310764_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Out

Type of Visit: O'Compl' a Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: d7 Arrival Time: Q!) Departure Time: 1 O County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: / Title: Phone:
%
Onsite Representative: a i► !t ^N f 'f� Integrator:
Certified Operator: Certification Number: % 7/6-T
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity op. Wet Poultry Capacity Pop. Cattle
WqaKio Finish I ILayer I Daia Cow
Design C►►urrent
Capacity Pop.
can to Feeder Z4/)
ZI iNon-La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current Dry Cow
©, l ouIt . Ca aci P,o Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
ether
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
0 No ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No ❑,NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
gNo ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of -Ins 2
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes I J Vo ❑ 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 o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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
❑ Noo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2' ]h o NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ff No NA
❑ NE
1 S. 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?
❑ YesVNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes❑
NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Judge 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 D No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: ?I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating 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
II"1° L7 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
qM____0 NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o NA ❑ NE
34. Does the facility require afollow-up visit by the same agency?
❑Yes
o ❑ NA ❑ NE
Comments (refer to, -question #) Explain any.YES answers'and/or any, additional recommendations or>any oilier comments
Use drat ings:of facility to bettetexplain situations `(use additional pages as "necessary).
— 2�— q 7 . P e a r e Sa �t
�cC4t�`rta� 4531AKf_/
Reviewer/Inspector Name: U� B Phone: 1 f� 71�G 7—
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

Type of Visit: Q 7Routine
pliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �.J&AZZ mt) mmt�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 1-71 S 7
Certification Number:
Longitude:
Design Current Design
Swine Capacity Pop. Wet Poultt:y Capacity
C*urrent Design C**urrent
attle Capacity Pop.
Pop. E4Non-Dairy
Wean to Finish
La er
ai Cow
Wean to Feeder`j
Nan -La er
ai Calf
ai Heifer
Feeder to Finish
Farrow to Wean
Design
NQ—rwltr.,v C•_a aci
Layers
C►►urrent Cow
P,o
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Lavers
Beef Feeder
Boars
Pullets
I 113eefBroodCow
Other
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes o
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes WNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑Yes WNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: S - Date of Inspection:
,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No ❑ NA
0 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:, /_Z_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6_
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
dNo ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment I. threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes fNo
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes V(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 o ❑ NA ❑ NE
❑Yes o ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes DNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

F'acili Number: -Q 113ate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � o ❑ NA ❑ NE
29. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes VNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes VNo ❑ 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
9 /4o
❑ NA
❑ NE
❑ Yes
t,A No
❑ NA
❑ NE
❑ Yes
To
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes dNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes E: o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
'.J a!
Phone: r[VVJ / 7 b —
Reviewer/Inspector Signature: ! Date:
Page 3 of 3 214

Type of Visit: q7Routine
pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
sit: Reason for Vi0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j Arrival Time: 3 Departure Time: I S County: SUP Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: a Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
f
Design Current
Design Current Design
Gurreat
Swine Capacity Pop.
Wet Poultry Capacity Pop. Cattle Capacity
Pop.
Wean to Finish
Layer Dairy Cow
k
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder D , Ploul Ga aci P.o , Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Pouets
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes /No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:].Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 ii
o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412014 Continued

Fa&lity Number: --a gn Date of Insection:
[ j
Waste Collection & Treatment
4. A storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: (A6w-FJ Bw) ( 4W2,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q q
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
[Z�'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environment threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
YNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 0 No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[]NNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
QZ
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: jDate of Inspection: r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes �No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ 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 [D"No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E:IKo
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.
❑ A 1' . F' ld ❑ L nIS P d ❑ O h
,
❑ Yes rNo
❑ Yes ZrNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes [.},?'fo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
pp rcat
on re agoo torage on t er.
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 IN ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:O t
Date: 3
aia ors

Type of Visit: (7Co ance Inspection O 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: ® County:[ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �Joog-rgpo�) Mal ya I I kn_
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
ILayer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
5JA5. >
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to finish
Design Curren#
It. Ga aci
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
I 113cef Feeder
Boars
Pullets
Turke s
Turke Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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 ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: C3 1 - Date of Inspection: 91141
,.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?
Structure Structure 2 Structure 3
Identifier: jA (1 1 1i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '� t7 �b
—
Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE _
❑ Yes C�/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 7No
❑ 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
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
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 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesVNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes9�N
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes G3 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes � No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [:]Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 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 dNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes VNo
" ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question #):,Explain any 7YES answers,andlor any.additional recommendat►ons or any other comments',= a
Use drawings of facility, to .better.,; explain situations. (use additional, pages as necessa ry ).� ,
Reviewer/Inspector Name: JCJA� Phone: lv y� V001,
Reviewer/Inspector Signature: Date: lam{
Page 3 of 3 2/4/2 14

Type of Visit: Q Co Hance Inspection U Operation Review Q 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:® County: _1XEUtL) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ��tiA>� lV (/� lux—_Q�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 1-11 0 1
Certification Number:
Longitude:
Design Current
Swine0 Capacity Pop.
Wean to Finish
Wet PoultnY
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design C►urrent
D , P,nu! Ca act P,o ,
Daia Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
Pullets
Beef Brood Cow
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 2f No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes ❑ ❑ NA ❑ NE
❑ YesVNo
❑ NA ❑ NE
[] Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

lFacitity Number: jDate of Inspection: g
tZ.
Waste Collection & Treatment
N
4.` Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ ❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1} Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �S % 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
16 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
lLJ No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes VNo
N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? El Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 40 ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EZr No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
hd "o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�/No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes 1.d4 ❑ 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 ❑ 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 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes L.II o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to property 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
dN
rNo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes [:, o ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes Ea<o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �No
'� ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
use drawings of facility to better explain situations (use additional pages as necessary}.
f11I I TE51-, z_/ LC vC-(s ? �
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:C t
D 2C — 3gy
Date: f 7
Z_5
21412011

