yes 0 No
c. If discharge is observed, what is the estimated flow in gal/min? jJ
d. Dees discharge bypass a lagoon system? (If yes, notify DWQ) ❑Yes EjNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ® No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
A
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes RLNo
7/25/97
Continued on back

i
Facility Number: --
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures {LaQoons.Holding Ponds, Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(ft):......2..r.1.C..�...........................................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes 9No
❑ Yes KNo
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(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?
Waste Applicatiorr
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .4........................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of -the Certified AWMP?
25- Were any additional problems noted which cause noncompliance of the Permit?
No.violAoits or deficiencies. were noted during this.visit.-:You.Will receive no ftirtlier
correspondence about this'. visit'. ,
Cottunert#s (refer torquestion #):Y Explain any:, anskers and/or any ierontmendations or an} ,o
Use drawrhgs of facility to better explain sttuahons (use additional pages as necessary}
:.._. „.
it. W t y K-• o cA v -r e L f-a w eA d-i w + �.A v..erc-e- d o, M o i t Jc
.> e_keLs
i Ir w o t.dL 6-P, ti o a rl'�j &11tL t #—t A —
iv y, lt--t, l S v ,_t_ V V , L.r_,1 1, S t
C. a t S a &V JA,.� I ,{-o v` C. O-W c. K-S o ti 1.
❑ Yes ® No
❑ Yes (X No
❑ Yes allo
❑ Yes R No
❑ Yes ® No
9LYes 9LNo
❑ Yes ® No
Yes ❑ No
❑ Yes ® No
❑ Yes CR No
❑ Yes ® No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes ® No
nmerrrs.
to[3 - u0cZ ti,
fir► t�-d-+ �"i 0 h�
7/25/97
Reviewer/InspectorName ;,
Reviewer/Inspector,
Signature: Q„ s,�r 4,h A ,_ Date: q l� 47