Type of Visit: Q Co Hance inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral Q Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
On site Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 177, 1 D
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
001
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I jNon-Layer I
El
Dairy Calf
Feeder to Finish
Design urrent
Ga aci P,o .
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Lavers
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?
[—]Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA 0 NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[:]Yes o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ YesVN�rNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - (p Date of Inspection:___ SvljL
Waste Collection & Treatment
4. ls,storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Rio ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L A („ffs N) (rA is 0Z N Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JZ 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 VNo ❑ 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 [o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes YNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:)Yes CENo ❑ 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
2�No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dpNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
54D
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[-, o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
M c
Mc
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M/No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
L a O
[] NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [3 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes &No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: S1- Date of Inspection: 19 1 J10 11 t.i
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0"Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ' No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes U No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes [/]� ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments..,,.
Use drawings of facility to better explain situations (use additional pages as necessary).
2�,) W►J.SSSh1� k19M AAMLI T 5 A✓Ek( Swz►(_,q(6l
0Xfr(- L�F U T acr'SZP (: a "rESS- MdJ r 5T tQ, PAVE / QUA sf PLACE
24) L'OL 9T6r Z.010 (AL �.6�-R�-v, .t.F �t/an�E, �6vN� Do G jq5�jp
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
l,jl-fi ri f A R$4& L
Phone:C— 3
Date: Zi
21412011

R
Type of Visit: 6 Com liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ( Z Arrival Time: y $ Departure Time: � County: OV 7 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: ?PqQ_;t.C_L Fyss E t.l., Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current
Design
Current
Current
Swine MEDesign
Capacity
Pop.
Wet Poultry
Capacity
Pap.
Cattle
Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Z 5b
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
1) , P„aultry
Ca aci
I;o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
MUMI
Turke s
Ot111!
1
ITurkeyPoults
Other
I
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
yp o❑NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: 31-76q JDate of Inspection: 11
Waste 611ection & Treatment
ZNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 06 agJIi
Spillway?:
Designed Freeboard (in): }
Observed Freeboard (in): 9 V t�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[ No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes �/No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E�(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes o
94
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes Yo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 9,0
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes � o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes WNNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes fNo
❑ 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. VYcs ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " rainfall Inspections OoSludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Wo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did Xhe facility fail to calibrate waste application equipment as required by the permit.
❑ Yes o ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
01yes ❑ N ❑ 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 CJ No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes n No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes VN❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ NA
❑ NE
Comments.(refer to question ft Explain any YES answers and/or any additional recommendations or any other comments..'...
Use drawings of facility to better explain situations (use additional pages as necessary).
NEL-h
St vV&6
SuNEEi
1sIL-1_A&ztJ #Z Alt-- ZoIP
Al(*g
cie i
4-rC
CA2D w4�V kecotcvsS
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date: f
Page 3 of 3 /4 oil

Type of Visit MCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit yRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /0 Arrival Time: )f0 Departure Time: County: N Region:
Farm Name: �J_ 5 / YLl S 12 1-k Owner Email:
Owner Name: / n � L )A l Phone: 9I6- 925-SRS 0
Mailing Address: `ly4 I ! PQ i~A'0U VA C a/T /JgLA.Q QJX . N(2, DR�SoQ I
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: Ke17Nb1JC f ,_'Y1MA1Ny LAIVrCV--
Certified Operator: / * tO.1a(A� )� •,bA K-
Back-up Operator:
Phone No:
Integrator:
RD /b l��Oper Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = ' = Longitude: = o = S 0
it
Destgn Current Design Current reacrook
0"OR,Ca a Po ulati©n
P t} P P h
❑ Wean to Finish
❑ Layer
Wean to Feeder
SaoU
❑Non-L;
❑ Feeder to Finish
;
❑ Farrow to Wean
`Dry P©
❑ Farrow to Feeder
❑ Farrow to Finish"
❑ Layers
". ❑Gilts
�' ❑ Non-L
❑ Boars
❑ Pullets
-
y ❑ Turke
Other
❑ Turke
" ❑ Other
❑� 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-DaiEZ
Beef Stocker
Beef Feeder
Beef Brood C
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 KNo ❑ NA ❑ NE
El Yes
El No
El NA
❑NE
El Yes
[I No
❑NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: --?,bq
Date of Inspection / jam]
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 Struc e 2 Structure 3 Structure 4
Identifier: � l Z W5
Spillway?:
Designed Freeboard (in): /q. S
Observed Freeboard (in): 30
❑ Yes X'No
❑ Yes ❑ No
Structure 5
El NA El NE
❑NA ❑NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes }(J No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 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 YNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes V&
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
A
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
KNo
❑ NA El NE
El Excessive Ponding El Hydraulic Overload ❑ Frozen Ground El 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
l2.
Croptype(s) gleeM S�q
13.
Soil type(s) ACA
F>
l4,
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ INo
/K\
El 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 El 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. twquestion.#):- Explain any YES.answers and/or any -recommendations or -any other comments <
Use drawings of facility to better explain situations. (use addition I" pages as necessaryj,
.5..s,e_
ReviewerlInspectorName IH %AfN��: .,y Phone: 91a/_-�9�0-����
Reviewer/Inspector Signature: Date: % f / Vib
Page 2 of 3 12/2"4 Continued

Faeilily Number: 3 I Date of Inspection(C—�
Re
uired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
XNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
X 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 ❑ Waste Transfers ❑�inual Certification
0 Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 0 Monthly and 1"
Rain Inspections El
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
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
>(Nfo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
X NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ElYeso
Tl�
❑ NA
❑ NE
Additional Comments and/or Drawings:
W . A , gw I Bw
5114po 3,3 ;•S
IADI�c�
►r/a5I6 � �. 5 � �
gL143(ZAT1� �uE o�I aR
2E cyEcK 1; ��S mug, 1pt_E pA�l"_ u F surz1Lj �� ��� gc► - PoA ESw
4 UND- NF
-#'s • zNr< Vatz€S A
'i 7 u 57 t;E i A KEN ci4�E orrIK�QS . POSE u Auc Pa A cur 70 fit,
w !J
X�A_A)wq
I A7-M:40A4NDA GRtA/ES : Ar1N•• Awt4t4oA CA►NES
SENt�, To ' AC
t C aeorNAc 5 Ex
o q10 3s� - aooy
Page 3 of 3 12128104

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: lv Q Arrival Time: Departure Time: County: t4 AlRegion:
Farm Name: }A, aLA2Q0� N(At MEVLt W 144& Owner Email:
Owner Name: 02WC50(_,_., A I L_- Phone: 9�0' �$5- 3g3a X 5 SDI
Mailing Address: (n jgREPJ�PLC (2p/ A 11 Nc (Q& 5Q 1
Physical Address:
Facility Contact: ` j Title: Phone No:
Onsite Representative: ..]Or•— L aI4r aiz Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E=i o = , = Longitude: [� ° 0 i 0
61
Swine
Design Current
Capacity Population Wet Poultry
Design Current
Capacity Population
Design Current
Cattle C►apacity Population
Wean to Finish
❑ La er
❑ Dairy Cow
54 Wean to Feeder
❑ Non -Layer I
I
❑ Dairy Calf
.Feeder to Finish
Dry Poultry
❑ Layers
❑ Dairy Heifer
❑ Farrow to Wean
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
�Eol Giits
Boars
Other
❑ Beef Stocker
Non -La ers❑
❑ Pullets.
❑ Turke s
❑ Turkey Poults
❑Other
Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Other
Disci & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
VNo
[INA
ElNE
Discharge originated at: ElStructure ❑ Application Field ElOther
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�'(,No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Iiacility.Number:--31 — (fly
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
Identifier: i cC
Spillway?:
Designed Freeboard (in): • S /9 . 5
Observed Freeboard (in):
Structure 4
❑ Yes 7§kNo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes V 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 V( o ❑ 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 V�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes t6No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes &o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes &NO ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �6 eQ- ( P> J 6
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JkNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
'ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
�jNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
tNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VLNo
❑ NA
❑ NE
'No o�cr ��SIc�N
&%16/ 471_10
C� TO :
Reviewer/Inspector Name
Reviewer/Inspector Signature:
r eCo PL Op
l�(nP Aj G ES
XlcD &.'V 2- IJ wQ
[&'* COILl,1A1 4L 09- rxi O i�
WtiuntAi4rodv, J�IC 9gko�
A "' - -
SGrJ_� /Al 01 C
C-LA C-N T Cal C
F" : coo-3 Sd --aWL/
Phone: --+q(o -43Q'4
Date:
Page 2 of 3 12128104 Continued

Facility Number: 3 Date of Inspection d 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [XNo ❑ NA ❑ NE
the appropirate box. D WUP ❑ Checklists El Design 0 Maps El Other
2l . Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Waste Application [] Weekl
y Freeboard El Waste Analysis 0 Soil Analysis ❑ Yaste Transfers ❑ A/ual Certification
El Rainfall 0 Stocking ❑ 0120 Minute Inspections ElMonthly and V Rain Inspections ❑WeatherCode
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes NJ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rambreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
Yes
[I No
El NA
El NE
❑ Yes
❑ No
)(NA
❑ NE
❑ Yes
14 No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
4No
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
❑ Yes ,® No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes Lo ❑ NA ❑ NE
Additionai Comments and/or Drawings:
iN )q 1 a
(o/ //09 (v d? �-
jjpgo g l' (-1 i . '�
glands 1") D,6
'F1&CDs Xrc--b 70'6c-�-'0"�
Page 3 of 3 12128104

Division of Water Quality
Facility Number. E�L� 0 Division of Soil and Water Conservation
0 Other. Agency
Type of Visit - -compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Poutine O Complaint O hollow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: V47 Arrival Time: �{�� Departure Time: County: L Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone No:
Integrator:
Operator Certification Number: 1 -+ I
Back-up Operator: I Back-up Certification Number:
Location of Farm:
Latitude: =' =' = r Longitude: = ° =
Design Current 'Design `Current < �Des�gn Current ;
Swine Capacity Population Wet.Poultry :. Capacity -Population C.attle Capacity Population:*
❑ Wean to Finish
gl Wean to Feeder
a U
a 66
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ La er
I`; ❑ Non -Layer
Dry. Poultry
❑ Layers.
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures �f
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
�'WNo
❑ NA
❑ NE
12128104 Continued

14 acih* Number: — Date of Inspection C371
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 0 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: w W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Z 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 tNo
❑ 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 Ej No
❑ NA ❑ NE
8. Do any of the stuctures 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 KNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes KNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ANo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
20 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JVNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
6 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
5No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
19"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):
Ge,7 c�oQckd F PE9-04 1 T c Kk:QP 0'4/ "Ou" s
&w l - St`�t,��sc��v y�•a'� k��Ea 4'oA- SeNT To QjqLHg141 N
3o tea `�
Reviewer/Inspector Name ( 5 I Phone: 9
Reviewer/Inspector Signature: Date: Vj(3a
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection rrJ
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA 4 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 54 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JdNo ❑ 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]
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
5;rNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,4 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes RNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
'WNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
R"No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
J�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
QNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
A No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality
Facility Number 3/ C 0 Division of Soil and Water Conservation
-- - - . 0 Other Agency f /
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access/s// ,I�
Date of Visit:9Tt'
Arrival Time: , Departure Time: i ounty: k Region: 4 �C o
Farm Name:G(/l - / 4'e-'6462 / M2 Owner Email:
OwnPrNamr- / "42zV1 e"n ZAZ(— Phnne:
Mailing Address:
Physical Address:
Facility Contact: Title: _rjDR 1"- hone No:
Onsite Representative: � JV �`�F `� Integrator:
Certified Operator: 4LZ2� ✓_24=,_ Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = a =' = Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
Oh ❑ Non -Layer
Wean to Feeder
Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
ElNon-Layers
El Pullets
ElTurkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population .
El Dairy Cow
❑ DairyCalf
El Dairy Heifej
❑ D Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of,Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes gNo
❑ NA
❑ NE
❑ Yes xf No
❑ NA
❑ NE
12128104 Continued

Date of Inspection O
Facility Number:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes )ZNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: f [/ wZ
Structure 5
Structure 6
Spillway?: %_ A0
Designed Freeboard (in): q 1
Observed Freeboard (in): 50 33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 0 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 0 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
/
❑ Yes �No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yes �No
❑ NA ❑ NE
maintenance or improvement?
Wasted -cation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 0 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes /No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift Application Outside of Area
12. Crop type(s) Ll f Cl-�� 0 04"Q
- T ._
_
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
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZfNo
❑ 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):
LReviewer/Inspector
ewer/Inspector Name Phone: IV
Signature: Date: 5 Z d
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents TT""
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes tA No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes jZfNo ❑ NA ❑ NE
,w the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n El maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. XYes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking [I Crop Yield El120 Minute Inspections [I Monthly and 1" Rain Inspections ❑Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes A No ❑ NA ❑ NE
'23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 0NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes 0 No
[]NA
❑ NE
❑ Yes (�No
[]NA
❑ NE
El Yes /❑ No
❑ NA
❑ NE
❑ Yes ❑ No
ONA
❑ NE
❑ Yes zoNo ElNA ElNE
❑ Yes ,No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes X/'��o ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
Additional Comments and/or Drawings:
2J} iv�•�J �ileP�� �aCt2pG �� � 7Ell,
�
2S) �CyOG,� Ael A�Xr 04D / OZ
12,128104

Division of Water Qualit y
FactlllyNuln6er ,j� (p Division of Sail and Water Conservation
Q Other Agency:
Qpe of Visit Q Compliance Inspection O Operation Re4ieW Q Structure E-0atuation Q Technical Assistance
Reason for Visit O Routine O Complaint O l ollo-oup O Referral 0 Emergenq 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: M ounty:
Farm Name: GS l!� Owner Email:
Owner Name: o�u00 Z1i Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: cone No:
Onsite Representative: G�7�/%T Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Region:
Latitude: = o = = Longitude: = ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
f�OQ Q ❑ Layer T _
❑ Non -Layer
Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder,
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at- ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge? -
❑ Yes Ld No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
X'No
❑ NA
❑ NE
El Yes
XNo
❑ NA
❑ NE
12128104 Continued

la
Facility Number: — Date of Inspection/ O �I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Stlucture 1 Sopeture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: � 0
Spillway?: OVb _ 11119
Designed Freeboard (in): %q` j
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
) ] No
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
7f No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
P(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 El Evidence of Wind Dri pplication Outsid
of Area
12. Crop s Q6! Q
p �e(} M L!
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�fNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
ClNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
/,q)&— — - 4n9R105:
a e- 4vv P44- �
Reviewer/Inspector Name I ' I Phone: — r V `�
Reviewer/Inspector Signature: Date: !o
12128104 Continued

i . .
Facility Number: — Date of Inspection lfT
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? IVYes ❑ No ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design g ❑ Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 011yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall VStocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewhnspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
91) ra'o " aeet i --
❑ Yes P No
❑ NA
❑ NE
❑ Yes XNo
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes ANo
❑ NA
❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes ❑ No 0 NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
?No
❑ NA
❑ NE
El Yes
VNo
❑ NA
❑ NE
12128104

Type of Visit 6 2Routine
mpliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: 3 9 o Time: l o 0
O Not Operational C Below Threshold
01 ermined EfCer 'hued� - ©` Conditionally Certified © Registered Date Last Operated or Above Threshold: ... .
Farm Name: W P C-S1 A S N U�SEIr-� r * 2- . . _ County: _ _ _0 Q P6LJ- _ ... ... __
Owner Name: _ - - - . _. _. .. Phone No:
.Marling Address:
Fad iity Contact: . » .. WW .r _ __ Title:.____ _ _W_ ..... _- Phone No:
Onsite Representative: ILEst+� _ DOa�11 Integrator. y''' ur" E w�i.........
Certified Operator: „. . . „ _ . , .. . .. .. , . Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle © Horse Latitude • �'4 Longitude • ' 119
Discharges & Stream Im acts
1 _ Is any discharge observed from any part of the operation? ❑ Yes [(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
13140
❑ Yes
0No
❑ Yes
No
Structure 6
12112103 Continued

Facility Number: 3 1 — 7 R Date of Inspection ! 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, 0 Yes [ /No
seepage, etc.)
6. Ar; there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes E No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) 1
7. Do any of the structures need maintenancefunprovement? ❑ Yes ZNo
o
8. Does any part of the waste management system other than waste structures require maintenan�mprovement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes dNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes E No
11. Is there evidence of over application? If yes, check the appropriate box below_ ❑ Yes WNO
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
I2. Crop type GC 7-m v p. ( G S
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 eNo
b) Does the facility need a wettable acre determination? ❑ Yes 7No
o
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes ff No
16. Is there a lack of adequate waste application equipment? ❑ Yes WNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ yes dNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes O(No
19. Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt, ❑ Yes O No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes [(No
Air Quality representative immediately.
iL C--c,aV-OS AO-0
Reviewer/Inspector Name
Reviewer/Inspector Signature:
❑ Field Copy ❑ Final Notes
Date:

Facility Number: 3 — "](, Date of inspection !� I
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?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes EdNo
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 dNo
25_ Did the facility fail to have a actively certified operator in charge? ❑ Yes fNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application) ❑ Yes 121No
27. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes Q No
28. Does facility require a follow-up visit by same agency? ❑ Yes E�No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 6No
NPDES Permitted Facilities
30. Is the facility covered under a NPDFS Permit? (If no, slap questions 31-35) ❑ Yes [!rNo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
Y21t2ro3

Type of Visit _P Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit o Routine 0 Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number 7 Date of Visit: Time:
"� Not O erational Q Below Threshold
Permitted 1p Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: _ %LDD 6 'iaai'i/ County D "'
Owner Name: !'.., ,q Dely00 ff Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: OU240!�
Certified Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑Horse Latitude o ' " Longitude 1�J0 '
Design
Ci of Deign
C+urrent Design Current
Swine
Ca aci
P.o ulation Poultry Ca achy
P,o ulation Cattle Ca13aci Ro ulation
Wean to Feeder
I 3ma❑
La er
❑Dai
❑ Feeder to Finish
❑Non La er
❑ Non-Dai
❑ Farrow to Wean
'
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design'C►apacity
❑ Gilts
❑ Boars
T©tal SSLW
Number of Lagoons ® ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Balding Ponds 1 Solid Traps
� ❑ No Li uid Waste
Mana ement System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1 %i
Freeboard (inches):
05103101
❑ Yes ;',No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Z No
❑ Yes �9 No
❑ Yes D3 No
Structure 6
Continued

Facility Number: — T Date of Inspection L1j' L
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes gNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes R3 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes J'@ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes O No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [SNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes bNo
12. Crop type t>11,,Ya0,f J 56-
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
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
E[No
D,No
[Q No
R1 No
[R No
[!TN,
❑ Yes [gNo
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
121 ivo
2 No
Ej No
ENO
EgNo
MNo
0 No
No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
Comments (refer to'question,.#):" Explain any YES'answers and/or an reeommendattons or any other conimen_ts
xy
stAe drawings of faryryc,ilit3 in to better explasituatiobs. (use additionaEpages as?ep�gcessary) ❑Field Copy ❑Final Notes r
l SailM��ry show-t�r'P�ds 3�- S� its L%r�,�e �� 0 7-
Reviewer/Inspector Name P
Reviewer/Inspector Signature: Date: Z Z ` 6�
0510310I k_�_ Continued

t .
Facility Number: Date of inspection 2S 2 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes EZNo
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 N No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes [&No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Callo
.&1
_]
5100

.1.
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit qRoutine O Complaint. Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Time:
0 Not Operational Q Below Threshold
Permitted [3 Certified, 7Condition/aUu Certified © Registered Date Last Operated or Above Threshold: ... .
Farm Name: 1(NQ,Q L.l� /.......... .......... County:lr!!�........................... .. . _ ..
Owner Name: 1 aak fJOa..d...... 4 ............................................................... Phone No: ........................................... .... ._....... .........
_. ._..._ �.
FacilityContact:............................................................................... Title:................................................................ Phone No:...................................................
Mailing Address: ............. ............................... ..........................
................................ ....... ......... ........... ........
Onsite Representative:.fr='�?`................. �tS..r1[ .�1 .......... Integrator:........r'.t!l..f�..................................... ..
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �°
��; Longitude
Design Cuirrent "._
Design
Current Desrgn` Cuceeat
SvrYne Ca aci Pa elation .
Panl =_ .Ca ail
try
P00ulation Cattle--, Ca acr .. Po eilation
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
❑Nan -Layer
❑Non -Dairy
❑ Farrow to Wean
Farrow to Feeder
❑Other
10 Farrow to Finish
TOtdl'Desl C8 a '
_C1
=
Gilts
Boars
Total SSLW
c Nher of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area r
Holding Ponds / Soiid,Traps. ❑ No Liquid Waste Management System
_ ari
Discharges & Stream Impaeks
1. Is any discharge observed from any part of the operation? ❑ Yes ATNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes dNo
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 ,rNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Lwo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
S lure i Str cture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...............................................
Freeboard (inches): ' r
5/00 Continued on back

)Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures Pbser�ved?%(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 maimcnance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Exc sive Ponding , ❑ PAtN ❑ Hydraulic Overload
12. Crop type 2Ze-'edUX&/1
13. Do the receiving crops differ with those designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15- Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Animal Waste Management Plan (CAWMP)?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
a.
i'!k! •Yi0fpi i0#s:er.deficjencies #it re n0 eO dig tb#s.v's't; - Yon wJdj-teeeiye nti i'ui•t ter
;correspondence about this visit.
n':�rnt�inae-nffoe�ili4v.4rti hnf4r+wisc�i4aincif..sfihne 'T�rcr+�rle�ilGna$Ir*aoisaa=
❑ Yes [(No
❑ Yes YNo
❑ YeNo
❑ YeNo
❑ Yes No
❑ Yes ONo
❑ Yes XNo
❑ Yes No
❑ Yes IE(No
❑ Yes FNo
❑ Yes No
❑ Yes No
❑ Yes o
❑ Yes No
❑ Yes No
❑ Yes Y�'o
❑ Yes No
❑ Yes YNO
❑ Yes ?No
❑ Yes ❑'No
❑ Yes No
❑ Yes XNG
Reviewer/Inspector Name - - x—
Reviewer/Inspector Signature: Date: 5/00

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ,0'0
liquid level of lagoon or storage pond with no agitation?
.27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Zr'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
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 JKo
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 ZrNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Oi No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes',O`No
Additionalomments art or wings:
2,
d5sE �19"40 ; M% r 6 4�i V5�7-5,
41110 GAG-a�n�5 GOoKEO Gva o,
5/00

I
-� r m ,' ----"`_"� •','1.:1'i+xrtswu ux iluxx,ax�u, rraaca �:vutirx-rauvu - v�rauv.x na;rxx;w � _ ,,.�, -� ar
M 0 Division
�Dtvtstona>Wrvation -:Compliance=of dter Consea
of Wtlerninspection �`s� r _
Quality _Compliance Lnspectlon y-t ; `" x
Agency Operation Review
10(Routine O Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other f
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted KCertified © Conditionally Certified © Registered E3 Not O erational Date Last Operated:
FarmName: ,,........ .. .... `"'+-............................................ County:....................... 9.. ..........................................
...
Owner Name: Phone No:
Facility Contact: .._ Title: Phone No:
MailingAddress: ..................................................,....................................................................................`..
...... .....
Onsite Representative: �''�?'............... ...�.....1................................... Integrator:.......:......... �...........................................
Certified Operator:......,,•„••,• ,., Operator Certification Number:
........................................................................................................................................
Location of Farm:
N
...............................................................................................................................................................—........................................................................................................
Latitude �' �� �« Longitude
Design- Current Design. Current Dest
v gn . gn urrent
C
Swine Capacity", Population 'Poultry Capacity Population Cattle Ca c>< Po ulatlon
Wean to Feeder Gd ❑ Layer ❑ Dairy
❑ Feeder to Finish 10Non-Layer ❑Non -Dairy
❑ Farrow to Wean = -
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design,Capacity.
❑ Gilts -
❑ Boars Total SSLw,
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray
HField Area A
olding Ponds/ Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes NNo
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,,a]lrnin?
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 jqNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes RNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �%i�
Freeboard (inches): ....
............ —..1............. ...............��............................................ .................................... .................................... ....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes P�No
seepage, etc.)
3/23/99. Continued on back

Faci4t Number: Bate of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
WNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?'
❑ Yes
§'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
Wo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
OdNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
19No
11. Is there eviden a of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
NNo
12. Crop type S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
JWNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
ONO
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?
fVves
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
0�10
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
gNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(ie/ WUP, checklists, design, maps, etc.)
❑
,�dNo
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
A No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
WNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ONO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes RNo
24. Does facility require a follow-up visit by same agency? []Yes I�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ONO
:: Rio-'VWl tigris:or• deficiencies -were noted• during tbis:visit; • :Y:oit will•receive •no fufth&.
rorrespori�ei�ce:ahatit this visit. ' • ' . ' .. ' :: : :
Comments (refer to question #): Expla�n:any YES answers and/or any recommendations or any other comments
>_ _
Use drawings of'faeihtyto better expla�rr:situations (use addthonal pages as necessary) _ -:
1
V�.,.,..
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

Facility Number Date of Inspection
Time of Inspection ® 24 hr. (hh:mm)
13 Permitted ■ Certified 13 Conditionally Certified 13 Registered 113 Not Opera Date Last Operated:
Farm Name: Ra& oQds.Nlurser.y.#.1.AJt2.................................................................. County: Duplin WILRO
OwnerNamc: T.rary...................................... W- twit C..............._....................................... Phone No:.......................................................................................
FacilityContact: ...............................................................................Title:............................................................... Phone No: ....................................................
Mailing Address: 44a.I.1'lamdy..)W.................................................................................. Cbimquapin..NC................................................... 2852j...............
Onsite Representative: .............................................................................. ......... Integrato►•:MLL pty..F.amily.Farms....................
Certified Operator:Adam.T.. ............................... Whaley ............................................. Operator Certification Number:1.7.329............................
Location of Farm:
Latitude ®• ®� ©°� Longitude • ®9 ©4.
W -Design Current design .Current Design Current
Swine Capacity -Population -_Poultry_ Capacity Population Cattle Capacity TPopulatiou
® can to Feeder
5200
p Feeder to mts
❑ arrow to ean
p Farrow to Feeder
❑ Farrow to Finish
p Gilts
❑ Boars
Number of'Lagooris _ `� p u sur ace rains resent p agoon rea ❑ pray �e rea
Holding' -Ponds Y Solid'Traps, ij o iqui aste anagentent System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? 17 Yes p No
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? p Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if ves, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaUrnin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) []Yes p No
2. is there evidence of past discharge from any part of the operation? []Yes p No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? © Yes p No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? p Spillway []Yes [:]No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
....................................
Freeboard(inches):...............30..............................24...........................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
3/23199 seepage, etc.)
p Yes [:]No
Continued on back

Facility Number: 31_764 Date of 111spection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? []Yes p 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 p No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? p Yes ❑ No
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level.
elevation markings? []Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes []No
11. Is there evidence of over application? ❑ Excessive Ponding 0 PAN ❑ Yes []No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22_ Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
ft : N.o.viotations;or. -de 'cieire'ies•were •anted A firing. tt><is visit.: You_ will .receive, no• further.:.:.
...cor:r6o ndeki aboitt this. visit: .................................. .
Floyd Assessment w
freeboard and dike is intact.
❑ Yes ❑ No
p Yes []No
❑ Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
p Yes []No
[]Yes []No
❑ Yes p No
p Yes p No
❑ Yes ❑ No
❑ Yes ❑ No
p Yes p No
❑ Yes []No
❑ Yes ❑ No
p Yes p No
SW: Dike is not saturated. Vegetative cover is good all over dike wall (inside and out). Does not appear to have
I during storm. Dike is in tact with sufficient freeboard. No recommendations
Reviewer/Inspector Name Greer McV�cker Brian Gannon D5
Reviewer/Inspector Signature: Date:

-Name -of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height: Febt
Lagoon Surface Area, Acres
Upstream Slope,xH:1V
Lagoon Dike inspection Report 1 044
k 31—�G
CV& e-5-5 rl-e d C% SS lro 2
( k_ki^ a;ie-, n , )K -:) Ica 1 V 2kf—
o L J Names of Inspectors
J�j c tII,C k
Freeboard, Feet C�
S e, P ro Top Width, Feet [�
<7 �. _ Downstream Slope, xH:1V
Embankment SIiding? Yes K No
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Yes No-
Yes X No
Did Dike Overtop? Yes x No Yes, Dep ofRvertopping, Feet
Follow -Up Inspection Needed? Yes X, No
Engineering Study Needed? Yes No -
Is Dam Jurisdictional to the Dam Safety Law of 1467?
Other Comments
is e 6-,/ C
Yes No
z
91) CC e.- �

Q
ll�

Lagoon Dike ,Inspection Report
�,N`-amL-of Farm/Facility
9 OP
31 ')dI
Location of Farm{Facility
Owner's Name, Address
and Telephone Number
Date of Inspection Ord` -9 Names of Inspectors
Structural Height, Feet Freeboard, Feet
Lagoon Surface Area, Acres ee-reve,S-C Top Width, Feet
— -�
Upstream S1ope,xH: IV �J + Downstream Slope, xH: IV
Embankment Sliding? Yes No
(Check One, Describe if Yes)
Seepage? Yes X No —
(Check One, Describe if Yes)
Erosion? Yes No
(Check One, Describe if Yes)
Condition of �01
Vegetative Cover
(Grass, Trees)
r- UY AAre < (n,,�s
Did Dik Overtop? Yes_ No ?f Yes, Depth of Overtopping, Feet
i °P
Follow -Up Inspection Needed? Yes ^ No
Engineering Study Needed?
Yes -Y' No,
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
1, R (_ WI-, l I /!1
Yes No
M
<; 0 P I' it � Pr C e .� J0�1 r j , 'A- D

� '�
G, 'a0

�,n goon Lagoon Dike Inspection Report O 4 "a--
i&e of Fann/Facility c oo i11'_ ��4 k r� 1
Location of Farm/Facility 12OA-., CyA rSS (lC' e K C% S5 ro ,:�,l
Owner's Name, Address c e- v 1,.J
and Telephone Number
Date of Inspection 1 Names of Inspectors a/(J
Structural Height, Feet Freeboard, Feet �d
Lagoon Surface Area, Acres C' "t' :- 2 Top Width, Feet 0 _
Upstream Slope,xH:I V � e? +. � Downstream Slope, xH: IV �
Embankment SIiding? Yes K_ No
(Check One, Describe if Yes)
Seepage? Yes " No_ 3. C �. i d S
Ugh
(Check One, Describe if Yes)
C(50/� ),L0 A z I e, �1A_
Erosion? Yes No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
IL
Did Dike Overtop? Yes X No "T(f Yes, Depl ofBvertopping, Feet
Follow Up Inspection Needed? Yes No
Engineering Study Needed? Yes No j
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments
a
D y r
JI.% C�
r c C> >NA ,n Q•� c' { U

Q
C1 �
1

'i4me of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Lagoon Dike Inspection Report o
_Clf 0 -0) S �ja/- Q 9��Z_
Date of Inspection bs? Lq Names of Inspectors
MC ✓iC
Structural Height, Feet Freeboard, Feet .2 q f I �_
Lagoon Surface Area, Acres CC CevC',5-C Top Width, Feet
Upstream SIope,xH:1V 3 I I Downstream Slope, xH:1V r
Embankment Sliding? Yes No
(Check One, Describe if Yes)
t 1 j
Seepage? Yes X No_ t_4 GL.)CZ,,
(Check One, Describe if Yes)
Erosion? Yes No
(Check One, Describe if Yes)
Condition of U U1 a - or- & r e S
Vegetative Cover
(Grass, Trees)
Did Dik Overtop? Yes _C�z No fYes, Depth of Overtopping, Feet
��
Follow -Up Inspection Ne. d� Yes _L No
Engineering Study Needed? Yes �NQ ,
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments r� 1� t w r} I r111 1�c
i r

��:
'� ad
.�

Division of Soil and"Water_Conseryation�-.Operation Revie6
4 =" D n Division of Soil ad Water Conservatxon Coinglianceylnsp
w Division of Water Quality" Compll_ance Inspection
Other Agency - Operatic Review
Routine O Com taint 0 Follow-up of DWQ inspection 0 Fallow-u of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection (i d 24 hr. (hh:mm)
© Permitted 9(ce[rrttified © Conditionally Certified Q Registered 0 Not O erational Date Last Operated .
FaunName: ....... --..----...........`................................................... County: .............! ...........................-.....-............. I.......
OwnerName: ................................................... ........................................................................ Phone No: ....................
Facility Contact: ..............................................................................Title:
Mailing Address : ................................................
Onsite Representative...-d.W.., -Q
Certified Operator: ......................... ...................
Location of Farm:
............ Phone No:
......... .......................... .................... ...................... ............ .. ......................
..... Integrator:...........J%
Operator Certification Number: ......................................
...................................................................................................................................................................................................................................... ............i -
Latitude ���� �•° Longitude �• �� ��= -.
Design Current .-Design -Current Design __- Current
Swine r. Poultrv^ l on�ni*v Pnnnhfinn Y
Ca ac�ty Po Mahon ".Cattle
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number of Lagoons ❑ _ Subsurface Drains Present ❑ Lagoan Area ❑Spray Field Area
Holden Pands:/ Solid.Tra s ❑ No Liquid Waste Management System
g• a p
DischarXes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 19No
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 gaUmin'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes b<No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: }�
Freeboard (inches): ............�.............................. 1....L........... ................................. ..
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes 0 No
Continued on back
3/23/99

Facility Number: — .6 I Date of Inspection
' 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(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 maintenarice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence.of over application? []Excessive Ponding [-]PAN
12. Crop type )D D i S
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 XNo
❑ Yes XNo
❑ Yes 9 No
❑ Yes OdNo
❑ Yes KNo
❑ Yes gNo
❑ Yes g No
❑ Yes XNo
❑ Yes ONo
IS Yes ❑ No
❑ Yes A No
❑ Yes 9No
❑ Yes C<No
4(Yes OovNo
❑ Yes 0 No
o violatitiris:or efieiecies were itO(p. during this:visit; Y'oU W.. il.. l.-.. &.. .*. ii. , l,.io further .
corresponnence abaut this .visit_ • • • • • • • . . • • • • • • • •
Comments (irder to question #} .Explain any YES aniswers and/or any recommendations or stay other comments:
Use drawings of facility to betterexplain situati6ns (use additional pages as necessary}
Reviewer/Inspector Name =yr
Reviewer/Inspector Signature. Date:
❑ Yes XNo
❑ Yes XNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
3/23199

Fa4lity Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes KNO
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes gNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes gNo
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 O(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 NINO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes gNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 9(No
IA-dditionall, Comments and/or- rawings - -
AJ
3/23/99

[] Division of Soil and Water Conservation [3 Other Agency
El Division of Water Quality
12 Routine O Complaint O Fallow -up of DNVQ inspection O Follow-up of DSWC review O Other
Date of Inspection -7
Facility Number
Time of Inspection } ; +-� 24 hr. (hh:mm)
U Registered ,,Certified 0 Applied for Permit 0 Permitted 0 Not O erational D4ate Last Operated: ..........................
Farm Name:..........JaA kftl......11.r�,:Iul......+.(...:.#.L........................... County:... �t`ll�............................................................
Owner Name :..........................Th l.............}d(��... ... Phone No:..0g:16.}.Zis-mir-..............------.--.....................
Facility Contact:.... ................. ....... Title:.................... . Phone No:
MailingAddress: ` �.... fcvxady.... R..:.......................................................... ....Cr�� tl + ..j1�..................................... .Z&T �...........
� f
Onsite Re resentative:...............
p 41........W...............:....................... Iutegrator:.......... t11r
Certified Operator..................................................................... ..... Operator Certification Number;.................
Location of Farm:
r....... v.i�,...ca t....' c.....a......5.....mzz..}..Q:.. ...r�.�i�s......5otx +...4rns,f....Q.........kw.4?...........................................................;
------ ---- -- ... .--.--............................................... __...... ..................---..... .
Latitude �` �' �" Longitude �• �' �"
y : Desrgn Current
:- ;Design';`. Current Design Current =
. :=Swine .,;: , Capacity P6pulation
P Poultry .f a , Capacity; 'Population Cattle,
Capacity i'Populat�on, ,
Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
❑Non -Layer
❑Non -Dairy
❑ Farrow to Wean
- q <
'
❑ Farrow to Feeder
❑ Other 4
❑ Farrow to Finish
Total Destgn.Capacity,
❑ Gilts`'
N
❑Boars
Total SSI
..
T,
IVumberof Lagoons / Iioldrng Ponds
?
❑ Subsurface Drains Present
❑ Lagoon Area
❑ Spray Field Area
.... .. ....
❑ No Liquid Waste Management System
m
, , • ,'
„
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑ Yes
[[ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
I
a. If discharge is observed, was the conveyance man-made?
❑ Yes
[ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
�No
c. If discharge is observed, what is the estimated flow in gaUrnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
(9 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
P No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
ru( No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yesj
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
11[ No
7/25/97
1
Continued on back

l7iicifity Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? 0 ❑ Yes ( No
Structures (Lagoons,Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes V3 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: k Z
Freebaard(ft):..........'`................. ...........3:.Z................................................ ............................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12.
Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
[P No
Waste Application
14.
is there physical evidence of over application?
❑ Yes
1�1 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ....................5!...... VU4\................... ........................... ................................... ...............................................
I........
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
❑ Yes
® No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
[N Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[P No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
rp No
0 No:vio'lationsor. defieiencie's.were noted-diiririg this.visit.• Vou.will receiveno'ftirttier
:. e6rre9p6ndenee about this'visit: : . ......
f `L- cow- V1' Utz W O'k i i1 • O
zI.Is „c�rr)z swW
'Jn
Reviewer/Inspector Name
Reviewer/Inspector Signature:
MVttt%%c_ )Qt-sit: 04-(.as or. l�geonL z.
ILL. v US:rl� `bSrac ►w+rila�r: L��oc.� r7es,�� �br j �gw� #!-Z
7/25/97
Date: R /g�

Mailing Address: _...: IL_ h" T_...LSti.:__......._.... ..... _....._.......
Onsite Representative: __......... .....
Certified Operator:. T......... _....... ln&&4-t....... ........... _..... .....__..
Location of Farm: 1
140 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
® Certified ❑ Permitted or Ins ection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name: __.. l��a...__..fe ._..�_ ... .......... _......
Land Owner Name: ... Phone No:
Facility Conctact: ...lf.S_ ...IQ Title- ......_Cw4L .Y.._....... _---•-_ Phone No:--�'�19� •-.�L�....._.....
I ..... �1A.- 1111-1�.ta..... .i.A L............._...---._...... IKA..........
Integrator:_.. ��.............._...............
_.....__.
Operator Certification Number: L?t.__...._._.... ..
....�' ....�s)�.. so .ems... .... t� Qin. �.,A.. tar...c� --•tom./... ....$R::�f. �. ....�a ..ate.._ ... _........ 4
...:.....C?srx?-.15.._........4>15.....1r...S,l..._...... .}.............. ........ ........................ ........ ..... ...... ........... �}
Latitude '* �' � u Longitude s �•
Type of Operation and Design Capacity
bail Current Design Current 1)es�gu Curcm
renE
Poul Cattfe�
�Srvrne�. s; Ca sct Po ulatiou try, =.Ca aci Po ulat�on CavaciiPo ulatton=
Wean to Feeder 0 '� ❑ La er ❑ Dairy
Feeder to Finish ''^ ❑Non -La -Layer ❑Non Da
Farrow to Wean ¢ ._ b ��
Farrow to Feeder Total Deli n Capacit}F o0�
Farrow o Finish t
- .x. .......... _.._._
❑ Other Y: :. r � - v� � � ��°
.-: �..:,:�w .x.S.,.etarov...:. -:-,v ,..q'p'r, r.:Y. x,. � .::. .. -�.., .: � =r-�»-'y�:!�"3'.`: .l!"•
Nutuber of Lagoons IIio1ding Ponds ❑ Subsurface Drains Present
� E s
LET u z ago spray F
Ewi` ❑ Lagoon Area ❑ Field Area
,
ral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes R No
❑ Yes M No
❑ Yes [�No
❑ Yes [� No
❑ Yes No
❑ Yes [;RTNo
❑ Yes 0 No
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes P No
Continued on back

Facility Number:... ....__ —1 . _
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
12 No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
UNo
Structures (Lagoons and/or Holding. Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
Ca No
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
..... ..1.3. ..... ............. ....... .............. _ ....................... ...............
_.... _......
10. Is seepage observed from any of the structures?
❑ Yes
VO No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
IR Yes
❑ No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
ER No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............ _- _ ..... W.........._5 _.�L...... ._......--... ...._ ..... .. -
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
[RNo
17, Does the facility have a lack of adequate acreage for land application?
❑ Yes
N No
18. Does the receiving crop need improvement?
❑ Yes
U No
19. Is there a lack of available waste application equipment?
❑ Yes
®lNo
20. Does facility require a follow-up visit by same agency?
Yes
❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
tj No
JEor d Facilities
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
QjNo
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
%Yes
No
24. Does record keeping need improvement?
V Yes
❑ No
Comments {refer to yueshon #1) � Explain any YES answers`andlor any recornmendattons ar arty other comments : - -
-h
Use drawtngs:of facility ezpl to better atn situations `(use addi honal pages as necessary)
��•/rz. E►-�s;or ono w�11 off- loLrN Z 5ka,l) he ,'I Lea c ",t<,ecdad.
Q
&-rc S?c6 are kajvLS —41 u)J �e_ rrme-eJed.
Z� • Sy�rt reco,,J s ay\ NJ.,; SW d contsrnJ i,414 -I�L xLsk LjJi4-m boil
i3e mvc�� aT avgy 5 lrf � `�rau it4&,L3 w t ,nhSfQtr i 5 W� qr
J tvtos:o/r iv% +vvt.l • add aft ' e Spy i'1ClJ5 i►.11ayl .
' f 1
ru
eZ, ov:
`. _:'�`
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97